特発性小脳内血腫—手術治験例と外科的治療についての文献的考察

SPONTANEOUS INTRACEREBELLAR HEMATOMA:REPORT OF A CASE AND REVIEW OF SURGICALLY TREATED CASES IN THE LITERATURE

はじめに

　特発性大脳内血腫の診断，治療に関する論文は多いが，小脳内血腫に関するものは非常に少ない。これは小脳内血腫の発生そのものが比較的まれな上に，診断が困難で，かつ急速に死亡するものが多いため見逃がされやすいということに原因があるように思われる。本症についての一般的関心が高まれば，より多くの症例が発見されるものと考えられる。

　本邦においては，諸外国に比べ，特発性頭蓋内出血が特に多いにもかかわらず，剖検例はあつても，小脳内血腫が外科的に除去されたという例は少なく，われわれの知る範囲内では，佐野ら^13），佐藤ら^14）の計2例の報告があるに過ぎない。最近当院において，比較的ゆるやかな経過をとり，手術によつて救命された症例を経験したので，ここに報告し，併せて，特に外科的治療に関して若干の文献的考察を行なつた。

The authors reported a case of spontaneous intra-cerebellar hematoma which was successfully treated by surgical intervention. A 63 year-old male had a sudden onset of headache, dizziness and vomiting one month prior to admission. He had been rest-ing in bed at home and had the tendency to take the left lateral position. The clinical history and neurological examinations suggested the presence of a lesion in the posterior fossa. Vertebral angio-graphy and positive contrast ventriculography showed a space taking lesion in the left cerebellar hemisphere. At suboccipital craniectomy, intra-cerebellar hematoma was discovered and evacuated. The postoperative course was uneventful. The cause of hemorrhage was considered to be hyper-tension with arteriosclerosis.

Review of autopsy series in the literature indicated that hemorrhage into the cerebellum accounts for nearly 10 per cent of all spontaneous intracerebral hemorrhage, the incidence being strictly in propor-tion to the weight of brain concerned. The single commonest cause is hypertension (50-80 %), and the next is angioma (18-20 %). Relatively few cases were treated surgically. 56 cases were found in the literature. More than half of these cases were caused by angiomatous malformations and 56.2 % were operated upon more than 8 days after the onset. This implies that early diagnosis has been difficult and cases with hemorrhage from angioma-tous malformation are apt to survive the initial critical periods and more frequently treated surgi-cally than with hypertensive hemorrhage. It is expected that more patients be saved by early diagnosis with better use of diagnostic precedures including positive contrast ventriculography.