Hemorragia de tronco cerebral após remoção cirúrgica de cisto aracnóide da fissura silviana: Relato de caso

Borges, Guilherme; Fernandes, Yvens B.; Gallani, Nevair R.

doi:10.1590/S0004-282X1995000500021

Resumos

Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecção de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensão intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores são discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuição do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia parenquimatosa em casos como o relatado permanece obscura. Uma abordagem cirúrgica mais cautelosa é proposta nesses pacientes com de hipertensão intracraniana.

cisto aracnóide; craniotomia; hemorragia do tronco cerebral; complicação cirúrgica

The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension.

arachnoid cyst; craniotomy; brainstem hemorrhage; surgical complication

Hemorragia de tronco cerebral após remoção cirúrgica de cisto aracnóide da fissura silviana. Relato de caso

Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: case report

Guilherme Borges^I; Yvens B. Fernandes^II; Nevair R. Gallani^III

^IProfessor Assistente Doutor;Disciplina de Neurocirurgia da Faculdade de Ciências Médicas da UNICAMP

^IIMédico Residente

^IIIPós-Graduando

RESUMO

Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecção de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensão intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores são discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuição do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia parenquimatosa em casos como o relatado permanece obscura. Uma abordagem cirúrgica mais cautelosa é proposta nesses pacientes com de hipertensão intracraniana.

Palavras-chave:cisto aracnóide, craniotomia, hemorragia do tronco cerebral, complicação cirúrgica.

SUMMARY

The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension.

Key-words: arachnoid cyst, craniotomy, brainstem hemorrhage, surgical complication

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Agradecimentos - Os autores agradecem ao Dr. Hugo L. F. Brito pelo material anátomo-patológico.

Dr Guilherme Borges - Rua Barão Geraldo de Rezende 282 - 13020-440 Campinas SP - Brasil.

