外傷性硬膜下水腫手術症例の検討

Surgical Outcome of 32 Cases in Traumatic Subdural Hygroma

　32例の成人外傷性硬膜下水腫traumatic subdural hygroma（以下，TSH）手術症例を対象とした。平均年齢は69歳。性別は大多数が男性で，水腫発生側は両側性に多く，部位は前頭部を中心とした大脳穹隆部であった。初回手術は穿頭術，水腫除去あるいは洗浄を行い，3例に再貯留を認め，約1カ月後に硬膜下腔腹腔短絡術を施行した。

　TSH術後の神経症状の改善が，32例中22例（69％）に認められた。手術改善例は受傷から手術までの期間が短く，術前の意識障害が軽度のものに多かった。TSH手術は水腫以外の他の脳損傷の程度を充分に考慮し，比較的受傷早期に行うべきと思われた。

　しかし，TSH術後にCT上7例（22％）の脳室拡大と5例（16％）の慢性硬膜下血腫を認め，そのうち5例に脳室腹腔短絡術，3例に血腫洗浄術を施行した。TSH術後にはCTなどによる注意深い経過観察も必要と考えられた。

32 cases of traumatic subdural hygroma (TSH) in adults with surgical treatment were retrospectively investigated by means by clinical features and CT findings. The cases consisted of 29 males and 3 females, aged 41 to 87 years (mean 69). Preperative CT scan of all cases revealed low density area and crescent shape in frontotemporal or frontoparietal subdural space. Half of the cases had bilateral lesions. At operation of TSH, color of subdural fluid collections was more water clear or xantho-chromic than bloody.

As a results, 22 out of 32 cases (69%) in TSH improved with surgical treatment. Many of effective cases of surgical treatment in TSH had short inter-val from trauma to operation and light disturbance of consciousness before operation. However, the other intracranial damage will also affect the clini-cal outcome of TSH, because the majority of cases in this study was accompanied by an intracranial damage including cerebral contusion, subarachnoid hemorrhage or intracranial hemorrhage.

Nevertheless, surgical management for TSH was so effective that the operation should be undergone sooner interval from trauma, simultaneously con-sidering the another intracranial lesions except TSH.

But then, we experienced 7 cases (22%) of ventricular dilatation and 5 cases (16%) of chronic subdural hematoma in postoperative follow up CT scans. In 5 cases among the former, ventriculope-ritonial shunt was done, and in 3 cases among the latter, burr hole evaculation was performed.

Therefore, the postoperative course of TSH should require carefull observation by CT scan and so on.