2009 年 31 巻 2 号 p. 197-202
Objective: The Japan Neurotrauma Data Bank (JNTDB) 2004 newest data that registered from the selected hospitals which are distributed all over the country are analyzed from the viewpoint of operative treatment, and it aims at using for the present understanding and a future medical guideline.
Method: Object were brain injury cases who's GCS on admission were 8 or less on admission or within 48 hours after admission and operated cases. The comparative analysis of treatments (550 operated and 497 not-operated cases ) was made for 1047 cases excluding 52 CPA on admission and two undecided outcome cases from 1101 whole registration data.
Results: In analysis of 550 operated cases, burr hole was performed to 87 cases as the 1st-step operation, and craniotomy for hematoma removal was performed to 392 cases, and there were 37 external decompressions. When 119 operated cases of GCS 3 – 4 of the acute subdural hematoma are compared in terms of the 1st operation, outcome of the craniotomy group was better significantly. About external decompression, 187 cases were analyzed by the age group, and decline in favorable outcome and the upward tendency of mortality rate were accepted by the group aged over 61yr.
Conclusion: It is difficult to decide the indication and operative methods, such as a burr hole operation, craniotomy for hematoma removal, an external decompression, internal decompression, and CSF drainage simultaneously because of many factors. However, the usefulness of the craniotomy was shown as a whole as the 1st operation of an acute subdural hematoma except some cases.
