耳性側頭葉膿瘍の一治験例

OTOGENIC TEMPORAL LOBE ABSCESS, REPORT OF A CASE

　I．緒言

　われわれは，最近耳性側頭葉膿瘍で，中耳根治手術後，乳突洞天蓋部より穿刺排膿（総量約150ml）を繰返し施行するも一般状態改善せず，一時意識消失，片麻痺に陥つた症例に対し開頭手術を施行し，膿瘍被膜外全摘出を行ない救命し得た。手術結果よりみて本症例は膿瘍の被膜自体が巨大なspace occupying massとして存在したため，穿刺排膿のみでは一般状態を改善させ得なかつたものであると考えられた。本症例の経過より，また若干の文献的考察を行なつた結果，膿瘍による大きなspace occupying massがあり，かつそれが厚く被膜化したと考えられる場合には，穿刺排膿のみでは治療効果は不十分であり，開頭手術による膿瘍摘出を施行することが患者救命に対する良策であると考えられたので報告する。

　A male, aged 26, complained of severe headache, left ear discharge, change of his personality and disorientation to time and place. Radical mastoidectomy was performed under general anesthesia and the content of temporal lobe abscess was aspirated repeatedly via the tegmen antri. The quantity of pus from the abscess was about 150 ml. But the patient became deteriorated with coma and hemiparesis. And the removal of the abscess was carried out by craniotomy. The abscess was about 7.5×4.5×3.0cm in volume and 35 g in weight. The wall of abscess was markedly thickened but no pus was found within the cavity. Because the abscess was existed as a large space occupying mass in the intracranial space, the patient developed an increase in intracranial pressure. The patient recovered satisfactorily. The authors reviewed the literature and discussed the therapeutic methods for the otogenic cerebral abscess.