硬膜外血腫の手術

抄録

Epidural hematoma (EDH) is most often caused by trauma. EDH occurs most frequently in young people following high-speed accidents. CT scanning is the diagnostic method of choice.

Craniotomy provides the most definitive form of surgical treatment of EDH. Recent guidelines have recommended evacuation of EDH for lesions greater than 30 ml in volume, and that any patient with an EDH and coma (GCS < 9) or anisocoria undergo evacuation as emergently as possible.

Craniotomy for evacuation of EDH mandates identification and elimination of the source of bleeding, via cauterization of vessels, waxing of bone sources. Dural sinus lacerations must sometimes be repaired, plugged, or tamponaded. Epidural tack-up sutures are placed in the perimeter and the center of the craniotomy, to prevent subsequent reaccumulation of blood in the epidural space. Bone flaps may usually be replaced due to frequent absence of underlying lesions and edema. Fractures may need to be repaired.

Mortality in the surgical subset of EDH patients has been reported around 5%. Functional outcome and mortality are affected by the following clinical findings: age, neurological status, time to evacuation, intracranial pressure elevations, and medical complications. CT findings affecting outcome from EDH include: hematoma volume, degree of midline shift, compressing of isterns, associated intracranial lesions, signs of active bleeding (heterogeneous density), presence of a skull fractures across a meningial artery, vein, or dural sunus.