鉄鋼線が脳実質内へ完全に埋没した経眼窩的穿通性頭部外傷の1例

A Case of Transorbital Penetrating Brain Injury Caused by a Steel Wire Entirely Embedded in the Brain Parenchyma

Ⅰ．はじめに

　銃社会でない本邦では，欧米諸外国と比べて穿通性頭部外傷は比較的稀である．また，諸外国も含めた穿通性頭部外傷に関する文献のほとんどが症例報告であり，異物の性状，刺入経路などによって病態がそれぞれ異なるため，エビデンスに基づく統一された治療ガイドラインはなく，症例ごとの検討が必要である．今回，われわれは鉄鋼線の一部が経眼窩的に頭蓋内へ刺入し脳実質内へ完全に埋没した稀な穿通性頭部外傷を経験したため，文献的考察を踏まえて報告する．

　Penetrating brain injury（PBI）is very rare in Japan. Because there is a very wide variety of pathological condition of PBI, the guideline for the treatment of PBI has not been established yet. We report the unique case of PBI caused by a steel wire piece completely embedded in the brain parenchyma. A 75-year-old man was brought to the emergency department due to ocular injury caused by a steel wire piece. Neurological examination revealed only left visual disturbance. CT scan revealed a steel wire piece located intraparenchymally between the left frontal lobe and the ventricles, but digital subtraction angiography showed no significant vascular injury in the surrounding structures. We performed an open surgery and removed the steel wire piece. Because the steel wire piece was completely embedded in the brain, we used intraoperative X-ray fluoroscopy to choose a less invasive approach for the brain. The patient suffered no additional neurological deficit and no sign of cerebral infection or seizure after surgery. He was discharged after a 4-week administration of antibiotics.

　In most cases of PBI caused by low velocity injury, foreign bodies are not completely embedded in the brain except for remnants after surgical removal. This is the first report of low velocity PBI caused by a foreign body completely embedded in the brain.