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Neurological Surgery No Shinkei Geka Volume 32, Issue 7 （July 2004）

Neurological Surgery 脳神経外科 32巻7号（2004年7月発行）

Japanese English

症例

緊急手術を施行した上矢状静脈洞閉塞を伴う開放性頭蓋骨骨折の1例 Superior Sagittal Sinus Occlusion Caused by a Compound Depressed Skull Fracture : A Case Treated by Emergency Surgery 田中秀一 ¹ , 田中英夫 ¹ , 小畑仁司 ¹ Hidekazu TANAKA ¹ , Hideo TANAKA ¹ , Hitoshi KOBATA ¹ ¹大阪府三島救命救急センター ¹Osaka Mishima Emergency and Critical Care Medical Center キーワード： depressed skull fracture , superior sagittal sinus occlusion , cerebral angiography , intracranial hypertension , emergency surgery Keyword: depressed skull fracture , superior sagittal sinus occlusion , cerebral angiography , intracranial hypertension , emergency surgery pp.753-758

発行日 2004年7月1日 Published Date 2004/7/1

DOI https://doi.org/10.11477/mf.1436100460

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Abstract 文献概要
1ページ目 Look Inside

　Ⅰ．はじめに

　頭蓋骨陥没骨折により稀ではあるが静脈洞の損傷・閉塞を来すことがある．静脈洞から大量出血を来す可能性があることから，その治療は状態が許す限り保存的治療が選択される^15,17,18)．しかし，大量出血が続いている場合，あるいは静脈洞閉塞による頭蓋内圧亢進や重篤な神経症状を呈している場合は緊急手術を要する．今回，われわれは開放性の頭蓋骨陥没骨折によりsuperior sagittal sinus（SSS）の圧迫閉塞を来し意識障害を呈した症例に対し緊急手術を施行し，良好な結果を得た．SSS閉塞を伴う陥没骨折について，若干の文献的考察を加えて報告するとともに，治療上の問題点につき検討を加えた．

　Depressed skull fractures compressing major venous sinuses are rare,and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses,but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis,bone fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion,we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.