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Neurological Surgery No Shinkei Geka Volume 48, Issue 11 （November 2020）

Neurological Surgery 脳神経外科 48巻11号（2020年11月発行）

Japanese English

症例

皮質下出血術後早期の血腫腔に発生した症候性expanding porencephalic cystの1成人例 Early Development of a Symptomatic Expanding Porencephalic Cyst in the Hematoma Cavity after Subcortical Hematoma Removal in an Adult:A Case Report 品川博光 ¹ , 松尾彩香 ² , 小川由夏 ² , 塩崎絵理 ² , 小野智憲 ² , 伊藤健大 ² , 森塚倫也 ² , 本田和也 ² , 日宇健 ² , 川原一郎 ² , 原口渉 ² , 牛島隆二郎 ² , 堤圭介 ² Hiromitsu SHINAGAWA ¹ , Ayaka MATSUO ² , Yuka OGAWA ² , Eri SHIOZAKI ² , Tomonori ONO ² , Takehiro ITO ² , Tomoya MORITSUKA ² , Kazuya HONDA ² , Takeshi HIU ² , Ichiro KAWAHARA ² , Wataru HARAGUCHI ² , Ryujiro USHIJIMA ² , Keisuke TSUTSUMI ² ¹国立病院機構長崎医療センター ²国立病院機構長崎医療センター脳神経外科 ¹National Hospital Organization Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center キーワード： intracerebral hematoma , post-surgery , porencephalic cyst , symptomatic , adult case Keyword: intracerebral hematoma , post-surgery , porencephalic cyst , symptomatic , adult case pp.1035-1042

発行日 2020年11月10日 Published Date 2020/11/10

DOI https://doi.org/10.11477/mf.1436204317

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　脳出血手術後の血腫摘出腔は通常，経時的に縮小する．再出血以外で，短期間に再増大しmass effectを示すことはない．今回われわれは，皮質下出血の開頭術後，一時縮小した血腫腔が急速に拡大し，porencephalic cystを形成して症候化した1成人例を経験した．極めて稀な経過であり，文献的考察を加えて報告する．

　A 69-year-old woman presented on an emergency basis, with headache and left hemiparesis. Initial head CT at the time of admission revealed a large subcortical hematoma with perihematomal edema extending from the right parietal to the occipital lobe. A small part of the hematoma extended toward the trigone of the right lateral ventricle. CT angiography revealed no vascular abnormalities. Emergency craniotomy was erformed, and the patient's initial postoperative course was unremarkable. However, the patient's neurological symptoms worsened 10 days postoperatively, and CT revealed a new low-density cystic lesion with perifocal edema at the site of hematoma removal, in addition to severe cerebral compression. We performed a reoperation, and intraoperatively we observed hematoma fluid mixed with cerebrospinal fluid without any abnormal blood vessels or neoplastic lesions in the hematoma cavity. We identified the choroid plexus deep within the surgical field, and slight leakage of cerebrospinal fluid was detected from the ventricular aspect, indicating the formation of a small passage between the hematoma cavity and the ventricle. After the second operation, her postoperative course was uneventful without recurrent cyst formation.

　An early symptomatic expanding porencephalic cyst in the hematoma cavity after removal of an intracerebral hematoma is rare, and only a few cases have been reported in the literature. Based on literature review and considering the likely mechanism of cyst development, we speculated that progressive cyst expansion could be attributed to a check valve mechanism between the ventricle and the cavity from which the hematoma was removed, as observed in the present case.