高血圧性脳出血の気脳ルーレット断層撮影について

PNEUMOENCEPHALO-ROULETTE TOMOGRAPHY OF HYPERTENSIVE INTRACRANIAL HEMORRHAGE

はじめに

　高血圧性脳出血の手術は，本邦の脳外科施設においても普及の途にあり^1），その診断や手術適応について種々論議されている。手術の対象となる高血圧性脳出血の大半は，外側型又は混合型の出血であり，通常は脳血管写の所見で手術侵襲の方法が決定出来る。しかしながら症例によつては，脳血管写でも血腫の局在診断が困難な場合が偶々みられる。最近私達は4 vessel angiographyでも異常所見の得られなかつた原発性橋出血や内側型出血の症例に気脳ルーレット断層写^2,3）を行なつて局在診断や予後の推定に役立たせ，又原発性橋出血の血腫摘出を行なつたので，若干の症例を供覧し報告する。

Almost all of surgically treated hypertensive intracerebral hemorrhages are lateral or combined types, in which diagnoses or operation approaches are possible to determine mainly by cerebral angio-graphy. There are, however, some cases in which-cerebral angiography is not enough to decide loca-tion of hematoma.

We have recently encountered a primary pontine or mesial type hemorrhage that showed no abnor-malities in even four vessels serial angiograms. Combined pneumoventriculo-pneumoencephalo rou-lette tomography has been performed in cases of stroke, in which location of hematoma has not been distinctly demonstrated by cerebral angiography.

Pneumoencephalo-roulette tomograms of mesial type, primary pontine and cerebellar hemorrhage have been described herein in detail, and a case of successfully evacuated intrapontine hematoma has been reported as the first case in Japan.