|
男性，60岁，伴有鼻窦疾病病史，行内窥镜手术治疗后头痛，颈部强直。 
另一例 ↓ 颅脑外伤后 
又名火山征 颅脑CT扫描时，表现为导致额叶受压剥离的两侧硬脑膜下低密度影，两侧的气体张力作用使额叶后移，额叶塌陷和额顶叶间空间扩大，形似富士山的剪影。
During the CT scan of the brain, low-density shadow of the dural membrane on both sides of the frontal lobe was seen, which caused the compression of the frontal lobe to peel off. The gas tension on both sides caused the frontal lobe to move back, and the space between the frontal lobe and the parietal lobe expanded, which looked like the silhouette of Mount Fuji.由于医源性或非医源性的原因导致颅底或颅骨破裂，空气进入颅内形成低密度影。张力性气颅导致硬脑膜下间隙气压增高，气压增高与球阀原理相似，空气可以经颅底或颅骨裂隙进入，出路被阻塞。压力增高导致占位效应，并发额叶受压，两侧额顶叶间出现空气，说明气压比其间的脑脊液压力要大。As a result of iatrogenic or non-iatrogenic causes, the base of the skull or skull is ruptured and air enters the skull to form low-density shadows. Tension pneumocephalus leads to increased pressure in the subdural space, similar to that of a ball valve. Air can enter through the base of the skull or through cracks in the skull, and the outlet is blocked. The increase in pressure leads to a mass effect, with frontal lobe compression and air between the frontal and parietal lobes on both sides, indicating that the pressure is greater than that of the cerebrospinal fluid in between.富士山征是鉴别张力性气颅与非张力性气颅的一个有用的征象，张力性气颅是神经外科的一个急症，最常发生在颅内血肿清除术后，其发生率为2.5%~16%。张力性气颅也可由颅底、鞍旁、坐位颅后窝手术或创伤引起。其临床主要特征是：①颅内压增高，表现为意识障碍、进行性头痛加重等；②神经症状加重或出现偏瘫等，发展迅速者可致脑疝危及生命。Mount Fuji sign is a useful sign to distinguish tension pneumocephalus from non-tension pneumocephalus. Tension pneumocephalus is an emergency in neurosurgery and most often occurs after the removal of intracranial hematoma, with an incidence of 2.5%~16%. Tension pneumocephalus can also be caused by surgery or trauma to the base of the skull, parsella, posterior fossa in the sitting position. The main clinical features are: Increased intracranial pressure, the performance for consciousness disorders, progressive headache, etc.; (2) aggravation of neurological symptoms or hemiplegia, such as rapid development can lead to brain hernia life-threatening. Ishiwata等描述了5例经外科手术证实为张力性气颅的患者，其中有4例出现富士山征，非张力性气颅中未见富士山征，在非张力性气颅中可出现山峰征(peaking sign),而张力性气颅未见。山峰征表现为两侧额叶受压，但无额顶叶间增宽，额叶尖端于中线处呈山峰尖样。脑池及蛛网膜下隙或硬脑膜下间隙弥散存在的小空气泡称为小气泡征(small bub-bles)。Lschiwata等认为此为气体张力增加撕裂蛛网膜，使气体弥散至蛛网膜下间隙所致。由于部分容积效应的影响，CT扫描上测定气体容量不确切，因此不能依据积气量多少，以及有无中线移位来确定有无张力性气颅，应主要依据有无临床表现，以及硬脑膜下积气有无张力而确认。其认为富士山征和脑池蛛网膜下间隙的小气泡征较山峰征更能显示积气的张力，有助于张力性气颅的诊断。Ishiwata et al. described 5 cases of patients with tension pneumocranium confirmed by surgery, among which 4 cases showed Fujiyama sign, but no Fujiyama sign was found in the non-tension pneumocranium, and peaking sign was found in the non-tension pneumocranium, but no tension pneumocranium. The peak features compression of the frontal lobes on both sides, but there is no interparietal broadening, and the tip of the frontal lobe is like a peak at the midline. Small air bubbles that diffuse in the cisterna and subarachnoid Spaces or subdural Spaces are called small bub-bles. Lschiwata et al. believed that this was caused by the tearing of arachnoid membrane caused by increased gas tension, which made the gas diffuse to the subarachnoid space. Due to the partial volume effect, the determination of gas capacity on CT scan is not exact. Therefore, the presence of tension pneumocephalus cannot be determined based on the amount of gas volume and the presence of midline shift. It should be confirmed mainly based on the presence of clinical manifestations and the presence of tension of subdural gas. It is believed that the small bubble sign in the subarachnoid space of the Mount Fuji sign and cerebellum sign can better show the tension of gas accumulation than the mountain sign, which is helpful for the diagnosis of tension pneumocephalus.富士山征是头颅创伤和颅脑手术后一个重要的CT表现，它的出现提示张力性气颅，认识这个征象可以及时地发现对病情和预后有重要影响的并发症。当正确识别临床和影像表现后，急诊减压可以缓解脑组织压力，张力性气颅的治疗包括颅骨钻孔、开颅术、针吸、脑室造口放置术、纯氧吸入、脑膜缺损封闭。Mount Fuji sign is an important CT manifestation after craniocerebral trauma and craniocerebral surgery, and its appearance indicates tension pneumocephalus. Knowing this sign can timely discover complications that have important influence on the condition and prognosis. When clinical and imaging manifestations are correctly identified, emergency decompression can relieve pressure on brain tissue. Treatment of tension pneumocephalus includes cranial drilling, craniotomy, needle aspiration, ventriculostomy placement, pure oxygen inhalation, and closure of meningeal defects.
|
