頭蓋穿通創—特異な2症例の報告と文献的考察

Penetrating Craniocerebral Injuries:Report of two unusal cases and review of literature

I．はじめに

　頭蓋穿通創は戦時下に多く発生し，一般市民生活には比較的稀な外傷であるが，ときに特異な刺入物や穿通経路の報告がみられる．成人では犯罪や自殺行為，労務災害が主な原因となり，ことに近年釘打機による受傷が散見される^{5,11,13,16,21,22）}．銃創を除く頭蓋穿通創では，通常脳組織の損傷が軽度であるため，症状が予想外に軽微である場合が多く特徴的といえるが，主要脳血管を損傷したり感染を引き起こしたため重篤となることもあり，治療上いくつかの難しい問題を含んでいる．

　著者らは，頭蓋穿通創の特異な2症例を経験したので報告し，この種の頭部外傷について文献的考察を行った．

We reported two unusual cases of craniocerebral injuries.The first case is 47-year-old male carpenter. He was admitted to the Department of Neurosurgery of Oita Prefectural Hospital with a diagnosis of penetrating head injury due to nailing tool accident. The nailing tool operated by his son working beside the patient struck his head accidentally three hours prior to admission. He had transient headache and did not lose consciousness. On admission he was fully conscious and demonstrated no neurological deficits. The nailhead was seen in the midline of his vertex. Plan skull film showed a nail embedded intracranially from the parietal bone.