雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 39, Issue 10 （October 2011）

Neurological Surgery 脳神経外科 39巻10号（2011年10月発行）

Japanese English

研究

特発性脊髄硬膜外血腫の治療経験 Treatment of Spontaneous Spinal Epidural Hematoma 國保倫子 ¹ , 金景成 ¹ , 菅原淳 ² , 野村竜太郎 ³ , 森本大二郎 ³ , 井須豊彦 ⁴ , 小林士郎 ¹ , 寺本明 ⁵ Rinko KOKUBO ¹ , Kyongsong KIM ¹ , Atsushi SUGAWARA ² , Ryutaro NOMURA ³ , Daijiro MORIMOTO ³ , Toyohiko ISU ⁴ , Shiro KOBAYASHI ¹ , Akira TERAMOTO ⁵ ¹日本医科大学千葉北総病院脳神経センター ²岩手医科大学脳神経外科 ³日本医科大学武蔵小杉病院脳神経外科 ⁴釧路労災病院脳神経外科 ⁵日本医科大学脳神経外科 ¹Department of Neurosurgery,Chiba Hokusoh Hospital,Nippon Medical School ²Department of Neurosurgery,Iwate Medical University ³Department of Neurosurgery,Musashikosugi Hospital,Nippon Medical School ⁴Department of Neurosurgery,Kushiro Rosai Hospital ⁵Department of Neurosurgery,Nippon Medical School キーワード： spontaneous spinal epidural hematoma , conservative treatment , operative treatment , magnetic resonance imaging , computed tomography Keyword: spontaneous spinal epidural hematoma , conservative treatment , operative treatment , magnetic resonance imaging , computed tomography pp.947-952

発行日 2011年10月10日 Published Date 2011/10/10

DOI https://doi.org/10.11477/mf.1436101540

PDF(644KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　脊髄硬膜外血腫は重篤な神経症状を呈することもあり，早期診断と治療は患者の機能予後に大きな影響を与える．好発部位は頚胸髄移行部および下位胸髄であり，頚髄硬膜外血腫は全体の18.7％とされているが，その死亡率は26.2％と有意に高く，その診断，治療には十分な注意が必要である⁶⁾．今回われわれは誘因なく急性発症し，早期の手術治療により回復し得た5例，および保存的治療により治癒した1例の脊髄硬膜外血腫を経験したので，若干の文献的考察を加えて報告する．

　Objective: Spontaneous spinal epidural hematoma (SSEH) is rare. There was not enough information about diagnosis and treatment of SSEH,although they require emergency surgery and some surgeons may hesitate to use alternative treatments. We report our six cases SSEH and discuss treatment of SSEH from the literature.

　Materials and Methods: We encountered six cases of SSEH. They were 4 female and 2 male cases and age ranged from 61 to 75 years (averaging 67.3 years).

　The SSEH were located in the cervical (n＝3), cervicothoracic (n＝3) regions. In 4 cases, there were hematomas at the right side of the spinal epidural space, and 2 cases were at the left side.

　Results: All cases experienced severe neck or shoulder pain. In five cases, hemiparesis was noted. Cervical MRI showed that epidural hematoma had compressed the spinal cord posterolateraly. In all cases, cervical CT scans also revealed epidural hematoma, too. Five cases were operated on by removal of the hematoma with hemilaminectomy and one case was operated on with laminectomy because of severe paresis. The mean time since the start of the operation was 11 hours (ranging from 7 to 20 hours). Only one case who had only severe pain without paresis was treated conservatively. All except two patients completely recovered neurologically. The two cases continued to have sensory disturbance.

　Conclusions: We successfully treated 6 cases of SSEH. MRI is useful for diagnosis of SSEH,and CT scan can also diagnose it as in our cases. Cases with severe neurological deficit would be considered as needing surgical treatment at an appropriate time and the cases without neurological deficit should be kept under observation until surgery becomes necessary.