成人慢性硬膜下血腫の血腫外膜および硬膜の組織学的検討

Histological study of operated cases of chronic subdural hematoma in adults:relationship between dura mater and outer membrane

I．はじめに

　成人慢性硬膜下血腫（以下本症）はVirchow^16）以来多くの説があるけれども，未だその成因が明らかにされてはいない．これ迄の組織学的研究の多くは主に血腫外膜についてのものであった^9-11,18）．しかし，血腫外膜への血流の大部分は硬膜由来であり^13），本症の組織学的研究はどうしても硬膜と外膜を一緒に検討する必要があると考える．われわれはこれ迄本症にステロイド療法を行ってきた^14）が，手術を必要とする症例も少なからず存在した．手術時には硬膜と外膜を一塊として採取し，両者の関連や外膜の性状等につき組織学的に検討したので，その結果を報告する．

In 31 consecutive operated cases of chronic subdural hematoma (CSH) in adults, a histological study of the outer membrane and the dura mater was reported. Only 3 cases had vascular connections between the dura ma-ter and the outer membrane. The vessels from (or to) the dura mater entered into the sinusoidal channel of the outer membrane. Dura mater always showed nor-mal findings and was distinctly separated from the out-er membrane, except for vascular connections. Because of this, they were regarded as different tissues. Hemor-rhages in and out of the hematoma cavity of the outer membrane were seen in all 12 cases and seemed to be a reason for enlargement of CSH. There were 16 cases of eosinophilic infiltration in the outer membrane. No positive reaction was seen to estrogen receptor staining of either the dura mater or the outer membrane.