器質化した慢性硬膜下血腫6例の検討

Six Cases of Organized Chronic Subdural Hematoma

Ⅰ．はじめに

　慢性硬膜下血腫に対する手術法としてわれわれの施設では穿頭血腫洗浄ドレナージ術を基本としているが，稀に器質化した慢性硬膜下血腫に遭遇することがある．器質化慢性硬膜下血腫は，慢性硬膜下血腫の内容物が線維化し，結合組織塊が主体となったものとされ，ときとして石灰化を伴っていることがある¹⁵⁾．器質化血腫の場合，穿頭術では症状の改善が得られなかったり，再発を繰り返したり治療に難渋することが知られている¹⁴⁾．治療選択としては開頭術が勧められているが，開頭術を行っても再発を来したためいったん骨弁を除去することで病態の改善が得られた症例も経験した．そこで今回器質化した慢性硬膜下血腫症例について，診断に至るまでの経過・治療・術後経過を再検討し，画像所見および治療方法について若干の文献的考察を加え報告する．

　Surgical procedures for chronic subdural hematoma (CSDH) are performed using various methods on the basis of burr hole irrigation and drainage, but treatment for organized CSDH is rarely required. Primary operation for CSDH was performed in our hospital for 535 patients (391 men, 144 woman; age, 8 months to 104 years) between December 1991 and March 2007. Of these, 6 patients diagnosed with organized CSDH were reviewed. Five patients had a history of burr hole surgery. Computed tomography showed membranous structure and heterogenous distribution of air after burr hole surgery had perforated the subdural space. As for treatment, craniotomy was performed in all cases (small craniotomy, n＝4; enlarged craniotomy, n＝2), and additional treatment was required in 2 patients. Diagnosis of organized CSDH is not easy before a primary operation, but removal of both organized CSDH and the outer membrane by craniotomy in proportion to hematoma expansion is important once the presence of organized CSDH has been determined.