穿頭ドレナージ術にて治療した高齢者急性特発性硬膜下血腫の3症例

Single Burr Hole Surgery for Acute Spontaneous Subdural Hematoma in the Aged : Patient Reports of Three Cases

　Ⅰ．はじめに

非外傷性急性硬膜下血腫の内，出血源となる基礎疾患がない例が数多く報告され，急性特発性硬膜下血腫と呼ばれている^4,6,9,12)．一般的に外傷性硬膜下血腫と比較して予後は良好であるが⁴⁾，高齢者における治療法は確立されていない⁶⁾．今回われわれは，高齢者の急性特発性硬膜下血腫3症例を穿頭ドレナージ術で治療し，良好な結果を得たので文献的考察を加えて報告する．なお，穿頭ドレナージ術とは局所麻酔下に穿頭し，血腫腔内にドレナージを挿入して血腫を排出する方法である¹¹⁾．

　The method of treatment for acute spontaneous subdural hematoma in aged patients is controversial. Three cases of acute spontaneous subdural hematoma in aged patients,treated by single burr hole drainage without irrigation,were reported. The first case,an 80-year-old male was admitted with complaints of headache and stupor without any history of head trauma. CT revealed a left subdural hematoma with mixed density. Intractable facial convulsion occurred three days after admission. Single burr hole drainage was performed to remove the hematoma,and facial convulsion disappeared one week after the surgery. The second case,a 70-year-old male was admitted with complaints of consciousness disturbance without any history of head trauma. CT showed a right subdural hematoma with mixed density. The next day,he recovered consciousness and CT demonstrated shrinkage of the hematoma. However,his consciousness deteriorated again 11 days after admission,and CT revealed progression of the hematoma. We performed single burr hole drainage,and the next day,his neurological condition recovered. The third case,an 84-year-old female was admitted with complaints of consciousness disturbance without any history of head trauma. CT revealed a left subdural hematoma with mixed density. Single burr hole drainage was performed to remove the hematoma. She recovered completely and was discharged and return home 1 month after the surgery. Single burr hole drainage is less invasive than craniotomy. Our three cases indicate that this method may be one of the best methods for aged patients with acute spontaneous subdural hematoma which manifests mixed density in CT.