蝶形骨洞真菌症手術を契機として発見された後頭蓋窩鍼灸針遺残例

抄録

Acupuncture is widely used for the treatment of stiff shoulders and back pain, but complications can occur if the needles break off and remain in the body. A 77-year-old woman was referred to our hospital for sphenoid sinus mycosis. CT revealed a needle-like artifact in the posterior cranial fossa, in addition to the findings of right sphenoid sinus mycosis. We thoroughly reviewed her medical history and found out that she had undergone acupuncture treatment 33 years earlier for neck pain. During the treatment, a needle had got stuck and she had consulted a neurosurgeon. At the time, imaging had revealed the tip of the needle in the posterior cranial fossa. Surgical removal was performed under general anesthesia; however, the entire needle could not be removed in one piece and the patient was kept under observation. At the present admission, endonasal endoscopic sinus surgery was performed under general anesthesia. We used a video laryngoscope for safer intubation and avoidance of excessive neck extension. The sphenoid sinus was sufficiently opened and the fungal mass removed. The postoperative course was favorable and the histopathological findings revealed the lesion as an aspergillus fungus ball. Fortunately, the acupuncture needle had not damaged any blood vessels, nerves or the brain. The needle had apparently not caused any infection or allergy, and the patient remained asymptomatic for over 30 years. If the patient had not remembered the presence of the broken needle in her head due to cognitive impairment, etc., she could well have undergone MRI, etc., and suffered a fatal outcome. Confirming the detailed medical history and preoperative imaging findings, as well as sharing of information with the family and medical institutions is important for safe medicine.