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KMID : 0942820020010010041
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Journal of Korean Brain Tumor Society
2002 Volume.1 No. 1 p.41 ~ p.46
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Extensive Infarction of the Deep Cerebral Venous System:Unusual Complication Following the Surgery in the Posterior Fossa
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Lee Dae-Kyu
Hwang Sung-Kyun
Kim Dong-Gyu
Jung Hee-Won
Han Moon-Hee
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Abstract
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Objective and Importance：Infarction of the deep cerebral venous system is a rare clinical entity and is different from the infarction of the superficial system in its presenting symptoms, severity of the disease and prognosis. The authors present a case of extensive infarction of the deep venous system associated with a postoperative epidural abscess in the posterior fossa following the surgery of a vestibular schwannoma. Pathogenesis is also discussed with diagnosis and treatment.
Clinical Presentation：A 43-year-old woman underwent total removal of a vestibular schwannoma through retromastoid suboccipital craniectomy. The immediate postoperative course was uneventful. A high fever occurred on the eighth postoperative day and she subsequently became stuporous. Computed tomography(CT) revealed a crescent-shape lesion at the epidural space around the craniectomy site. Diffuse low-density lesions in the bilateral basal ganglia, thalamus and frontal paraventricular white matter were also seen.
Intervention： Revision of the previous wound was performed and the epidural abscess was removed. Postoperative magnetic resonance(MR) imaging showed extensive infarction in the same areas that were seen in the previous CT scan. Occlusions in the straight and lateral sinus were demonstrated by MR venography. Anticoagulation therapy was started and the neurological status of the patient gradually improved.
Conclusion： Although an infarction of the deep cerebral venous system is rare, it may occur in patients with postoperative intracranial infection in the vicinity of the dural sinus. A suspicion and rapid diagnosis are important, so that the morbidity of the disease may be reduced and the prognosis for the patient may be improved if an adequate treatment regimen would be taken early.
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KEYWORD
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Deep venous system, Infarction, Infection, Postoperative, Vestibular schwannoma
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