急性後頭蓋窩硬膜外血腫の手術例

SURGICALLY EVACUATED ACUTE EXTRADUAL HEMATOMA OF THE POSTERIOR FOSSA

はじめに

　後頭蓋窩の急性硬膜外血腫は稀なものとされ，現在まで19例報告されているにすぎない。また文献上血腫除去の行なわれた症例はわずかに12例であり，そのうち8例が救命されている。本邦に於ける報告では3例みられるが，手術生在例の報告はない。私達は過去2年間に後頭蓋窩の急性硬膜外血腫3例を経験し，その中2例に血腫除去を行ない救命し得たので，文献的考察を行ない報告する。

Nineteen cases of acute extradural hematoma of the posterior fossa have been reported in the literature. Evacuation of hematoma has been done in twelve cases, out of which eight cases have survived. Authors have encountered three cases of acute extradural hematoma in the past two years. Hematoma have been evacuated in two, saving them.

Case 1 : A seven-year-old boy entered the hospital with complaints of severe headach and vomiting after head injury. A linear fracture of 10cm was revealed in the occipital bone. Vertebral angio-graphy demonstrated an avascular area over the posterior fossa. Suboccipital craniectomy was done about five and half hours after trauma and extra-dural hematoma of nearly 60 gr was evacuated. The patient was discharged very much improved without neurological symptoms.

Case 2: A four-year-old boy presented in semi-coma after head injury. Carotid angiography showed no displacements of major cerebral arteries. Streching anterior cerebral artery suggested an internal hydrocephalus. Pneumoventriculography revealed the occlusion of the aqueduct of Sylvius. Suboccipital craniectomy was carried out as a fourth ventricle tumor. Extradural hematoma was re-moved over the posterior fossa and the possibly inflammatory occlusion of the aqueduct of Sylvius was verified. The patient was discharged improved after ventriculo-atrial shunting.

Case 3: A 14-year-old boy entered the hospital in coma about twenty hours after head injury. Bilateral serial carotid angiography revealed no vascular abnormalities. Decerebrated symptoms appeared during angiography, resulting in apnea shortly after the tracheotomy and he died on the 5th hospital day. An autopsy demonstrated an extradural hematoma of nearly 50 gr over the cerebellar hemisphere of the left side, and a linear fracture in the left occipital bone.