1. Aicardi J, Bauman F. Supratentorial extracerebral cysts in infants and children. J Neurol Neurosurg Psychiatry 1975, 38:57-68.
2. Anderson FM, Hervey DS, Canton WL. Use of computerized tomography scanning in supratentorial arachnoid cysts: a report on 20 children and four adults. J Neurosurg 1979, 50:333-338.
3. Bucy PC. Intrinsic tumors of the cerebellum and brainstem. In Bancroft FW, Pilchner C (eds). Surgical treatment of the nervous system. Philadelphia: J.B. Lipincott, 1946:212.
4. Choux M, Raybaud C, Pinsard N, Hassoun J, Gambarelli D. Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Child's Brain 1978, 4:15-32.
5. D'Avella D, De Blasi F, Rotilio A, Pensabene V, Pandolfo N. Intracerebral hematoma following evacuation of chronic subdural hematomas. J Neurosurg 1986, 65:710-712.
6. Dei-Anang, K. Klinik und Prognose der zerebralen Arachnoidalzysten, Inauguraldissertation, Johannes Gutenberg Universitaet. Mainz, 1982.
7. Dei-Anang K, Borges G, Schuermann K, Ludwig B. Cerebral arachnoid cysts. 20ş Congresso Latino Americano de Neurocirurgia, São Paulo, Brasil, 19-24/março/83, Anais do Congresso:74-75.
8. Di Rocco C. Arachnoid cysts. In Youmans JR. Neurological surgery. Ed 3. Philadelphia: W.B. Saunders, 1990, Vol II: 1299-1325.
9. Galassi E, Piazza G, Gaist G, Frank F. Arachnoid cysts of the middle fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 1980, 14: 211-219.
10. Gardner WJ, Mc Cormack LJ, Dohn DF. Embryonal atresia of the fourth ventricle; the cause of arachnoid cysts of the cerebellopontine angle. J Neurosurg 1960, 17:226-237.
11. Go KG, Houthoff H, Blaauw E, Havinga P, Hartsuiker J. Arachnoid cysts of the sylvian fissure: evidence of fluid secretion. J Neurosurg 1984, 60:803-813.
12. Horrax G. Generalized cisternal arachnoiditis simulating cerebellar tumor: its surgical treatment and end results. Arch Surg 1924, 9:95-112.
13. Iglesias JR, Sanjuanbenito L, Martinez-Cubelis J, Lousa M, Redondo C. Intracerebral arachnoidal cyst containing choroid plexus: case report. Acta Neurochir (Wien) 1982, 58:229-234.
14. Jakubiak P, Dunsmore RH, Brecktett R. Supratentorial brain cysts. J Neurosurg 1968, 28: 129-136.
15. Jelsma F, Ross PJ. Traumatic intracranial arachnoidal cyst involving the gasserian ganglion: case report. J Neurosurg 1967, 26:439-441.
16. Klintworth GK. The pathogenesis of secondary brainstem hemorrhage as studied in an experimental model. Am J Pathol 1965, 47:525-536.
17. Little JR, Gomez MR, Mac Carthy CS. Infratentorial arachnoid cysts. J Neurosurg 1973, 39:380-386.
18. Lesoin F, Dhellemmes P, Rousseaux M, Jomin M. Arachnoid cysts and head injury. Acta Neurochir 1983, 69:43-51.
19. Markakis E, Heyer SL, Werry H. Die Aplasie der perisylvischen Region. Neurochirurgia 1980, 22:211-220.
20. Mayr U, Aichner F, Bauer G, Mohsenipour I, Pallua A. Supratentorial extracerebral cysts of the middle fossa: a report fo 23 consecutive cases of the so-called temporal lobe agenesia syndrome. Neurochirurgia 1982, 25:51-56.
21. Mc Cullough DC, Harbert JC, Manz HJ. Large arachnoid cyst at the cranial base. Neurosurgery 1980, 6:76-81.
22. McKissock W. Subdural hematoma: a review of 389 cases. Lancet 1960, 25:1365-1370.
23. Modesti L, Hodge CJ, Barmwell ML. Intracerebral hematoma after evacuation of chronic extracerebral fluid collections. Neurosurgery 1982, 10: 689-693.
24. Okonek G. Extracerebrale Arachnoidalzyste der linken Grosshirnhemisphere. Zbl Neurochir 1938, 3:112-119.
25. Övül KO. Intracerebral hematoma after evacuation of chronic subdural hematoma. Neurochirurgia 1938, 31:160-161.
26. Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry 1987, 50:1001-1007.
27. Robinson RG. Intracranial collections of fluid with local bulging of the skull. J Neurosurg 1955, 12:345-353.
28. Robinson RG. Congenital cysts of the brain: arachnoid malformation. Progr Neurol Surg 1971, 4:133-174.
29. Russel DS. Observations on the pathology of hydrocephalus. N°. 256, 1-138, Her Majesty's Stationery Office. London, 1949-1952.
30. Spetezler RF, Wilson CB, Weinstein P, Mehdorn M, Townsend J, Telle D. Normal perfusion pressure breakthrough theory. Clin Neurosurg 1977, 25:651-672.
31. Starkman SP, Brown TC, Linell EA. Cerebral arachnoid cysts. J Neuropathol Exper Neurol 1958, 17:484-500.
32. Stein SC. Intracranial developmental cysts in children:treatment by cysto-peritoneal shunting Neurosurgery 1981, 8:647-650.
33. Taveras JM, Ransohoff J. Leptomeningeal cysts of the brain followin trauma with erosion of the skull: a study of seven cases treated by surgery. J Neurosurg 1953, 10:233-241.
34. Toennis W. Kongenitale Zysten der Zisternen. Zbl Neurochir 1937, 2:356.
35. Thompson RK. Cystic cerebellar arachnoiditis. J Neurosurg 1946, 3:461-467.
36. Trowbridge WV, French JD. Benign arachnoid cysts of the posterior fossa. J Neurosurg 1952, 9:398-404.
37. Turtas S, Oranesu G. Intracerebral hematoma following removal of chronic subdural hematoma. Zbl Neurochir 1989, 50: 115-117.
38. Van der Meché FGA, Braakman R. Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms. J Neurol Neurosurg Psychiatry 1983, 46:1102-1107.
39. Varma TRK, Sedzimir CB, Miles JB. Post-traumatic complications of arachnoid cysts and temporal lobe agenesis. J Neurol Neurosurg Psychiatry 1981, 44:29-34.
40. Williams B, Guthkelch AN. Why do central arachnoid pouches expand? J Neurol Neurosurg Psychiatry 1974, 37:1085-1092.
41. Wolpert SM, Scott RM. The value of metrizamidde CT cisternography in the management of cerebral arachnoid cysts. Am J Neurorad 1981, 2:29-35.
42. Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H. Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases. Acta Neurochir (Wien) 1991, 113:42-47
43. Zehnder M. Subarachnoidalsysten des Gehirns. Zbl Neurochir 1938, 3:100-112.
44. Zuelch KJ. Betrachtungen ueber die Entstehung der fruekindlichen Hirnschaedel auf Grund der klinischen und morphologischen Befunde. Arch Kinderheilk 1954, 149:1-27.
45. Zuelch KJ. Die Arachnitis ( A. adhaesiva cystica ) In Handbuch der Neurochirurgie. Berlin Springer-Verlag, 1956, Band III: 603-615.

