特発性脊髄硬膜外血腫の4治験例

Four Cases of Spontaneous Spinal Epidural Hematoma

Ⅰ．はじめに

　特発性脊髄硬膜外血腫（spontaneous spinal epidural hematoma，SSEH）は稀な疾患で10万人あたりの発生率は年間0.1程度と推測されている⁸⁾．発症形式は特徴的で，突然の頸部・背部痛に続いて急速に運動・知覚麻痺を呈する^5,7)．現在までに約500例が報告されており，従来は早期の診断・血腫除去術がすすめられていたが^9,13)，最近では保存的治療によって良好な予後を得た報告が増加している^3,5)．われわれは最近，4例のSSEHを経験し，2例に手術，2例に保存的治療を行って良好な結果を得たので，診断と手術適応などについて若干の文献的考察を加えて報告する．

Spontaneous spinal epidural hematoma (SSEH) is a rare clinical entity. Although approximately 500 cases have been reported, controversy exists concerning timing of the treatment and the validity of decompression surgery. We recently encountered four cases of SSEH. Evacuation of the hematoma was carried out in two patients with severe or persistent neurological defi cits. Other two patients were treated conservatively because of the rapid resolution of the symptoms. All four patients improved after the treatment; three patients fully recovered and one patient required rehabilitation for moderate quadriparesis. Many previous reports recommended decompression surgery within 48 hours after the onset, however, one patient in our series fully recovered after surgery 4 days after the onset. We reviewed 183 operative cases of SSEH with incomplete neurological deficits in the literature and found that 93 ％ of the patients who underwent surgery more than 48 hours after symptom onset showed good neurological recovery. Conservative treatment should be undertaken for rapidly improving patients, but surgical intervention should be considered in symptomatic patients regardless of the time from the onset.