脳膿瘍に関する研究—〔1〕臨床分類と治療を中心に

A CLINICAL SURVERY OF ABSCESS OF THE BRAIN: (1) SPECIAL REFERENCE TO ANGIOGRAPHIC CLASSIFICATION AND TREATMENT OF ABSCESS OF THE BRAIN

Ｉ．緒言

　脳膿瘍の治療に際して最も重要であるのは，その形成過程を適確に把握することである。脳膿瘍の形成過程を臨床的に知る手段として種々なものが挙げられているが，それぞれ一長一短があり，必ずしも満足すべき知見が得られていないといってよい。臨床的に膿瘍形成過程を最も良く表現するものの一つに脳血管写がある。しかしながら従来，脳膿瘍に特徴的といわれる，言わゆる"halo"に遭遇する機会は比較的少く，26％にも満たない。さらに，この"halo"形成を認める時期は比較的晩期である点からしても早期に脳膿瘍を把えるには役立たない恨みがある。われわれは当教室で経験した脳膿瘍23例について脳血管写所見，臨床症状，臨床検査成績，臨床病理所見に詳細な検計を加え，脳血管写とこれらの間に密接な相関関係があり，stage 1；　acute stage, stage2；　subacute stage, stage3；　chronic stage，の3つのstageに分類することが可能であり，この三期に分類することは最も適切な治療法の選択に極めて有意義であるとの知見を得たので少しく考擦を加えてみたい。

After antibiotic therapy has been developed, abscess of the brain seems to be under control, although mortality and morbidity of brain abscess are still high without adequate early diagnosis and treatment.

With regard to early diagnosis and treatment, several methods have been established, and it has been clarified that, the most powerful diagnostic aid is angiography, brain scan and EEG, however, brain scan and EEG could not manifest develop-mental process of the capsule of brain abscess.

In this paper, we intended to elicit the angio-graphical developmental process of the capsule of brain abscess and to establish adequate treatment according to angiographic classification of brain abscess.

In our series of 23 cases, clinical studies includ-ing angiography, clinical symptoms and patho-hystology of operative material and necropsy material are surveyed.

With regards to angiographic and pathohysto-logical classification, abscess of the brain is divided into 3 stages. The classification are as follows :

stage 1; acute stage

stage 2 ; subacute stage

stage 3 ; chronic stage

Each 3 stage has specific angiographic findings, therefore repeated angiographical study shows talkatively a clinical pathohystological process of brain abscess, and peri-capsular inflammatory process.

The treatment of abscess of the brain are still in debate. Our program of treatment of brain abscess are as follows. As to the diagnostic pro-cedure, repeated angiography is supreme and angio-graphical classification should be carried out.

In case with stage 1 of angiographical classi-fication; conservative treatments including adequatesystemic antibiotics and intravenous administration of gamma globulin, occasional use of steroid hormon and anti-hypertensive drugs such as mannitol and intrathecal administration of antibiotics.

In case of stage 2, under systemic administra-tion of antibiotics and intravenous gamma globulin, burr hole is opened and multiaspiration should be carried out and antibiotics and radio-opaque material are given into abscess cavity, and total extra-capsular extirpation of abscess should be performed in angiographical classification of stage 3.