2010 年 23 巻 1 号 p. 23-26
Pulmonary embolism (PE) is a potentially fatal perioperative complication, and ultrasonographic diagnosis of venous thromboembolism (VTE) in the lower limbs is essential for hemiplegic patients undergoing craniotomy. Prophylactic management of PE includes the use of elastic stockings, intermittent pneumatic compression, and administration of heparin, which carries a potential risk of intracranial bleeding. It is well known that low-molecular-weight heparin (LMWH) carries a lower risk of bleeding and has higher bioavailability than heparin. We describe two patients in whom VTE was diagnosed before elective craniotomy. Case 1 was a 67-year-old woman with a ring-enhanced lesion in the right motor cortex. Lower limb venous ultrasound (LVUS) demonstrated a venous thrombus in her left leg. She was administered LMWH (dalteparin) perioperatively, and underwent open craniotomy without pulmonary accident. Case 2 was a 72-year-old man with idiopathic encephalitis. Although open brain biopsy was planned. LVUS revealed a thrombus in the left soleus vein. He was treated sequentially with heparin, LMWH (enoxaparin) and warfarin, and the thrombus changed to an organized clot 4 weeks later. These cases suggest that if no intracranial bleeding is evident by CT on the day after craniotomy, LMWH is effective for prevention of PE in the perioperative period.