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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

左右血腫腔が交通性を有していた成人両側慢性硬膜下血腫の1例 Bilateral Chronic Subdural Hematoma with Communication between the Hematoma Cavities:Report of an adult case 都築伸介 ¹ , 山田日出雄 ¹ , 菅谷睦 ¹ , 橋爪敬三 ¹ Nobusuke TSUZUKI ¹ , Hideo YAMADA ¹ , Mutsumi SUGAYA ¹ , Keizo HASHIZUME ¹ ¹自衛隊中央病院脳神経外科 ¹Department of Neurosurgery, National Defence Central Hospital キーワード： Chronic subdural hematoma , Bilateral , Adult , Communication , CT scan Keyword: Chronic subdural hematoma , Bilateral , Adult , Communication , CT scan pp.1149-1151

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

DOI https://doi.org/10.11477/mf.1436902497

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Abstract 文献概要
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I．はじめに

　成人慢性硬膜下血腫が両側に存在する場合，左右同時の穿頭血腫除去術が治療の原則である^4）．今回われわれは左右血腫腔が交通性を有し，一側のみの穿頭術で治癒した両側慢性硬膜下血腫の1例を経験したので，文献的考察を加えて報告する．

The authors present a case of bilateral chronic subdu-ral hematoma with communication between the hema-toma cavities.

This 24-year-old male had hit his forehead while play-ing football and visited our hospital. An initial plain CT scan revealed extracerebral low density areas in the bifrontal region, which were considered to be post-traumatic subdural hygromas. The lesion was followed up with repeat CT scans. On plain CT scan performed seven weeks after the injury, the lesion had evolved into bilateral chronic subdural hematoma and the patient was admitted to our ward. He underwent burr hole drainage on the left side, bacause the hematoma volume on the left side was considerably larger than that on the right side. A plain CT scan on the day following the operation revealed complete resolution of the hematomas on both sides. A favorable re-expansion of the brain was con-firmed on consecutive CT scan performed two months after the operation.

In general bilateral chronic subdural hematomas in adults are considered to have no communication between the hematoma cavities and therefore they should be evacuated on both sides simultaneously. In our case, on the contrary, the operation revealed a communication be-tween the hematoma cavities.

The falx cerebri is narrow in front and this narrow anterior part is frequently perforated by one or more apertures. We attributed the communication to this anatom-ical feature of the falx cerebri. On preoperative CT scan, in addition, the inner surface of the bifrontal hema-toma cavity demonstrated a smooth concave figure in-dicating retrospectively that the cavity on the left side was continuous with that on the right side. Thus, meticu-lous investigation of CT scans is recommended in cases of bifrontal chronic subdural hematoma in adults, and when they demonstrate the figure mentioned above, treatment such as unilateral burr hole drainage may be applied.