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Neurological Surgery No Shinkei Geka Volume 48, Issue 7 （July 2020）

Neurological Surgery 脳神経外科 48巻7号（2020年7月発行）

Japanese English

症例

竹枝による経眼窩的穿通損傷に伴い海綿静脈洞損傷を来した症例に対しハイブリッド手術室で治療を行った1例 A Case of Transorbital Penetrating Cavernous Sinus Injury by a Bamboo Stick Treated by Craniotomy in the Hybrid Operating Room 河野智樹 ¹ , 大田元 ¹ , 河野朋宏 ² , 二見宗智 ¹ , 笠新逸 ² , 杉本哲朗 ² , 秋葉大輔 ³ , 横上聖貴 ¹ , 竹島秀雄 ¹ Tomoki KAWANO ¹ , Hajime OHTA ¹ , Tomohiro KAWANO ² , Munetomo FUTAMI ¹ , Shinitsu RYU ² , Tetsuaki SUGIMOTO ² , Daisuke AKIBA ³ , Kiyotaka YOKOGAMI ¹ , Hideo TAKESHIMA ¹ ¹宮崎大学医学部臨床神経科学講座脳神経外科学分野 ²宮崎県立日南病院脳神経外科 ³潤和会記念病院脳神経外科 ¹Department of Neurosurgery, Division of Clinical Neuroscience, Faculty of Medicine, University of Miyazaki ²Department of Neurosurgery, Miyazaki Prefectural Nichinan Hospital ³Department of Neurosurgery, Junwakai Memorial Hospital キーワード： penetrating intracranial head injury , wooden foreign body , bamboo stick , hybrid operating room Keyword: penetrating intracranial head injury , wooden foreign body , bamboo stick , hybrid operating room pp.607-613

発行日 2020年7月10日 Published Date 2020/7/10

DOI https://doi.org/10.11477/mf.1436204239

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参考文献 Reference

Ⅰ．はじめに

　眼窩壁を構成する骨は菲薄であり，外傷で容易に損傷する．眼窩貫通異物は比較的小児に多い外傷であるが稀である^1,16,21)．貫通部位に応じて周辺に重篤な神経脱落所見を生じ，周囲の構造物を損傷する可能性がある．竹などの木材は診断が難しく^6,15,17)，残存異物は感染源となり得るため¹²⁾，迅速かつ綿密な手術計画が必要である．

　Hybrid operating roomは，脳動静脈奇形や複雑な脳動脈瘤に対する治療使用例の報告があるものの，頭部外傷に対する使用例の報告はわれわれが知り得る限り認められない．今回，われわれは竹枝が上眼窩裂から海綿静脈洞近傍に刺入した症例に対して，血管内治療と外科的手術が可能であるhybrid operating roomを使用し治療を行った1例を経験したため，文献的考察を踏まえて報告する．

　Herein, we report a rare case of penetrating transorbital cavernous sinus injury caused by a bamboo stick, treated by craniotomy in a hybrid operating room. A 63-year-old gardener presented at our hospital with right upper orbital injury after falling on a bamboo basket. Neurological examination revealed right Ⅱ, Ⅲ, Ⅳ, and Ⅵ cranial nerve palsies. CT and MRI revealed a right transorbital penetrating injury by a small sharp wooden foreign body, extending from the orbit to the cavernous sinus via the superior orbital fissure. Preoperative digital subtraction angiography revealed partial occlusion of the right cavernous sinus by the foreign body and no internal carotid artery（ICA）injury. There was a nine-day waiting period after the injury because the patient was on dual antiplatelet therapy for ischemic heart disease. Subsequently, the bamboo stick was completely removed through the right fronto-temporo-orbito-zygomatic approach in a hybrid operating room. To treat the potential massive hemorrhage, a five-French balloon catheter was inserted in the right ICA at its origin via the right transfemoral approach before the craniotomy. The bamboo stick was completely removed with minor hemorrhage in the cavernous sinus；this was controlled using hemostatic materials. The postoperative course was uneventful. The patient was discharged with blindness and total ophthalmoplegia in the right eye but he was able to return to his prior job. This is the first report of such a treatment of a transorbital penetrating injury in a hybrid operating room.