未经批准:化学性脑膜炎,无菌性脑膜炎的亚型,作为后颅窝手术的并发症并不是罕见的并发症。然而,目前的文献中还没有描述表皮样囊肿手术切除后严重延长病程的描述.化学性脑膜炎被认为与高反应性炎症反应有关,部分由白细胞介素(IL)-10,IL-1β,和肿瘤坏死因子-α,从表皮样内容物自发渗漏或手术释放到蛛网膜下腔的术后角蛋白碎片,最终会导致患者出现脑膜炎和脑积水的症状。通常,这种情况仍然温和,推荐的治疗包括短期糖皮质激素.
UASSIGNED:作者报告了一例因第四脑室表皮样囊肿而接受再切除的患者。术后,患者多次返回,出现脑膜炎和脑积水的症状,在随后的几个月中需要多次住院。病人需要紧急分流脑脊液,进一步的后颅窝探查和延长大剂量皮质类固醇治疗方案。
UNASSIGNED:作者总结了目前对术后化学性脑膜炎罕见表现所涉及的生化过程的理解。
UNASSIGNED: Chemical meningitis, a subtype of aseptic meningitis, as a complication of posterior fossa surgery is not a rare complication. However, the description of a severe protracted course following the surgical resection of an epidermoid cyst has not been described in the current literature. Chemical meningitis is thought to be associated with a hyperreactive inflammatory response, mediated in part by interleukin (IL)-10, IL-1β, and tumor necrosis factor-α, to the postoperative keratin debris from the spontaneous leakage or surgical release of epidermoid contents into subarachnoid spaces, which ultimately can result in patient symptoms of meningitis and hydrocephalus. Often, this remains mild and the recommended management includes a short course administration of corticosteroids.
UNASSIGNED: The authors report such a case in a patient who underwent a redoresection for a fourth ventricular epidermoid cyst. Postoperatively, the patient returned several times with symptoms of meningitis and hydrocephalus requiring multiple hospitalizations in the ensuing months. The patient required emergent cerebrospinal fluid diversion, further posterior fossa exploration and an extended high-dose corticosteroid treatment regimen.
UNASSIGNED: The authors summarize the current understanding of the biochemical processes involved for the rare presentation of postoperative chemical meningitis.