Datas de Publicação

Publicação nesta coleção
08 Dez 2010
Data do Fascículo
Dez 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aicardi J, Bauman F. Supratentorial extracerebral cysts in infants and children. J Neurol Neurosurg Psychiatry 1975, 38:57-68.

[2] 2. Anderson FM, Hervey DS, Canton WL. Use of computerized tomography scanning in supratentorial arachnoid cysts: a report on 20 children and four adults. J Neurosurg 1979, 50:333-338.

[3] 3. Bucy PC. Intrinsic tumors of the cerebellum and brainstem. In Bancroft FW, Pilchner C (eds). Surgical treatment of the nervous system. Philadelphia: J.B. Lipincott, 1946:212.

[4] 4. Choux M, Raybaud C, Pinsard N, Hassoun J, Gambarelli D. Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Child's Brain 1978, 4:15-32.

[5] 5. D'Avella D, De Blasi F, Rotilio A, Pensabene V, Pandolfo N. Intracerebral hematoma following evacuation of chronic subdural hematomas. J Neurosurg 1986, 65:710-712.

[6] 6. Dei-Anang, K. Klinik und Prognose der zerebralen Arachnoidalzysten, Inauguraldissertation, Johannes Gutenberg Universitaet. Mainz, 1982.

[7] 7. Dei-Anang K, Borges G, Schuermann K, Ludwig B. Cerebral arachnoid cysts. 20ş Congresso Latino Americano de Neurocirurgia, São Paulo, Brasil, 19-24/março/83, Anais do Congresso:74-75.

[8] 8. Di Rocco C. Arachnoid cysts. In Youmans JR. Neurological surgery. Ed 3. Philadelphia: W.B. Saunders, 1990, Vol II: 1299-1325.

[9] 9. Galassi E, Piazza G, Gaist G, Frank F. Arachnoid cysts of the middle fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 1980, 14: 211-219.

[10] 10. Gardner WJ, Mc Cormack LJ, Dohn DF. Embryonal atresia of the fourth ventricle; the cause of arachnoid cysts of the cerebellopontine angle. J Neurosurg 1960, 17:226-237.

[11] 11. Go KG, Houthoff H, Blaauw E, Havinga P, Hartsuiker J. Arachnoid cysts of the sylvian fissure: evidence of fluid secretion. J Neurosurg 1984, 60:803-813.

[12] 12. Horrax G. Generalized cisternal arachnoiditis simulating cerebellar tumor: its surgical treatment and end results. Arch Surg 1924, 9:95-112.

[13] 13. Iglesias JR, Sanjuanbenito L, Martinez-Cubelis J, Lousa M, Redondo C. Intracerebral arachnoidal cyst containing choroid plexus: case report. Acta Neurochir (Wien) 1982, 58:229-234.

[14] 14. Jakubiak P, Dunsmore RH, Brecktett R. Supratentorial brain cysts. J Neurosurg 1968, 28: 129-136.

[15] 15. Jelsma F, Ross PJ. Traumatic intracranial arachnoidal cyst involving the gasserian ganglion: case report. J Neurosurg 1967, 26:439-441.

[16] 16. Klintworth GK. The pathogenesis of secondary brainstem hemorrhage as studied in an experimental model. Am J Pathol 1965, 47:525-536.

[17] 17. Little JR, Gomez MR, Mac Carthy CS. Infratentorial arachnoid cysts. J Neurosurg 1973, 39:380-386.

[18] 18. Lesoin F, Dhellemmes P, Rousseaux M, Jomin M. Arachnoid cysts and head injury. Acta Neurochir 1983, 69:43-51.

[19] 19. Markakis E, Heyer SL, Werry H. Die Aplasie der perisylvischen Region. Neurochirurgia 1980, 22:211-220.

[20] 20. Mayr U, Aichner F, Bauer G, Mohsenipour I, Pallua A. Supratentorial extracerebral cysts of the middle fossa: a report fo 23 consecutive cases of the so-called temporal lobe agenesia syndrome. Neurochirurgia 1982, 25:51-56.

