難治性慢性硬膜下血腫に対するOmmaya CSF Reservoirの留置治療

Use of Ommaya CSF Reservoir for Refractory Chronic Subdural Hematoma

I．はじめに

　慢性硬膜下血腫の術後再発には少なからず遭遇するが，再発症例のなかでも特に背景に基礎疾患として脳萎縮などがあり血腫腔の縮小に長期間を要すると考えられる症例や，全身的な疾患が存在する症例などは治療に難渋することが多い．われわれはこのような難治症例に対して，OmmayaCSF reservoirを用いて治療を行い，良好な結果を得たので報告する．

Ten patients with refractory chronic subdural hematoma were the subjects of this paper. All patientshad severe diseases influencing the clinical course of chronic subdural hematoma, such as cerebral infarc-tion, liver cirrhosis, thrombocytopenia, severe parkinsonism, severe heart disease, and spino-cerebellardegeneration. They were first treated in a usual manner; irrigation and drainage of the hematoma cavity.After recurrence of the hematoma, an Ommaya CSF reservoir was put into place and whenever thevolume of the hematoma increased the reservoir was punctured.

Postoperatively, 7 patients returned to the same conditions as they had before the onset. However, onepatient (lied of myocardial infarction and 2 patients with parkinsonism could not maintain the conditionthey had before the onset of their disease, resulting in their partially dependent state. Complications wereminor bleeding in one patient and an occlusion of the reservoir in another patient.

By using this method reoperation was unnecessary, and the patients were able to move early in the post-operative period. This method was suitable for refractory chronic subdural hematoma with severe diseaseinfluencing its clinical course.