脳室洗浄療法により治癒せしめた外傷後重症脳室炎の1例

A Case of Posttraumatic Severe Ventriculitis Treated by Intraventricular Lavage

I．はじめに

　重症脳室炎は予後不良の病態であるとされているが，持続脳室内灌流療法^8）（continuous intra-ventricular irrigation：以下C．I．V．I．）による救命例の報告が散見される^1,9,11）．われわれは重症脳室炎，髄膜炎に対しC．I．V．I．よりさらに積極的に脳室内を洗浄する脳室内洗浄療法（Intraventricular Lavage：以下I．L）を試み良好な結果を得た．本症例の臨床経過およびI．L．の利点について文献的考察を含め報告する．

A 44-year-old male was admitted in a state of semicoma, tonic convulsion and elevated body temperature nine days after sustaining head injury. He had severe nuchal rigidity. Computed tomography revealed dila-tion of ventricles and swelling of the brain parenchyma. We performed cerebrospinal fluid (CSF) drainage of both lateral ventricles immediately. The fluid drained from both ventricles was just like pus. We dia-gnosed the patient's condition as posttraumatic ventriculitis and meningitis.

We performed intraventricular lavage (IL) which was our ventricular irrigating technique. IL was repe-ated until the 7th day postoperatively. The CSF data improved immediately. Continuous spinal drainage (CSD) also was used for CSF drainage from the 7th day postoperatively. The patient recovered without the need for CSF shunt.

Some authors have reported the usefulness of continuous intraventricular irrigation (CIVI) for treatment of severe ventriculitis. However, their patients required CSF shunt surgeries. Such shunts are likely to be-come infected more frequently than routine shunting. Our IL was able to drain pus and inflammatory pro-ducts in the ventricles before the formation of septations in the ventricles. We emphasize that IL in com-bination with CSD is able to bring about good results for patients with severe ventriculitis.