Transtentorial Hiatus ApproachによるCT誘導下定位的膿瘍吸引ドレナージ術が奏効した小脳膿瘍の1例

CT-guided Stereotactic Operation for Cerebellar Abscess by the Transtentorial Hiatus Approach:A case report

I．緒言

　脳膿瘍に対する手術法としては，開頭による被膜外全摘出術または穿刺排膿術が一般的である．いずれの術式を選択するかは患者の全身状態，病期によって異なるが，近年ではCT誘導下定位的手術法の利用により正確な穿刺が可能となり，一般的にはまず穿刺排膿術が選択される^5,6,11）．しかし，小脳膿瘍に対しての報告は未だに多くない^2,17）．

　今回われわれは気管支拡張症に合併した小脳虫部高位に位置する膿瘍に対しTranstentorial hiatus approachによるCT誘導下定位的膿瘍吸引ドレナージ術を施行し良好な経過を得たので，若干の文献的考察を加え報告する．

We reported a case of cerebellar vermian abscess, well managed by CT-guided stereotactic aspiration and drainage via the transtentorial hiatus route. A 69-year-old man was admitted to our hospital because of acute deterioration of bronchiectasis. About one month later, he complained of headache and gait unsteadiness. CT scan revealed a multilocular abscess in the cerebellar vermis. Although conservative therapy with antibiotics was applied, the symptoms deteriorated and the lesion continued to grow. Aspiration and drainage were there-fore performed for the main lesion by CT-guided stereotactic surgery via the transtentorial hiatus route.This was completed without complications. The postop-erative course was good and the lesion had disappeared when enhanced CT was carried out about 2 months af-ter the operation. We consider this stereotactic trans-tentorial hiatus operation to he an effective treatment for patients such as the present one with a superior ver-mian lesion and who is at risk due to a poor respiratory condition.