[21] 21. Mc Cullough DC, Harbert JC, Manz HJ. Large arachnoid cyst at the cranial base. Neurosurgery 1980, 6:76-81.

[22] 22. McKissock W. Subdural hematoma: a review of 389 cases. Lancet 1960, 25:1365-1370.

[23] 23. Modesti L, Hodge CJ, Barmwell ML. Intracerebral hematoma after evacuation of chronic extracerebral fluid collections. Neurosurgery 1982, 10: 689-693.

[24] 24. Okonek G. Extracerebrale Arachnoidalzyste der linken Grosshirnhemisphere. Zbl Neurochir 1938, 3:112-119.

[25] 25. Övül KO. Intracerebral hematoma after evacuation of chronic subdural hematoma. Neurochirurgia 1938, 31:160-161.

[26] 26. Page A, Paxton RM, Mohan D. A reappraisal of the relationship between arachnoid cysts of the middle fossa and chronic subdural haematoma. J Neurol Neurosurg Psychiatry 1987, 50:1001-1007.

[27] 27. Robinson RG. Intracranial collections of fluid with local bulging of the skull. J Neurosurg 1955, 12:345-353.

[28] 28. Robinson RG. Congenital cysts of the brain: arachnoid malformation. Progr Neurol Surg 1971, 4:133-174.

[29] 29. Russel DS. Observations on the pathology of hydrocephalus. N°. 256, 1-138, Her Majesty's Stationery Office. London, 1949-1952.

[30] 30. Spetezler RF, Wilson CB, Weinstein P, Mehdorn M, Townsend J, Telle D. Normal perfusion pressure breakthrough theory. Clin Neurosurg 1977, 25:651-672.

[31] 31. Starkman SP, Brown TC, Linell EA. Cerebral arachnoid cysts. J Neuropathol Exper Neurol 1958, 17:484-500.

[32] 32. Stein SC. Intracranial developmental cysts in children:treatment by cysto-peritoneal shunting Neurosurgery 1981, 8:647-650.

[33] 33. Taveras JM, Ransohoff J. Leptomeningeal cysts of the brain followin trauma with erosion of the skull: a study of seven cases treated by surgery. J Neurosurg 1953, 10:233-241.

[34] 34. Toennis W. Kongenitale Zysten der Zisternen. Zbl Neurochir 1937, 2:356.

[35] 35. Thompson RK. Cystic cerebellar arachnoiditis. J Neurosurg 1946, 3:461-467.

[36] 36. Trowbridge WV, French JD. Benign arachnoid cysts of the posterior fossa. J Neurosurg 1952, 9:398-404.

[37] 37. Turtas S, Oranesu G. Intracerebral hematoma following removal of chronic subdural hematoma. Zbl Neurochir 1989, 50: 115-117.

[38] 38. Van der Meché FGA, Braakman R. Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms. J Neurol Neurosurg Psychiatry 1983, 46:1102-1107.

[39] 39. Varma TRK, Sedzimir CB, Miles JB. Post-traumatic complications of arachnoid cysts and temporal lobe agenesis. J Neurol Neurosurg Psychiatry 1981, 44:29-34.

[40] 40. Williams B, Guthkelch AN. Why do central arachnoid pouches expand? J Neurol Neurosurg Psychiatry 1974, 37:1085-1092.

[41] 41. Wolpert SM, Scott RM. The value of metrizamidde CT cisternography in the management of cerebral arachnoid cysts. Am J Neurorad 1981, 2:29-35.

[42] 42. Yamakawa H, Ohkuma A, Hattori T, Niikawa S, Kobayashi H. Primary intracranial arachnoid cyst in the elderly: a survey on 39 cases. Acta Neurochir (Wien) 1991, 113:42-47

[43] 43. Zehnder M. Subarachnoidalsysten des Gehirns. Zbl Neurochir 1938, 3:100-112.

[44] 44. Zuelch KJ. Betrachtungen ueber die Entstehung der fruekindlichen Hirnschaedel auf Grund der klinischen und morphologischen Befunde. Arch Kinderheilk 1954, 149:1-27.

[45] 45. Zuelch KJ. Die Arachnitis ( A. adhaesiva cystica ) In Handbuch der Neurochirurgie. Berlin Springer-Verlag, 1956, Band III: 603-615.