各種脳手術後に於ける脳圧の消長に就て—（脳圧の研究 II）

Studies of Intracranial Pressure after Brain Surgery : (The 2nd Report)

緒言

　脳手術後の脳圧の消長はその後療法及び予後決定上重大なる影響を与える事は云う迄もないが，今迄は唯一般状態，脈，呼吸，血圧，体温等を指標にして脳圧を推定し，盲目的な対症的処置に終始してきたぎらいなしとしなかつた。然し数年来，桂外科教室に於ては，既に脳と神経誌に於て発表した様に，脳手術後，前頭或は後頭部より一側側脳室^1）にポリエチレン管を挿入し，これに独得の操作簡便なる装置を装着して脳圧を観察し脳手術後の処置を時宜適切に行なつて良好な成績を収めているが^2），各種脳外科疾患に於て術後夫々興味ある脳圧の消長を示しているので，今回は，これまで観察した真性癲癇患者脳皮質切除術5例，天幕上良性腫瘍20例，天幕下良性腫瘍13例，天幕上悪性腫瘍2例，天幕下悪性腫瘍3例，炎衝性腫瘍1例，脳転移性腫瘍4例，脳下垂体腫瘍6例，外傷その他4例，計58例（脳室造影術は除く）の中，夫々の代表的なものに就て紹介する事により，今後の目安とし，又併せて高張糖液の静注による脳圧降下作用等に就ても種々所見を述べたいと思う。

Observation on the intracranial pressure (I. C. P.) during 3-10 days after the brain surgery have been done by inserting a catheter into the lateral ventricle, which was con-nected with a manometer, in 20 cases of supra tentorial benign tumor, 2 cases of supra ten-torial malignant tumor, 13 cases of subten-torial benign tumor, 3 cases of subtentorial malignant tumor, 1 case of brain abscess, 4 cases of metastatic brain tumor, 6 cases of hypophysial tumor, 4 cases of head trauma and etc. The rise and fall of the postopera-tive intracranial pressure are described in the representative neurosurgical cases.

1. Generally speaking, I. C. P. of supraten-torial malignant brain tumor rised above 1000 mmH₂O within 2 hours after operation, and though injections of hypertonic glucose solution and repeated removal of cerebro-spinal fluid were done, I.C.P. soon increased to about 1000 mmH₂O high again. It, how-ever, showed a tendency to decline to about 600 mmH₂O high gradually after 70-80 hours.

2. In cases of brain abscess, it rised above 1000 mmH₂O with a tendency of declining to 300-500 mmH₂O about 45 hours after opera-tion.