脳水腫の外科的療法の批判

Studies on Surgical Treatment of Hydrocephalus

　脳水腫の外科的療法は古くから多数試みられて来た。しかも現在尚次々と新しい方法が考案されつゝある。このことはとりもなおさず脳水腫の外科的療法の困難性と不確実性とを物語るに他ならないのであつて，実際脳神経外科医の最も頭を悩ますものの一つである。今数多くの業績を振返つて見ると，根治手術可能な所謂Neoplasmによる二次的脳水腫以外の脳水腫ではその永久治癒をもたらすことはまだまだ困難な様である。殊に先天性の急速に進行する脳水腫では，之を根治せしむることは極めて困難と云い得よう。

　吾々が現在まで経験した症例は第1表の如く36例39回の手術に過ぎず外国のそれと比較して未だ甚だ少い。しかも欧米諸家の考案した方法のすべてを試みたわけでもない。然し吾々なりに種々の方法を追試し，工夫し，更に中田教授により2〜3の新しい方法も考案され試みられて来たのであつて，今之等の経験からこの治癒困難な脳水腫の外科的療法に対する若干の批判を述べ，又吾々の見解を提起するのも無駄ではないと思うのである。

Up to now, the surgical treatment of hydro-cephalus has been tried with many various me-thods and being tried. This fact shows nothing but the difficulty and uncertainty of the opera-tion. The operated cases in our clinic as comp-ared with those in foreign clinlcs is very few. However, we have tried and contrived various methods of the operation. On the basis of the results, the another wishes to criticize the sur-gical treatment of hydrocephalus.

The methods performed were: Torkildsen's mehtod, third ventriculostomy (Dandy's method, postero-superior third ventriculostomy), ventri-culomastoidostomy, ventriculopleurostomy, ven-triculoperitoneostomy, salpingo-thecal anastomo-sis, plexectomy, and gently dilating of Sylvian aqueduct.

39 operations were performed in 36 cases. The surgical treatment caused death in 8 of 39 cases, resulted in the alleviation of symptoms in 10 of them, and produced no, or transient, effect in the rest. It is reported that the time-honoured method which drains the liquor into the subcutaneous or the subdural space, has been performed with casual success, although the method has been known to be unsuccessful.