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首页> 外文期刊>Neurosurgery >Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.
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Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.

机译：导致大脑受压的新生儿galgal下血肿：两例报告并文献复习。

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OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. Magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.
机译：目的和重要性：新生儿galgal下血肿（sghs）很少见，但在漏气后血中的诊断不足，通常是由真空输送引起的。随着大量流失进入下颌下腔，放血和低血容量性休克可导致20至60％的新生儿死亡。我们报告了头两个已知的SGH引起的颅外脑压迫患者。同样，以前没有描述过新生儿SGH的外科手术疏散。临床表现：一名患者是一个足月男孩，在无并发症的妊娠后通过真空抽气分娩。在几个小时内，他发展了头皮的积液，并扩散了血管内凝血和休克，需要进行插管，正性肌力支持和输血。他的头围从出生时的33厘米增长到了42厘米。他逐渐昏昏欲睡，并发展出姿势运动。头部的计算机断层扫描显示，大量的SGH导致颅骨缝线完全重叠和弥漫性脑水肿。另一名患者是在未成功进行真空抽吸和镊子分娩后经剖宫产分娩的足月男孩。最初的头围为34厘米。在几个小时内，他形成了头皮不断扩大的液体集合，并随着姿势逐渐昏昏欲睡。头部的磁共振成像显示大量的SGH，伴有颅脑损害和弥漫性脑水肿。干预：两个孩子的影像学特征均表明颅内压升高以及神经功能代偿失调。第一名患者被带到手术室，血肿通过一个小的头皮切口被抽空。最初，大约150毫升的血液被清除，在接下来的2天中，杰克逊-普拉特（Jackson-Pratt）的引流管又转移了200毫升的血液。婴儿恢复得很好。在第二种情况下，患者仍然不稳定，无法进行手术干预并死亡。结论：颅外压迫是新生儿SGH危害婴儿生命的另一种方式。管理包括纠正低血容量性休克和弥散性血管内凝血的措施，以及控制颅内压升高的外科手术。

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