Traumatic Pneumocephalusの5例

FIVE CASES OF TRAUMATIC PNEUMOCEPHALUS

はじめに

　頭部，顔面の外傷，その他の原因によつて，頭蓋内外に気体が貯溜している状態をPneumocephalus気脳症と呼んでいるが，このうち頭蓋内のものは外界と頭蓋内腔との交通を意味し，髄液漏，頭蓋内感染および頭蓋内圧亢進の発生の恐れがあるので臨床上重要な疾患である。

　本症に関しては，欧米ではかなり以前から多数の報告がなされているが，本邦では最近の頭部外傷の激増に伴い，その報告例もみられるようになり^{7）9）10）12）14）15）20）22）}，今後さらに増加するものと思われる。

Traumatic pneumocephalus, though still rare, is now being recognized with increasing frequency.

For the past ten years, we have encountered five cases of traumatic pneumocephals with cerebrospinal fluid rhinorrhea or otorrhea among 1300 cases of head injuries treated in our clinic.

Case 1. T. H. male patient, aged 21, was sustained the severe head injury associated with the depressedfracture of left frontal bone by autobycycle accident.

He complained of meningeal irritative symptom with rhinorrhea. A shadow of air collection was demonstrated in the left frontal lobe communicat-ing with ventricle by X-rays on fortieth day after injury.

At operation on ninety-seventy day after injury, a tiny bone defect of ethmoid and left frontal pneu-mocyst with herniated damaged brain was found under the dural tear.

There was connection between this cyst and ven-tricle.

This bone defect was covered with kiel bone, and dural opening was sutured including herniated brain resection.

The postoperative course was uneventful.

Case 2. S. T. male patient, aged 17, complained of headach, nausea, mild fever and rhinorrer in two weeks after injury by road trafic accident.

A shadow of air collection was demonstrated in left frontal subdural space with depressed fracture of the left frontal bone, though this collection was deminished for three weeks by conservative therapy.

Case 3. H. K. male patient, aged 21, was sustained severe head injury complicating linear fracture of right temporal bone towards the middle cerebral fossa.

The collection of gas was demonstrated radiol-ogically in subdural and subarachnoid space com-municating with ventricle immediately following injury. This gas was escaped in a week.

Case 4. M. Y. female girl, aged 2, was fallen from a second-story window to a concreat side walk.

She had depressed fracture of right frontal bone, who recovered for three weeks.

When she complained of rhinorrhea in five months following injury, A shadow of air collec-tion was revealed radiologically in right frontal subdural space. This shadow has remained in the same area for two years without rhinorrhea.

Case 5. Y. T. male patient, aged 53, was struck the head by train accident. Comatose state was sus-tained from the time of injury associated with linear fracture of right temporal bone.

Air collection was revealed radiologically in right frontal subdural space immediately following injury. He was expired on sixth day after accident caused by severe cerebral contusion.

These three cases except Case 5. would seemed to be recovered by conservative treatment.

Becase of importance of preventing infections, it should be emphasized that exploratory cranitomy offers the best means of cure except where pneu-mocephalus with cerebrospinal fluid rhinorrhea can be brought under the control by antibiotics for two or three weeks.