脳室造影術及び気腦術による直接死亡例の検討

Investigation of Dead Cases by Pneumoventriculography and Pneumoencephalography

緒言

　1913年Lucketが頭部外傷の患者に於いて遇然に脳室像を得，又1918年Dandyが経脊椎法，経脳室法による脳室造影術を創始してから，脳室造影法は脳の機質的変化の発見に資する所多く，脳外科の発展は之により上昇の一途を執り，Bailey，Cushingの脳腫瘍統計と相俟ち，之なくしては脳外科は成立し得ないと云う段階に迄達している。然しTönnis等の云う適応不適応を注意深く採用しても，尚偶々不慮の事態が惹起され，断腸の思いに耽ける事は我々脳外科医の再三遭遇する事である。

　我々は桂外科教室に於いて過去14年間に1268例の脳外科的疾患患者に実施した腰椎及び大槽穿刺440回，気脳術（P．E．G．）950回，脳室造影術（P．V．G．）221回の中，大槽穿刺により1例，腰椎穿刺により1例，P．E．G．により1例，P．V．G．により13例の貴重なる経験例を得たので種々反省検討を加えてみた。

　We have tried 440 lumbar puncture, 950 P.E.G. and 221 P.V.G. in 1268 cases of brain surgical patients for these 14 years in Katsura Surgical Clinic, in Sendai, Japan. and we have had 16 dead experiences, 1 by cysternal puncture, 1 by lumbar puncture, 1 by P.E.G. (0.01%),13 by P.V.G. (6.2%).

　So we have reflected and investigated them from many points of view. The classification of the cases according to the causes is;

1. Bleeding death;1 by cysternal puncture. 2 by P.V. G.

2. Congenital hydrocephalus in infant ; 2 by P. V. G.

3. Cerebellar herniation : 1 by P.E.G.

4. Tumor of adjacent brain tissue herniated into incisura tentori ; by anbalance between supra-tentorial and subtentorial intracranial pressure, then, their symptom was at the point of death, ; 1 by lumbar puncture, 9 by P.V.G.

13 cases of all was brain tumor and 10 cases of them was not determined the locality before procedure.

9 cases of brain tumor which dead by P.V.G. except 2 bleeding death was adjacent tumor of incisura tentori and with blockade of aque-duct of sylvius.