脳出血に対する内視鏡的血腫除去術の有用性と問題点

Retrospective Analysis of Effects and Complications in Cases Treated with Endoscopic Evacuation of Intracerebral Hemorrhage

Ⅰ．はじめに

　近年の神経内視鏡の進歩および内視鏡手術機器の改良により，脳神経外科領域における内視鏡手術の適応は広がってきている．脳出血に対する外科的治療としては，開頭手術や定位的吸引術が主に行われてきたが，内視鏡手術も治療法として確立したものとなってきている^2-5,8,10,11)．

　青森県立中央病院脳神経外科では2001年12月より神経内視鏡を導入し，脳出血に対する手術に内視鏡を用い始めた．当科における内視鏡的血腫除去術の治療成績と問題点に関して検討した．

　We described our experience of 22 cases treated with endoscopic evacuation of intracerebral hematoma,including 16 putaminal,3 thalamic,and 1 cerebellar hemorrhages. All endoscopic procedures were performed under local anesthesia. A rigid-rod endoscope and a suction device attached was introduced through a transparent sheath into the hematoma cavity. Putaminal hemorrhage was sufficiently evacuated (56-100％),but thalamic hemorrhage was insufficiently removed (less than 40％). In 3 cases,postoperative CT demonstrated enlargement of the hematoma after the endoscopic procedure. In one case,postoperative rebleeding was recognized on a postoperative follow-up CT scan. In 2 cases,uncontrollable arterial bleeding occurred during the endoscopic procedure,followed by craniotomy and removal of the hematoma under a microscope. Endoscopic hematoma evacuation should be an efficient procedure for intracerebral hemorrhage after a secure method of hemostasis during the endoscopic evacuation process has been developed.