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Neurological Surgery No Shinkei Geka Volume 21, Issue 12 （December 1993）

Neurological Surgery 脳神経外科 21巻12号（1993年12月発行）

Japanese English

症例

自然軽快傾向を示したSpontaneous Spinal Epidural Hematomaの1手術例 A Case of Spontaneous Spinal Epidural Hematoma with Spontaneous Remission before Surgery 鈴木秀謙 ¹ , 山本義介 ¹ , 星野有 ¹ , 米田千賀子 ¹ Hidenori SUZUKI ¹ , Yoshisuke YAMAMOTO ¹ , Tamotsu HOSHINO ¹ , Chikako YONEDA ¹ ¹松阪中央総合病院脳神経外科 ¹Department of Neurosurgery, Matsusaka Chuo Sougo Hospital キーワード： Spinal epidural hematoma , MRI , Spontaneous remission , Treatment Keyword: Spinal epidural hematoma , MRI , Spontaneous remission , Treatment pp.1119-1123

発行日 1993年12月10日 Published Date 1993/12/10

DOI https://doi.org/10.11477/mf.1436902492

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Abstract 文献概要
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I．はじめに

　Spontaneous Spinal Epidural Hematoma（以下，SSEDH）は，従来，緊急手術が必須とされてきた比較的稀な疾患である^11）．しかし，SSEDHのうち，発症後早期に自然軽快傾向を示す症例の治療方針は，最近，議論があるところである^5）．われわれは発症後早期より，臨床的にも画像的にも改善し続け，自然治癒も考えられた症例に対して敢えて手術を施行し，神経症状を早期に完全消失せしめた．ここに症例を報告し，このような症例に対する治療方針につき，文献的に若干の考察を加え報告する．

A 61-year-old man was reterred to our department with spontaneously remitting sensorimotor disturbance and bowel and bladder dysfunctions. He had no specific previous history and neither received any drug nor suffer-ed from hypertension. On onset, complete flaccid paralysis of lower extremities, almost complete sensory disturb-ance of all modalities below the level of Th12, and bowel and bladder dysfunctions were observed. MRI and CT scan revealed an epidural hematoma in the posterior re-gion of the spinal cord at Thll level. Afterwards he con-tinued to improve gradually both clinically and radiologi-cally. Four days subsequent to onset, on admission to our department, he had slight sensorimotor disturbance, and bowel and bladder dysfunctions still existed. MRI de-monstrated a shrinking and flattened hematoma. We per-formed laminectomy and evacuation of the hematoma. Grossly and histologically, no underlying lesion was re-vealed. Postoperative course was not eventful. He was discharged without residual deficits.

In our case, surgery accomplished three goals : defini-tive diagnosis, secure decompression and prevention of recurrence. We believe, the possibility of spontaneous re-solution of spontaneous spinal epidural hematomas (SSEDHs) with spontaneous remission may be high, but prompt surgical evacuation should be the treatment of choice for such cases, even if no underlying lesion is re-vealed by MRI, except in cases where operative morbid-ity and mortality rate is high and in cases with no neuro-logical deficits other than pain. A review of the literature indicated that not all SSEDHs with spontaneous remis-sion resolved spontaneously and completely.