穿頭閉鎖式ドレナージ術後に急性硬膜外血腫を発症した慢性硬膜下血腫の1例

Acute Epidural Hematoma Following Evacuation of Chronic Subdural Hematoma with Continuous Closed System Drainage

I．はじめに

　慢性硬膜下血腫の治療として穿頭による洗浄術が広く行われているが術後重篤な合併症が報告されており，最近では緩徐な血腫除去を目的とした穿頭閉鎖式ドレナージ術の有用性が強調されている．1986年以来，当施設においても穿頭閉鎖式ドレナージ術を28例の慢性硬膜下血腫に対し行っているが，今回初めて術後合併症として急性硬膜外血腫を経験した．穿頭洗浄術後に急性硬膜外血腫が発生した報告は散見されるが穿頭閉鎖式ドレナージ術後に発生した報告はなく，本法の注意点についての考察を加えて報告する．

The authors report a case of acute epidural hematoma occurring after evacuation of chronic subdural hematoma with continuous closed system drainage. Laboratory data of the patient including bleeding time were within nor-mal limits. The cause of the postoperative intracranial hematoma was the rapid surgical decompression of the initial lesion, and we considered that it could be prevented if chronic subdural hematoma was treated us-ing closed system drainage and slow decompression. But acute epidural hematoma occurred after this operative procedure and it was accelerated by evacuation of the chronic subdural hematoma through the drain. An emer-gent craniotomy and removal of the hematoma was per-formed, so the patient was discharged from hospital with satisfactory neurological recovery. A careful check of the evacuated hematomal volume is very important, and CT scanning should be immediately performed if postopera-tive hematoma is suspected.