脳手術後における中枢性過高熱の臨床的観察

CLINICAL OBSERVATION OF THE CENTRAL HYPERTHERMIA AFTER BRAIN SURGERY

緒言

　脳外科医によつて脳手術後の過高熱こそ最も警戒すべき，又恐しい症状であり，その原因や対策に関しては，古くから種々検討されて来て居る。然しそれらの研究にも拘らず，その原因さえも未だ明らかでなく，又種々な対策が行われて居るにも拘らず，無効に終る例が数多く見られる。兎に角，体温調節中枢は，脳幹部にある事に間違い無いようであるが，その詳細な位置に関しては，先人はその動物実験から，或る人は線状体^{4）5）6）14）35）}，視床下部^{7）12）13）16）23）29）31）}，灰白隆起^17），第三脳室壁灰白質等と云い，或は温冷二中枢が別個に存在すると主張し^{8）18）24）25）26）28）30）37）38）}，又自律神経系の緊張状態が関与すると云う人^2）42），大脳皮質も関与して居るのだと云う人^36）もあり，全く異論のある所である。一方臨床的報告では，Kornblum　等^11）19）は頸髄の損傷でも過高熱を来す事があると報告し，Davison^10），Alpers^1），中田^32）33），荒木^3），山口^49）等はその臨床例から第三脳室周辺部の損傷が過高熱の発生を来すものと主張し，Bea-ton^9）はpreoptic regionの破壊が過高熱の原因になると報告して居る。

The hyperthermia observed in 164 cases after excision of brain tumors at this clinic in recent days was studied from many an-gles, to seek for possible countermeasures, and some new informations were obtained, as reported herein.

1) The cases of postoperative hyperther-mia were classified into 8 types and the eti-o1ogy and the countermeasures were discu-ssed per type.

2) The sites of brain tumors prone to fre-quent causation of hyperthermia upon exci-sion were the trunk part of the cerebrum, the vicinity of the third and the fourth ven-tricles, and the superficial parts of the cere-brum, the extracortical parts being the least prone thereto. Diffuse tumors caused hyper-thermia more frequently than circumscribed ones, and the larger the tumor, the danger of postoperative hyperthermia was also thelarger.

3) Subtotal excision was more frequently followed by hyperthermia than total excision and hyperthermia was frequent after opera-tions. involving copious hemorrhage. The tu-mors in the cerebral trunk, however, were always prone to involve hyperthermia, regard-less of their nature, type, size or any cir-cumstances connected with the operation.