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Brain and Nerve No to Shinkei Volume 43, Issue 8 （August 1991）

Brain and Nerve 脳と神経 43巻8号（1991年8月発行）

Japanese English

症例報告

Peptostreptococcusによる急性硬膜下膿瘍の1例 Acute Subdural Empyema due to Peptostreptococcus 上野雅巳 ¹ , 中井易二 ¹ , 仲寛 ¹ , 木戸拓平 ¹ , 木下和也 ² , 板倉徹 ³ , 駒井則彦 ³ Masami Ueno ¹ , Ekini Nakai ¹ , Yutaka Naka ¹ , Takuhei Kido ¹ , Kazuya Kinoshita ² , Toru Itakura ³ , Norihiko Komai ³ ¹和歌山労災病院脳神経外科 ²和歌山労災病院耳鼻咽喉科 ³和歌山県立医科大学脳神経外科 ¹Department of Neurological Surgery, Wakayama Rousai Hospital ²Department of Otolaryngology, Wakayama Rousai Hospital ³Department of Neurological Surgery, Wakayama Medical College キーワード： acute subdural empyema , peptostreptococcus , surgical treatment , frontal sinusitis , Killian's operation Keyword: acute subdural empyema , peptostreptococcus , surgical treatment , frontal sinusitis , Killian's operation pp.781-785

発行日 1991年8月1日 Published Date 1991/8/1

DOI https://doi.org/10.11477/mf.1406900236

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Abstract 文献概要
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　無芽胞嫌気性菌であるpeptostreptococcusによる前頭洞副鼻腔炎に由来したと考えられる急性硬膜下膿瘍の1例を経験したので報告する。症例は11歳女児で意識障害と右上下肢麻痺を認めた。開頭外減圧，膿瘍除去術にて症状の軽快を認めたが，第1回手術後7日目には再び弛張熱を来しX線CTにて前頭蓋底，左前頭洞に膿汁貯留の所見を認めた。第2回手術では開頭膿瘍除去術に加え，耳鼻科にて左前頭洞根本手術（キリアン氏手術）を行い根治が得られ，独歩退院となった。peptostreptococcusによる急性硬膜下膿瘍はきわめて稀であるが，最近の口腔領域での感染症をみると本菌の分離頻度が第3位と高く，今後硬膜下膿瘍の起炎菌として考慮しておく必要がある。鼻性頭蓋内合併症の時は原発巣に対する耳鼻科的処置を早期に行うことが重要と考えられる。

A very rare case of acute subdural empyema due to peptostreptococcus was reported. A 11-year-old-girl was admitted to our hospital with high grade fever, unconsciousness and rt hemiparesis. CT scans showed the mass effect caused by the subdural empyema over the left frontotemporal region. Sub-dural empyema was evacuated by the craniotomy. Peptostreptococcus was found in the pus obtained during the operation. However, CT scans 10 days after the operation revealed another subdural empyema in the left frontal base and interhemis-pheric fissure, which was removed again by thecraniotomy using coronal incision 14 days after the first operation. Frontal sinusitis was also demon-strated by CT scan. Killian's operation to the fron-tal sinusitis was performed by otorhinolaryn-gologists at the same time. Six weeks after the second operation, she was discharged without any neurological deficits. Peptostreptococcus is one of the indigenous microflora of the oral cavity, skin, gastrointestinal tract and genitourinary system and may be a causative microorganism in every type of human infection due to its abnormal localization. There is a controversy concerning surgical manage-ment subdural empyema. Both the burr hole drain-age of pus and the craniotomy are advocated. Associated otorhinologic lesions must not be over-looked. Otorhinologic consultation should immedi-ately be obtained so that the drainage of an infected paranasal or mastoid sinus can be performed at the time of craniotomy. This is critical to prevent the recurrence of the subdural empyema from further extension of the extracranial disease.