硬膜下血腫の治療法

TREATMENT OF SUBDURAL HEMATOMA

I．いとぐち

　頭部外傷の主死因を占める脳損傷と頭蓋内血腫は，近年いちじるしく注目を集めつつあるが，ここでは頭蓋内血腫のうち，硬膜下血腫の問題，特に，治療を中心に検討を加えてみたいと考える。

　硬膜下血腫は，由来，隠微の間に発生して，徐々に発症をきたす，いわゆる慢性硬膜下血腫と，外傷機転の明らかな急性あるいは亜急性硬膜下血腫とがある。ここでは，両者の病因その他の問題には触れず，その治療面についてのみ，われわれの知見を中心として検討をすすめてゆきたい。

In the treatment of subdural hematoma there are two methods. One is by means of a large craniotomy with removal of the capsule and contents of the hematoma and the other is by means of small trepanations with irrigation of the contents of the hematoma. The merits and demerits of these methods have been argued by many neurosurgeons.

Recently we treated twenty-two cases of acute, subacute and chronic subdural hemato-ma by means of two tiny trepanations to remove contents of the hematoma by irriga-tion. Results have been good on all cases, though recurrence was seen in two cases, which was considered to be due to insuffi-cient irrigation and they were cured by re-irrigation.

It is concluded that in the treatment of subdural hematoma the irrigation method should by resorted to first because of its small operative risk, though there may remain some cases that require large craniotomy method. Recurrence is prevented only by complete removal of the contents. Further investigation is being pursued as to the fate of the rem-nant capsule.