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Neurological Surgery No Shinkei Geka Volume 45, Issue 12 （December 2017）

Neurological Surgery 脳神経外科 45巻12号（2017年12月発行）

Japanese English

症例

テント上外傷性血腫に併発した後頭蓋窩急性硬膜下血腫の3手術例 Surgical Treatment for Traumatic Acute Subdural Hemorrhage in the Posterior Cranial Fossa:Three Cases Reports and Review of the Literature 土井一真 ¹ , 大谷直樹 ¹ , 美山真崇 ¹ , 松本崇 ¹ , 藤井隆司 ¹ , 大塚陽平 ¹ , 竹内誠 ¹ , 豊岡輝繁 ¹ , 和田孝次郎 ¹ , 森健太郎 ¹ Kazuma DOI ¹ , Naoki OTANI ¹ , Masataka MIYAMA ¹ , Takashi MATSUMOTO ¹ , Takashi FUJII ¹ , Yohei OTSUKA ¹ , Satoru TAKEUCHI ¹ , Terushige TOYOOKA ¹ , Kojiro WADA ¹ , Kentaro MORI ¹ ¹防衛医科大学校脳神経外科 ¹Department of Neurosurgery, National Defense Medical College キーワード： trauma , posterior cranial fossa , acute subdural hemorrhage , intracranial pressure Keyword: trauma , posterior cranial fossa , acute subdural hemorrhage , intracranial pressure pp.1101-1107

発行日 2017年12月10日 Published Date 2017/12/10

DOI https://doi.org/10.11477/mf.1436203654

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　後頭蓋窩に発生する外傷性急性硬膜下血腫（acute subdural hemorrhage：ASDH）は稀であるが，中でもテント上外傷性血腫や脳幹・小脳挫傷を伴う病変は極めて予後不良である⁵⁾．今回われわれは，テント上外傷性血腫に併発した後頭蓋窩ASDHに対して，複数回にわたる外科的手術を要した3症例を経験したので，文献的考察を踏まえて報告する．

　Acute subdural hemorrhage（ASDH）in the posterior cranial fossa is rare. Extremely unfavorable outcomes are reported among cases accompanied by supratentorial hematoma, brainstem contusion, or intracerebellar contusion.

　We report three cases surgically evacuated several times for traumatic ASDH in the posterior cranial fossa simultaneously accompanied by supratentorial hematomas. In our three presented cases, the mean age was 72.3 years, and all patients were male. The mechanisms of injury included traffic accidents in two cases and fall in one. The median Glasgow Coma Scale score on admission was 6. On admission, the patients had traumatic ASDH in the posterior cranial fossa accompanied by supratentorial hematoma, so they first underwent external decompression or ICP sensor insertion for the supratentorial lesions. However, after their first surgery, all patients developed upward herniation, and subsequently underwent suboccipital craniotomy and evacuation of hematomas. Glasgow Outcome Scales were death in one case, persistent vegetable state in one case, and severe disability in one case.

　The patients with ASDH in the posterior cranial fossa accompanied by supratentorial hematoma should immediately undergo suboccipital craniotomy and supratentorial decompression simultaneously when the hematomas compress the brainstem and upward herniation develops.