目的:张力性气颅(TP)是一种罕见的病理,其特征是颅内间隙中不断积聚空气,与疝的风险增加有关,神经系统恶化和死亡。关于神经外科创伤病例,TP主要是在慢性硬膜下血肿清除后遇到的。在这个案例报告中,我们介绍了一例罕见的在开颅手术治疗急性硬膜下血肿(aSDH)后发生的致命性术后TP.病例介绍:一位83岁的先生因意识受损而被送往我院急诊科。初步检查显示Glascow昏迷量表(GCS)3/15,两侧瞳孔3mm,瞳孔光反射受损。CT扫描显示左侧aSDH较大,具有显著的压力现象和中线偏移。通过开颅手术对患者进行血肿的顺利清除,并放置了闭合的重力下引流管。第二天,在他转移到CT扫描仪后,他表现出迅速的神经系统恶化,伴有急性发作性角膜不畅,最后伴有固定和散瞳的瞳孔散大。术后CT扫描显示大量TP,病人被转移到手术室做紧急左骨瓣减压手术,术中没有颅内滞留空气的迹象。最后,他仍然处于严重的临床状态,在术后第八天去世.结论:TP代表罕见但严重的神经外科急症,在急性创伤情况下开颅手术后也可能遇到。相关从业者应该意识到这种潜在的致命并发症,以便进行早期发现和适当管理。
UNASSIGNED: Tension pneumocephalus (TP) represents a rare pathology characterized by constant accumulation of air in the intracranial space, being associated with increased risk of herniation, neurologic deterioration and death. Regarding neurosurgical trauma cases, TP is majorly encountered after chronic subdural hematoma evacuation. In this case report, we present a rare case of fatal postoperative TP encountered after craniotomy for evacuation of acute subdural hematoma (aSDH).
UNASSIGNED: An 83-year old gentleman was presented to the emergency department of our hospital with impaired level of consciousness. Initial examination revealed Glascow Coma Scale (GCS) 3/15, with pupils of 3 mm bilaterally and impaired pupillary light reflex. CT scan demonstrated a large left aSDH, with significant pressure phenomena and midline shift. Patient was subjected to an uneventful evacuation of hematoma via craniotomy and a closed subgaleal drain to gravity was placed. The following day and immediately after his transfer to the CT scanner, he presented with rapid neurologic deterioration with acute onset anisocoria and finally mydriasis with fixed and dilated pupils. Postoperative CT scan showed massive TP, and the patient was transferred to the operating room for urgent left decompressive craniectomy, with no intraoperative signs of entrapped air intracranially. Finally, he remained in severe clinical status, passing away on the eighth postoperative day.
UNASSIGNED: TP represents a rare but severe neurosurgical emergency that may be also encountered after craniotomy in the acute trauma setting. Involved practitioners should be aware of this potentially fatal complication, so that early detection and proper management are conducted.