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目的总结儿童自发性硬脊膜外血肿(spontaneous spinal epidural hematoma,SSEH)的病因、临床特点、治疗及预后。方法回顾性分析重庆医科大学附属儿童医院神经外科8例SSEH患儿的临床资料。6例年长儿以颈背部疼痛为首发症状,1例婴幼儿以颈部活动受限为首发症状,数小时或数天后出现神经功能障碍;1例婴幼儿以肢体无力为首发症状。发病至手术时间为1~15 d;均行硬脊膜外血肿清除术。结果 MRI能准确显示病变,血肿位于颈胸段背侧,累及4~9节段。5例神经功能完全恢复,2例部分恢复,1例无变化。3例明确病因为血管畸形。结论儿童SSEH的早期诊断主要依据临床特征和MRI,一旦确诊,尽早手术清除血肿。及早诊断及治疗是改善预后的关键。
Objective To summarize the etiology, clinical features, treatment and prognosis of children spontaneous spinal epidural hematoma (SSEH). Methods The clinical data of 8 children with SSEH admitted to Department of Neurosurgery of Children’s Hospital of Chongqing Medical University were retrospectively analyzed. 6 cases of elder children with neck back pain as the first symptom, 1 case of infants and young children with neck activity limited as the first symptom, a few hours or days after the emergence of neurological dysfunction; 1 case of infants and young children with limb weakness as the first symptom. The onset of operation time was 1 ~ 15 d; line epidural hematoma removal. Results MRI can accurately show the lesion, hematoma located in the dorsal cervical neck, involving 4 to 9 segments. 5 cases of complete recovery of nerve function, partial recovery in 2 cases, 1 case no change. 3 cases of a clear cause of vascular malformations. Conclusion Early diagnosis of childhood SSEH mainly based on clinical features and MRI, once diagnosed, as soon as possible to remove the hematoma. Early diagnosis and treatment is the key to improving prognosis.