脳室穿破を来した脳膿瘍の1治験例—抗生物質による脳室灌流療法の有用性について

Brain Abscess Ruptured into the Lateral Ventricle:The usefulness of treatment by intraventricular irrigation with antibiotics.A case report

I．はじめに

　脳膿瘍は抗生物質の普及によりその発生率が下がり，最近ではCT scanの導人により早期に診断が可能となり，その治療成績は飛躍的に向上している^1,9）．しかし，脳室穿破を来した脳膿瘍の予後は依然不良であり，治癒例の報告は散見されるに過ぎない^3,4）．

　今回，われわれは左側頭葉の脳膿瘍が左側脳室に穿破し重症脳室炎を呈した症例に対し，抗生物質による脳室灌流療法を試み，良好な結果を得たので文献的考察を加え報告する．

A case is reported of a brain abscess, which ruptured into the lateral ventricle and was treated using in-traventricular irrigation with antibiotics.

A 37-year-old man was suffering from a headache and high fever. Precontrast CT scan revealed a hetero-geneous low density area in the left temporal lobe, and postcontrast CT scan showed a multilobular ring-like enhanced mass. Diagnosed as a brain abscess, in-travenous administration of antibiotics was performed. On the sixth day the patient suddenly became drowsy. Postcontrast CT scan revealed an enhanced effect in the left lateral ventricular wall. Drowsiness was attri-buted to increased intracranial pressure and severe ven-triculitis. Bilateral continuous ventricular drainage viathe anterior horn of the lateral ventricle was performed. The drainage fluid from the left lateral ventricle was just like pus. Intraventricular irrigation with antibiotics between the bilateral anterior horns of the lateral ven-tricle, was performed in order to save the patient. The infusion fluid, Lactate Ringer's solution containing Cefazolin sodium, was infused into the right ventricle and CSF-like pus was drained from the left ventricle. The CSF reading gradually improved, and on the 14th clay postoperatively irrigation was terminated. The postoperative course was uneventful.

The diagnosis, treatment, and prognosis of patients with brain abscesses have improved dramatically as a result of more reliable methods of identifying infecting organisms, more effective antibiotic regimens, the de-velopment of microsurgical techiques and CT scan. However, despite these advances, the prognosis for brain abscess ruptured into the ventricle is usually very pessimistic. Intraventricular irrigation therapy with effective concentration of antibiotics and rapid drainage of pus and inflammatory products is useful for severe ventriculitis, such as was presented in this case.