Curettage and suction techniqueを応用し，内視鏡下穿頭術により治癒した器質化慢性硬膜下血腫の1例

A Case of Organizing Chronic Subdural Hematoma Treated with Endoscopic Burr-Hole Surgery Using a Curettage and Suction Technique

Ⅰ．はじめに

　慢性硬膜下血腫は，脳神経外科医が日常診療で最も多く遭遇する疾患の1つである．治療には穿頭血腫除去術が広く行われており，良好な治療成績が得られている．しかし，その中には難治性の慢性硬膜下血腫が存在し，器質化慢性硬膜下血腫もその1つである．今回われわれは，穿頭術中に器質化慢性硬膜下血腫と診断し，硬性鏡下に屈曲させた吸引管を用いて可及的な血腫除去を行い，治癒し得た症例を経験したので報告する．

　A 70-year-old man presented to our hospital because of difficulty with discrete movement of the right upper limb and dysarthria. Computed tomography（CT）of the head revealed a chronic subdural hematoma（CSDH）on the left side. The patient underwent single burr-hole irrigation and drainage on the same day. In addition to the burr hole, a cross-shaped dural incision was made which revealed a thick outer membrane and solidified hematoma. We removed as much of the clotted hematoma as possible using a curved suction tube under neuroendoscopy. The postoperative CT revealed that the hematoma was partially removed and the mass effect was reduced. As a result, the patient's neurological deficits improved. We reached a diagnosis of organizing CSDH following histologic examination of the removed hematoma that showed inflammatory cell infiltration and multiplication of fibroblasts. Neuroendoscopic hematoma evacuation via a burr hole is minimally invasive and may be a useful procedure in the treatment of some cases of organizing CSDH.