2 cases of epidural epidural hematoma in the non-surgical region after intracranial tumor surgery
Last Update: 2020-06-16
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1Clinical data Case 1: Male, 26 years old, admitted to hospital with severe headache for more than 1 month, aggravated drowsinessCheck body: drowsiness, poor mouth, limb muscle strength is normal, the residual nervous system did not see abnormalHead MRI showing after admission: right frontal lobe takes up position, T1 slightly lower signal T2 high signal (see Figure 1A), ring strengthening (see Figure 1B)Consider glioma, open cranial surgery, postoperative review of CT, right top pillow epidural epidural hematoma (see Figure 1C)Because of the patient's state of consciousness, The mind is clear, the line of conservative treatment, closely observe the patient's stateAfter a review of CT, the patient's hematoma is absorbed (see Figure 1D)Figure 1 Case 1 Head MRIA: Preoperative MRI; B: Preoperative-enhanced MRI; C: CT on the day of surgery; D: Conservative post-treatment CT case 2: Female, 52 years old, admitted to hospital for 1 month due to weakness associated with a decrease in the flexibility of right limb activityCheck body: Shen Qing language, left limb muscle force V level, right level IV, muscle tension normal, no pathological signs, the residual nervous system did not see abnormalHead MRI shows that the left base section is occupied (see Figure s 2A, B)Consider surgery for glioma, open cranial surgeryAfter surgery, the patient did not wake up for a long time, was in a shallow coma, reviewed CT indication, left top pillow epidural hematoma (see Figure 2C)Due to poor patient awareness, emergency line to bone valve hematoma removal, postoperative review CT, hematoma removal (see Figure 2D), the patient recovered wellFigure 2 Case 2 Head MRIA: Preoperative MRI;B: Preoperative enhancement MRI; C: CT on the day after surgery; D: After removal of hematoma CT 2 Discussion of intracranial tumor surgery and non-surgical epidural hematoma, mostly located near the surgical area and far away Because it occurs after anaesthetic, coupled with the neurosurgery special site tumor affects the patient's awakening, resulting in the disease hidden Failure to detect them early can have serious consequences or even death The main factors that produce epidural hematoma after surgery are common risk factors for the formation of hematoma, including (1) age Compared with the elderly, the young people's epidural and skull are not closely adhesion, when the cranial pressure drops, the epidural and skull are prone to peeling, resulting in bridge vein tearing, bleeding (2) Low cranial pressure During the operation, the epidural was cut open, the cerebrospinal fluid was released too fast, the preoperative tumor was huge or the hydrocephalus was conjoined, and the tumor was removed, causing the brain tissue to collapse further; Studies have shown that patients with epiduralhes have an increased risk of epidural hematoma after surgery when the amount of bleeding during surgery is 800 ml (4) Excessive hydrospinal fluid drainage after surgery The epidural drainage tube is placed too low, resulting in a large amount of cerebrospinal fluid flow, resulting in low cranial pressure, resulting in epidural hematoma Therefore, even if the tight lysis of the epidural, can not prevent the cerebrospinal fluid from self-epidural drainage tube outflow (5) postoperative hematoma is located in the forehead area, especially in the forehead area, because the epidural of the epidural and the intracranial plate adhesion loose, easy to peel off, and the epidural of the epidural joint with the intracranial plate tight, not easy to peel off In addition, when lying on the back, the pillow brain tissue has skull support, not easy to collapse, and the upper area of the brain tissue no skull support easy to collapse Early diagnosis of postoperative epidural hematoma has the following: (1) the brain pressure is still high after the tumor is removed, and even the brain tissue in the surgical area is puffed out; (2) the end of the metabolism of the anaesthetic drug, the patient still can not wake up, the wake-up time is prolonged, the wake-up consciousness level is not ideal or after the coma; (3) the postoperative positive signs of the nervous system, surgical injury can not be fully explained; (4) the early examination of the brain CT; Common treatments for epidural hematoma include, (1) conservative treatment Such as small volume of hematoma, better patient consciousness, can dynamically review CT, pay close attention to consciousness, pupils, vital signs (especially autonomous breathing) and limb movement Continuous interruption Glasgow coma index score score, 24h prohibitthe use of high doses of dewatering drugs, the surgical area or adjacent area of the epidural hematoma can be mostly absorbed by the drainage device (2) Drilling pipe drainage Suitable for small hematoma, poor consciousness state, or rapid change of consciousness state, craniofacial surgery can not be treated in time; Such as the larger volume of hematoma, consciousness of the decline and CT review process of increased bleeding volume, puncture drainage can not completely drainhes, are surgical indications, surgery often use open craniofacial hematoma However, most can not find the bleeding point, the operation needs to be tightly suspended epidural, surgery to place the drainage tube The incidence of acute epidural hematoma after craniofacial surgery is low, risk factors are complex, and are not easy to detect, and the fatality rate is higher if not treated in time Therefore, for high-risk patients who may have epidural hematoma, before surgery should be given the corresponding preventive measures, surgery should be operated carefully, immediate lying after surgery CT, once the appearance of epidural hematoma, should be highly valued, and actively take appropriate treatment measures If handled in a timely manner, most patients have a good prognosis
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