乳幼児水頭症における髄液短絡術後の硬膜下血腫

Post-Shunt Subdural Hematorna in Infants and Children:Analysis of Eleven Cases

Ⅰ．はじめに

　水頭症の症例では，軽微な外傷により^25，28）あるいは気脳写^3，12），脳圧降下剤の投与^13）といった頭蓋内圧の変動により，硬膜外または硬膜下血腫を生じやすい．したがって急激な髄液圧の変動をきたす髄液短絡術後の合併症として硬膜下血腫を発生しやすいことは十分に予想されうる．今回，私どもが経験した乳幼児水頭症術後の硬膜下血腫11症例について，術前の水頭症の病態，髄液短絡術施行時の状態，硬膜下血腫の発生状況，治療方針について検討を加えたので報告する．

Out of 122 hydrocephalic infants and children treated by cerebrospinal fluid shunt, post-shunt subdural hematoma was found in 11 patients in total, 8 cases with non-tumorous hydrocephalus and 3 cases with brain tumors obstructing the cerebrospinal fluid pathway. In most cases the diagnosis of subdural hematoma was delayed since signs of increased intracranial pressure were absent initially. The signs of increased intracranial pressure appeared later, when the shunted venricle collapsed and could not give any more space to the growing subdural hematoma.