術後緊張性気脳症の3例

Postoperative Tension Pneumocephalus: Report of 3 cases

I．はじめに

　緊張性気脳症は頭蓋内の硬膜外，くも膜下，脳室内あるいは脳実質内に空気ないしはガスが貯留し，頭蓋内圧上昇をきたすものをいう．

　著者らは，現在までに稀な原因により発生した3例の術後緊張性気脳症を経験したが，これらの発生には種々の人為的な操作による髄液圧の低下が大きな役割を果たしていると考えられた．そこで症例を呈示し，若干の文献的考察を加え報告する．

Three cases of tension pneumocephalus are reported and pathogenesis, clinical features and management of this complication is discussed.

Case 1: A 12-year-old female underwent a crani-otomy for a suprasellar tumor following V-P shunting. At that time, Mayfield's pin fixing head holder was used and a CSF leak from a puncture wound caused by the head holder was noted postoperatively. Al-though she showed uneventful recovery from the anesthesia, several hours after surgery, she developed general convulsions and deteriorated. CT scan revealed a huge bifrontal accumulation of air com-pressing the entire brain postern-caudally.