開頭術・ドレナージ術

Treatment for Subdural Hematoma in Infants

Point

・乳幼児急性硬膜下血腫の治療においては，乳幼児特有の病態を理解する必要がある．

・成人症例とは異なった手術コンセプトと術後管理が求められる．

・手術における要点は，出血点の処置の対応，急激な脳腫脹の回避，骨片を安易に外さない，に集約される．

・術後の集中治療管理において最も大切な点は，大脳半球の広範に生じる二次性脳損傷と，その後の急速な脳萎縮をいかに防ぐかである．

　This chapter will discuss the treatment for infant subdural hematoma.

　In adult cases, treatment focused on intracranial pressure（ICP）management alone is generally sufficient, but in infant cases, special ingenuity is required.

　First, there are some points to keep in mind regarding surgical procedures. It is important to perform blood transfusion from an early stage, avoid exposure of bleeding points, and reduce ICP by floating the bone flap that preserves blood flow.

　Next, it is necessary to understand the pathophysiology peculiar to infants. Extensive lower density changes seen on head computed tomography can have a profound effect on clinical outcome. This phenomenon should not be considered as simple cerebral ischemia, but is representative of the brain damage caused by status epilepticus and hyper perfusion injury. Therefore, not only ICP management, but also treatment for status epilepticus is extremely important for postoperative management.

　Further, cases where abuse is the cause of subdural hematoma often display poor outcomes due to a variety of medico social factors.