頭部外傷患者の經驗，頭蓋穹窿部の陷沒骨折に就いて

　緒言

　著者は嘗て耳鼻咽喉科第10卷第1号（昭和12年）に於て急性乳嘴突起炎を併発せる頭蓋骨折症例に就いて記載し，特に頭蓋底骨折と聽器疾患とに関して論述した．当時附図として患者及び骨折線を示すレ線豫をも掲載した．而もその第1図は右側側頭部の外傷による陷沒を示すものであつた．著者は当時この陷沒骨折に関しては何等の理解も持たず，從つて本文に於てもこの頭蓋陷沒部に就いては特に言及しなかつた．

　然るに近年全く偶然の機会からかゝる頭蓋穹窿に於ける陷沒が時に如何なる意味の持ち得るかに関し聊か教えられる所があつたので，此処にその症例を記載し前記論文に追加し併せて將來の參考にしたい．

Tsuiki says in reference to the optimum time and the method of choice of the regimen for treatment of skull fractures, particularly the depressed type and located in and about the tuberrosities, is an open question. The author complains that even text-books on general sur-gery fail to give a clear account of the subject. For this reason various observations made on a patient the recipient of lesion of this nature are recorded and presented here. A man aged 39 recieved traumatic injury of the head which caused a depressed fracture of the skull on the left side. About one year after the injury symptoms of paresthesia, which gradually in-creased in degree, developed in both extremities of the opposite side of the, injury. These sym.- ptoms were much relieved when bone from the depressed area was removed but did not esta-blish a complete cure. Obviously then, removal of the affected bone alone at this late stage was not enough to cause relief to the state of cerebral edema or consequent increasing cere-bral pressure. Question arises in this case in regards to time element of the treatment in that whether it had been instituted when still in the effective period of the treatment. Onset of paresthesia which is the result of progres-sive cerebral pressure should be regarded as a condition as that of approaching the final stage of chronic affects of cerebral trauma and it might be adequately considered that the object of treatment of cerebal trauma should be point-ed primarily to obviate just such a state of chronicity.

Lessons gained from the present case may be summarized into following points:

That in cases of skull fractures that are de-pressed in type and in region of tuberosities the patient, though presenting no signs of cerebral lesions at the time, should be placed under observation for a sufficient length of time.

That proper surgicrl treatment should be instituted immediately when there are signs of increasing cerebral pressure by resection of the depressed area or other measures in the cranium with whicn to bring relief of pressure off cerebral tissues.