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Neurological Surgery No Shinkei Geka Volume 42, Issue 3 （March 2014）

Neurological Surgery 脳神経外科 42巻3号（2014年3月発行）

Japanese English

研究

当院における頭蓋内膿瘍の治療成績の検討 A Review of Treatment Outcomes for Intracranial Abscess at Our Institution 矢内啓 ¹ , 大宅宗一 ¹ , 藤澤直顕 ¹ , 土屋掌 ¹ , 印東雅大 ¹ , 中村巧 ¹ , 松居徹 ¹ Kei YANAI ¹ , Soichi OYA ¹ , Naoaki FUJISAWA ¹ , Tsukasa TSUCHIYA ¹ , Masahiro INDO ¹ , Takumi NAKAMURA ¹ , Toru MATSUI ¹ ¹埼玉医科大学総合医療センター脳神経外科 ¹Department of Neurosurgery, Saitama Medical Center, Saitama Medical University キーワード： antibiotics , brain abscess , diffusion-weighted MR image , infection , subdural abscess Keyword: antibiotics , brain abscess , diffusion-weighted MR image , infection , subdural abscess pp.213-219

発行日 2014年3月10日 Published Date 2014/3/10

DOI https://doi.org/10.11477/mf.1436102197

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参考文献 Reference

Ⅰ．はじめに

　頭蓋内感染性疾患は，画像診断の進歩あるいは抗生剤の開発などにより1970年代以前より格段に治療成績が改善した⁹⁾．さらに2000年代初頭にはMRI拡散強調画像（DWI）による頭蓋内膿瘍の診断の有効性が確立した^4,5)．しかし未だ先進国においても頭蓋内膿瘍は頭蓋内占拠病変の2%を占めるとされ⁸⁾，死亡率は10～20%といわれている⁶⁾．起炎菌同定前の適切な抗生剤投与法などに関する理解が進んでいる一方で，合併症などの状況が症例ごとに多様であり画一的な治療法は存在しないことが，治療が難しい原因と思われる．具体的には，①外科的排膿は行うべきか，行うのであれば開頭術がよいか穿頭術がよいか，②膿瘍被膜外摘出が必要な状況とはどういった状態か，③起炎菌同定後の抗生剤治療の期間，④経口抗生剤投与の意義，などに関して未だに不明な点が多く，標準的治療が確立されていない．

　そこでわれわれは，現代的な画像診断および抗生剤治療のもとでの頭蓋内膿瘍の治療成績を検討し，今後さらなる治療成績改善につなげることを目的として，当科における脳膿瘍の治療成績の後方視的解析を行った．

　Background:Intracranial abscesses account for 2% of the intracranial mass even in advanced countries. Because of the variety of causative organisms and symptoms, a standard treatment for intracranial abscess has not yet been established.

　Materials and methods:We retrospectively reviewed the treatment outcomes for intracranial brain abscess and subdural abscess to assess the risk factors for poor prognosis and problems related to treatment.

　Results:In total, 28 patients were included in this study. Preceding craniocervical infections were found in 35.7% of patients. In 39.3% of patients, causative organisms were not identified. The treatment outcome evaluated using the modified Rankin Scale was 0 in 17 patients, 1 in 1 patient, 2 in 2 patients, 4 in 3 patients, 5 in 1 patient, and 6 in 4 patients. All mortality was noted in patients older than 60 years. Advanced age and the development of ventriculitis were significantly associated with poor outcome, i.e., a modified Rankin Scale score of 4 or worse. In contrast, the presence of fever or headache as initial symptoms, severity of neurological deficit, location of the abscess, and lack of identification of causative organism were not related to poor outcome. Compared with our previous treatment results, diffusion-weighted MR imaging has significantly contributed to the improvement of outcomes.

　Conclusion:Early administration of antibiotic therapy based on MR findings was critical in obtaining a good outcome in the treatment of brain abscess. Based on our experience, treatment should be continued, even for patients in a critical condition.