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Neurological Surgery No Shinkei Geka Volume 47, Issue 5 （May 2019）

Neurological Surgery 脳神経外科 47巻5号（2019年5月発行）

Japanese English

症例

中頭蓋窩くも膜囊胞に合併し，うっ血乳頭で発見された慢性硬膜下血腫の小児例 Chronic Subdural Hematoma with Middle Cranial Fossa Arachnoid Cyst Concomitant with Bilateral Papilledema:A Case Report 縣正大 ¹ , 東山史子 ¹ , 大屋房一 ¹ , 酒井圭一 ¹ Masahiro AGATA ¹ , Fumiko HIGASHIYAMA ¹ , Fusakazu OYA ¹ , Keiichi SAKAI ¹ ¹国立病院機構信州上田医療センター脳神経外科 ¹Department of Neurosurgery, National Organization Hospital Shinshu Ueda Medical Center キーワード： arachnoid cyst , chronic subdural hematoma , children , head injury , sports Keyword: arachnoid cyst , chronic subdural hematoma , children , head injury , sports pp.531-536

発行日 2019年5月10日 Published Date 2019/5/10

DOI https://doi.org/10.11477/mf.1436203977

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　くも膜囊胞（arachnoid cyst：AC）は，小児期に多く指摘される良性の囊胞性病変である¹⁾．頭部画像検査により偶発的に発見され，無症状で経過することが多いが，囊胞自体の増大や硬膜下水腫・血腫を併発すると症候性となることがある⁹⁾．頭蓋内圧亢進症状や局所神経症状を呈すれば外科的治療の適応となり，その予後は良好であるとの報告が多い¹⁶⁾．しかし，無症候性ACの手術適応は，脳神経外科医のなかでも意見が分かれる¹⁸⁾．また，軽微な頭部外傷，特にコンタクトスポーツで硬膜下血腫が合併しやすいともいわれているが，現在のところ，ACの小児へのスポーツ制限に関する明確な基準はない¹¹⁾．

　今回われわれは，うっ血乳頭で発見したACに合併する慢性硬膜下血腫（chronic subdural hematoma：CSDH）に対し，外科的介入により良好な転帰を得た1例を経験した．小児におけるACとスポーツとの関連も踏まえ，最近の文献的考察を加え報告する．

　Arachnoid cysts（AC）are benign cystic lesions often diagnosed in childhood. Although usually asymptomatic, AC can become symptomatic when the lesion size increases or coexists with a subdural hygroma or hematoma. AC patients with signs of increasing intracranial pressure（IICP）or neurological deficits may need surgical intervention；this usually results in a good prognosis. However, whether asymptomatic AC patients should undergo surgical treatment is controversial. Although trivial head trauma, such as that from contact sports, can cause subdural hematoma in AC patients, there are currently no definite criteria regarding sports participation for children with AC.

　CASE：A 12-year-old boy who belonged to a soccer club visited an ophthalmologist with the chief complaint of having had diplopia for two weeks. He was identified as having bilateral papilledema. Since he had been diagnosed with a right middle cranial fossa AC five years earlier, he was referred to our outpatient clinic. Cranial CT scans showed right chronic subdural hematoma alongside the AC. The patient subsequently underwent burr hole surgery and was discharged after one week.

　In this case, the patient did not present with the typical signs of IICP, such as headache or vomiting. This experience indicates that care must be taken when encountering patients with atypical symptoms, particularly children. In addition, it is important to carefully consider sports participation for children with AC.