クロスボウの矢による経口的穿通性頭部外傷の1例

A Case of Transoral Penetrating Head Injury from a Crossbow-Fired Arrow

Ⅰ．はじめに

　本邦では銃社会である欧米諸国と比べて，穿通性頭部外傷は稀である．異物の性状や侵入経路・速度によって病態は多種多様であり，治療方法は統一されていないため，症例ごとに治療方法を検討する必要がある．今回われわれは，クロスボウの矢が経口的に頭蓋内へ刺入した，穿通性頭部外傷の1例を経験したので，文献的考察を踏まえて報告する．

　Penetrating head injuries are extremely rare in Japan. The authors describe a case involving a penetrating head injury from an arrow fired from a crossbow. A 52-year-old man who had shot himself transorally in a suicide attempt was admitted to the authors' hospital. On admission, he was conscious and exhibited no neurological deficits. The end of the arrow was visible inside his oral cavity. Computed tomography revealed the arrow had penetrated the right cerebellum and occipital lobe, resulting in a very small hematoma. Digital subtraction angiography revealed no significant vascular injuries. After considering these findings and the nature of the object, the authors decided to remove the arrow from the cranium by pulling it from the patient's oral cavity. To remove the arrow, surgery was performed with several devices, including intraoperative X-ray, endoscopy, and intraoperative angiography. The authors were able to completely remove the arrow, and the patient experienced no new deficits, except mild ataxia and mild dysphasia, and no signs of cerebral infection or cerebrospinal fluid leakage after the surgery.

　Although most cases of penetrating head injuries require craniotomies, the authors were able to safely remove the foreign object in this case without performing a craniotomy. Because guidelines for the treatment of penetrating head injuries have not been established, the treatment of each case must be modified according to the nature of the foreign object and the findings of preoperative imaging techniques.