片側性脳性小児麻痺に対する大脳半球剔除術の経験

Experience of Cerebral Hemispherectomy for Infantile Hemiplegia

緒言

　脳性小児麻痺に対しては従来確たる治療法もなく，ただ僅かに，電気療法，マツサージ或は水治療法等の理学的療法を行うとか，特殊の施設において根気よく訓練したり，或は幾分でも歩行運動に有利なように整形手術を行い，また，痙攣に対しては諸種の抗痙攣剤を用いる等の姑息的な対症療法に頼るしかなく，患者及び家族の苦悩は察するに余りある現況である。

　しかしながら，脳性小児麻痺の中には，両側性麻痺とは別に，特有な偏癱を見ることが稀でない。このように病変が片側大脳半球に限局し，その上に頻発する痙攣発作または精神障碍を伴つた患者に対して，Krynauwが大脳半球剔除術を行い驚くべき良好な結果を得たことは，片側性脳性小児麻痺の患者にとつて非常な福音というべく，また，吾人医師の立場からしても本症治療上に大なる光明を見出した感がある。

　Since R. A. Krynauw first performed cerebral hemispherectomy for infantile hemiplegia and reported its excellent results in 1950, many cases of hemispherectomy have been reported in foreign literatures, while only few cases have been seen in Japan.

　The authors recently performed the left cerebral hemispherectomy for a 18 years old girl with right infantile hemiplegia and frequent epileptic convulsions, who had suffered from a encephalitis at the age of 3 years and 8 months.

　The removed cerebral hemisphere included the Caudate nucleus and a lateral part of the thalamus, and its weight was only 330 grams.

　Aphasia could hardly be observed postoperatively and the convulsive seizures, which were seen 4 or 5 times daily before the operation, completely disappeared after the operation, except only one seizure being observed on the 29th postoperative day.The electroencephalographic findings improved markedly, i. e. a striking decrease of dysrhythmia and disappearance of the spike discharges were observed after the operation.