後頭蓋窩の急性硬膜外血腫:小児10例と成人20例の比較検討

Acute epidural hematoma of posterior fossa:comparative analysis between 20 cases in adults and 10 cases in children

I．はじめに

　当施設における30例の後頭蓋窩急性硬膜外血腫について，小児例と成人例とに分けて比較検討したところ，若干の相違点を認めたので文献的考察を加えて報告する．

A comparative study of the clinical features was made among 30 patients, 10 children (less than 14) and 20 adults (older than 15) with traumatic acute epidural hematoma of the posterior fossa (PFEDH).

The characteristic findings in both groups were as follows: 1) PFEDH accounted for 15% of 200 epidural hematoma cases. Incidence of PFEDH was 23.3% (10/43) in children and 12.7% (20/157) in adults. Thus, PFEDH is more common in children than in adults. 2) In seven out of 10 children, PFEDH was confined to the posterior fossa but in the other three children, PFEDH extended to the supratentorial area. On the other hand, in all the adult cases PFEDH extended over the supratentorial space. 3) Hematoma density was high in 5 out of 10 children and 18 in out of 20 adults. Mixed (including low) density occurred at a higher rate in children (50%) than in adults (10%). 4) Brain contusion associated with PFEDH was found by CT scan in 12 adult cases and one child case. Subarach-noicl hemorrhage was found by CT scan in 4 adult cases. Subdural effusion was found by CT scan in 1 adult case. Thus, intracranial complications associated with PFEDH occurred in a significantly higher number in adults than in children. 5) 20 cases (4 children, 16 adults) of 30 underwent surgery, and 10 cases (6 adults, 4 children) were given conservative treatment. Results (GOS); GR was observed in 22 cases (in all 10 children and in 12 adults), and MD in 8 cases. There were no SD, VS or cases ending in death.