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Neurological Surgery No Shinkei Geka Volume 49, Issue 5 （September 2021）

Neurological Surgery 脳神経外科 49巻5号（2021年9月発行）

Japanese English

特集頭部外傷診療アップデート—ガイドラインを読み解く

Ⅱ　外科的治療と神経集中管理・治療

頭蓋内圧亢進に対する減圧開頭術 Decompressive Craniectomy for Intracranial Hypertension 大谷直樹 ¹ , 吉野篤緒 ¹ Naoki OTANI ¹ , Atsuo YOSHINO ¹ ¹日本大学医学部脳神経外科学系神経外科学分野 ¹Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine キーワード：頭蓋内圧亢進 , 減圧開頭術 , 外減圧術 , ランダム化比較試験 , 治療選択 , intracranial hypertension , decompressive craniectomy , external decompression , randomized controlled trial , RCT , surgical strategies Keyword: 頭蓋内圧亢進 , 減圧開頭術 , 外減圧術 , ランダム化比較試験 , 治療選択 , intracranial hypertension , decompressive craniectomy , external decompression , randomized controlled trial , RCT , surgical strategies pp.964-975

発行日 2021年9月10日 Published Date 2021/9/10

DOI https://doi.org/10.11477/mf.1436204479

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Abstract 文献概要
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参考文献 Reference

Point

・減圧開頭術（DC）による転帰は内科的治療と比べて致死率は減少するが，機能予後は不変である．

・重症頭部外傷で脳ヘルニア徴候や開頭術の適応がある症例，特に若年症例ではDCを施行してもよい．

・DCを施行する場合には，大開頭による前頭側頭頭頂開頭（12×15 cm以上，あるいは直径15 cm以上）が勧められる．

　Decompressive craniectomy（DC）for intracranial hypertension after traumatic brain injury（TBI）can be divided into two treatment strategies: primary DC and secondary DC. DC has an important intracranial pressure-lowering effect; however, the standard treatment has not been established because the treatment policy with respect to surgical indication, optimal timing, and surgical method are often determined according to the empirical rules of each institution. In addition, the effects of DC on clinical outcomes remain unknown. Recently, the results of a large multicenter randomized controlled trial（RCT）about the effects of secondary DC for severe head trauma have been published. The study showed that secondary DC improved the mortality rate but had no effect on functional prognosis. Another RCT about the effects of primary DC for TBI is ongoing and the results are awaited. We herein describe the indications, surgical methods, and issues of DC for TBI based on the results of these clinical trials with a high level of evidence.