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Neurological Surgery No Shinkei Geka Volume 19, Issue 7 （July 1991）

Neurological Surgery 脳神経外科 19巻7号（1991年7月発行）

Japanese English

研究

軽症被殻出血例に対するCT誘導定位的血腫吸引術の評価 Evaluation of CT-guided Stereotactic Hematoma Aspiration in Mild Cases with Putaminal Hemorrhage 興村義孝 ¹ , 小野純一 ¹ , 岩立康男 ¹ , 烏谷博英 ¹ , 須田純夫 ¹ , 礒部勝見 ¹ Yoshitaka OKIMURA ¹ , Junichi ONO ¹ , Yasuo IWADATE ¹ , Hirohide KARASUDANI ¹ , Sumio SUDA ¹ , Katsumi ISOBE ¹ ¹君津中央病院脳神経外科 ¹Department of Neurosurgery, Kimitsu Central Hospital キーワード： Mild putaminal hemorrhage , CT-guided stereotactic aspiration , Neuropsychological evaluation , Perifocal edema , Cerebral blood flow Keyword: Mild putaminal hemorrhage , CT-guided stereotactic aspiration , Neuropsychological evaluation , Perifocal edema , Cerebral blood flow pp.611-617

発行日 1991年7月10日 Published Date 1991/7/10

DOI https://doi.org/10.11477/mf.1436900284

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Abstract 文献概要
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I．はじめに

　1978年Backlundら^1）の1例報告上次来，諸家によりCT誘導定位的血腫吸引術の有用性が報告されている^{2-6，8,13,14,16,17,19）}．しかしながら，その手術適応に関しては，なお議論の余地があると思われる^7,18,24）．

　われわれは軽症被殻出血例を2群に分け，CT誘導定位的血腫吸引群（以下吸引群）と保在的治療群（以下保存群）とし，両群の比較検討を行ったので報告する．

Abstract

Reported here is the effectiveness of surgical man-agement in mild cases with putaminal hemorrhage (neu-rological grading 1 or 2, described by Kanaya, et al.).

Ten cases were treated by CT-guided stereotactic hematoma aspiration (aspiration group) , and another 10 cases were treated by only medical therapy (conser-vative group) . The mean interval from the onset to op-eration was. 7.2 clays. In both groups, serial change in the motor function of the upper extremity was ex-amined and the neuropsychological function was also evaluated at 2 weeks after onset. Perifocal low-density area around the hematoma was estimated on CT scan at 2 weeks after onset. Mean hemispheric cerebral blood flow (mCBF) was measured at 5-clays, 2 weeks and 6 months after onset, respectively in each group. The activity of daily life (ADL) was evaluated at 6 months after onset.

There was no statistically significant difference in age, neurological grading and CT findings on admis-sion between the 2 groups. At 2 weeks after onset, no case had deteriorated in motor function in the aspira-tion group. On the other hand, 2 cases had deteriorated in the conservative group. The neuropsychological function was considerably improved in the majority of cases in the aspiration group. Perifocal low area was significantly narrow on CT scan in the aspiration group. At 2 weeks after onset, the mCBF of the affected side was 53.8 ± 6.0 ml/100g/min in the aspi-ration group, whereas it was 42.0 ± 5.7 ml1/100g/min in the conservative group. This difference was statisticallysignificant. In spite of these favorable results in the aspiration group, the ADL at 6 months after onset was the same in both groups (ADI. I & II : 70%).

These results suggested that CT-guided stereotactic hematoma aspiration might be effective during theacute and subacute stage in the managment of mild cases with putaminal hemorrhage. The authors expect early ambulation in these cases, and a shorter hospita-lization period by this management.