小児急性硬膜外血腫非手術例の長期予後

Long-term Prognosis of Nonoperative Acute Epidural Hematoma in Children

I．はじめに

　CTの普及に伴い，急性硬膜外血腫のうちでも非手術的に加療し得る症例がしばしば経験されるようになってきた．しかし，脳の発達過程にある小児において，短期間ながらも吸収されるまで脳を圧迫する血腫が真に将来的にも中枢神経系に影響を与えないものか否かについて詳細に検討した報告は，われわれが渉猟し得た限りにおいては認められない．今回われわれは，小児急性硬膜外血腫非手術例に対して人院時所見を再検討するとともに追跡調査を施行し，その長期予後を明らかにすることを目的として検討したので，文献的考察を含めて報告する．

Computed tomography (CT) scan has revealed that certain acute epidural hematomas (AEH) don't need op-erative therapies. But, it is difficult to determine especial-ly in childhood, whether AEH compressing the brain for a short-term would or would not effect the function of the central nervous system in the future. For this reason, the authors report the long-term prognosis of nonopera-tive AEH in children.

Twelve children suffering from AEH were transported to our clinic. On admission, they had no neurological de-ficits and CT scan revealed hematomas that had max-imum thickness of 5-19 mm without midline shift. With nonoperative therapy they were discharged and the hematornas disappeared within 3-12 weeks. After long-term follow-up (3-10 years), it was shown that they had no epileptic episodes, and no changes in their school study records. Also, the Yatabe-Guilford personality test revealed no abnormal data.

These data suggest that children can be cured who suffer from AEH with no neural deficits, and in whom the maximum thickness of the AEH is less than 20 mm, and in whom there is no midline shift in CT scan, can be cured without undergoing an operation, and will have a good long-term prognosis.