乳児—小児脳膿瘍の診断と手術成績の研究

DIAGNOSIS AND SURGICAL TREATMENT OF BRAIN ABSCESS IN INFANTS AND CHILDREN

I．緒言

　化学療法の発達に伴い，脳膿瘍の予後はいちじるしく改善されたが，小児脳膿瘍の治療成績は一般に悪く，ことに乳児では死亡率が高い。その最大の原因は抵抗力の弱いということより，診断の確立がおくれることにあると考えられる。一般に小児に比較的多い悪性脳腫瘍などと異なり，脳膿瘍や血腫など二次的頭蓋内腫瘤は現今の脳外科技術をもつてすれば救いうる疾患群であるから，可及的速やかに確診をくださねばならない。このためにはわれわれ脳外科医と，症例の初診にたずさわることの多い小児科，内科，耳鼻科その他の諸医との密接な協力を要する。

　過去5年半の間（1956後半〜1961年）に群大第1外科に入院，手術を受けた4例の乳児および小児脳膿瘍患者と，群大小児科において経験された非手術脳膿瘍患者4例，計8例を対象として診断，手術術式および治療成績について考察を加えた。8例とも脳実質内膿瘍であつて，脳結核腫，寄生虫性脳膿瘍は含んでいない。

The purpose of this study is to report four cases of brain abscess in infants and children treated surgically in the past five years in Neurosurgical Dept. and compared with four non-surgical treated cases in Pediatric Dept. of Gunma University Hospital, to review the salient clinical features and to discuss the diagnosis in the hope that this may be help in earlier recognition. The age of the patients ranged from three months to 15 years. There were 6 males and 2 females. Two cases of brain abscess in neurosurgical unit were eva-cuated and two were excised totally. There was one death in 4 surgical cases, who had two abscesses in the right parietal lobe, which were extirpated totally. All of the non-sur-gical treated cases in Pediatric Dept. died. Of special importance in diagnosis are persistent headache, vomiting and consciousness distur-bance and in infants focal convulsions. Focal signs may be slight, in which case the diagno-sis rests on the history and symptoms, and any child who still has symptoms or signs of cerebral dysfunction more than 7 to 10 days after the onset of an infective illness should be suspected of having a cerebral abscess and acertained it by cerebral angiography as soon as possible. Cerebral angiography will reveal evidence of an avascular area and is most useful diagnostic method than others. In cases received evac uation (aspiration) therapy should be acertained by means of periodic carotid arteriographies.