脊椎手術後の髄液漏による頭蓋内硬膜下血腫を生じた2例

Intracranial Subdural Hematoma Secondary to Cerebrospinal Fluid (CSF) Leak Following Spinal Surgery. Report of 2 Cases

　脊椎手術後の髄液漏による頭蓋内硬膜下血腫を生じた2例を経験した．症例1は77歳の男性で胸椎転移性脊椎腫瘍に対して椎体全摘術を施行した．術後髄液漏が原因と思われる頭蓋内硬膜下血腫を認め，保存的治療で改善した．症例2は70歳の女性で，上位頚髄の髄膜腫の摘出術後に激しい頭痛と嘔吐を繰り返し，脳CTで頭蓋内硬膜下血腫を認めた．保存的治療の効果が乏しく，髄液漏の閉鎖を行い症状は劇的に改善した．保存的治療により改善が得られない場合には，髄液漏の閉鎖術が有用であると考えられた．

　We report two cases of intracranial subdural hematoma secondary to a cerebrospinal fluid (CSF) leak following spinal surgery.　One patient was a 77-year-old male who had undergone total spondylectomy for a thoracic metastasis to a thoracic vertebra.　A subdural hematoma resulting from a CSF leak was diagnosed, and the symptoms and hematoma improved in response to conservative treatment.　The other patient was a 70-year-old female who experienced repeated severe headaches and nausea after resection of an upper cervical meningioma.　A subdural hematoma was diagnosed on the basis of the brain CT findings.　Conservative treatment was not very effective, but closure of the CSF leak was followed by a dramatic improvement in the symptoms.　Closure of the CSF leak may be an effective means of treating cranial subdural hematoma following spinal surgery, if conservative treatment is ineffective.