広範脳梗塞に対する内減圧術（特に海馬回切除）の経験—外減圧術との比較

Internal Decompression with Hippocampectomy for Massive Cerebral Infarction

I．緒言

　内頸動脈や中大脳動脈などの脳主幹動脈閉塞症例では，脳梗塞急性期に高度の脳浮腫をきたし内科的治療のみでは救命できない場合がある．このような症例に対する外科的治療としては外減圧術が行われているが，必ずしも満足すべき結果は得られていない^{2,3,5,6,8,11-15）}．その一因として外減圧術が逆に術後脳浮腫を増強させるため，という報告も見られる^1,4,7）．そこで著者らはこのような例に対して，海馬回切除を含む内減圧術を行い満足すべき結果を得た．外減圧術を行った12例と内減圧術を行った2例の転帰，脳浮腫の増減などを比較検討し，若干の知見を得たので報告する．

Massive cerebral infarction due to the occlusion of amain cerebral artery is often unresponsive to medical treatment. Internal decompression with hippocampec-tomy was tried for two patients and satisfactory results were obtained without advancing cerebral edema. Exter-nal decompression was also performed on 12 patients, but it was accompanied by intensified edema postoper-atively. Satisfactory results were obtained in four cases, but three patients remained in vegetative states, and five patients died.

The internal decompression with immediate hippo-campectomy resolves compression to the brain stem without aggravating cerebral edema and may be more effective in preserving life than external decompression.