開頭術後短期間で再増大した器質化慢性硬膜下血腫の1例

A Case of Organized Chronic Subdural Hematoma Showing an Early Recurrence after Craniotomy

Ⅰ．はじめに

　器質化慢性硬膜血腫は全慢性硬膜下血腫の0.5～2.0％と言われている．比較的稀な疾患であり，その手術方法については様々な意見がある．今回われわれは穿頭術では治癒せず，開頭術後，短期間に器質化血腫が再増大した難治性器質化慢性硬膜下血腫症例を経験した．開頭手術所見より検討した手術法に関するわれわれの考えを若干の文献的考察を加えて報告する．

A 64-year-old man who had undergone single burr hole drainage twice prior to this admission was hospitalized with a recurrent right chronic subdural hematoma. A head CT showed a mixed density subdural hematoma on the right frontotemporoparietal region. Based on the intraoperative findings of the previous surgeries,the hematoma was known to be organized. Therefore,we decided to do a small craniotomy under general anesthesia,and remove the organized subdural hematoma and thick outer membrane while leaving the thickened dura matter intact. The inner membrane was left untouched. One week later,despite adequate decompression,the hematoma recurred with midline shift on head CT. It is likely that the uniquely thick and vascular enriched outer membrane and dura contributed to such an early recurrence. Finally,we performed an extensive craniotomy,removing all the organized hematoma,outer membrane and dura. Again,the inner membrane was left intact. On one year follow-up the patient has been asymptomatic with complete resolution of the subdural hematoma on CT scan.

　The successful treatment of organized chronic subdural hematoma can be challenging. We strongly recommend an extensive removal of the organized hematoma,outer membrane and excision of the dura mater in order to achieve a successful outcome after failed burr hole evacuation.