器質化慢性硬膜下血腫に対して神経内視鏡下小開頭血腫除去術の１例

抄録

We here report a case of organized chronic subdural hematoma radically cured by small craniotomy with neuro­endoscope. A 75-year-old woman presented with right motor weakness and aphasia. Burr hole trepanation surgery was performed, but the hematoma was hardly removed, because of the hardness of the hematoma. Based on the first operation findings, the diagnosis was organized chronic subdural hematoma. We planned the craniotome surgery. However, the general anesthesia seemed to be risky because the patient suffered from cirrhosis of the liver and angina pectoris. That was why we used the rigid neuroendoscope under local anesthesia (1% lidocaine) with propofol and pentazocine providing sedation. Intraoperatively, two burr holes were made and connected. The final opening was approximately 4 cm in diameter. Her symptom was free after this surgery. No recurrence of hematoma was encountered after an operation for two years. This operative method is less invasive than wide-ranging craniotomy to evacuate the hematoma. In addition, advantages of the endoscopic approach include access to the entire hematoma cavity through a small craniotomy and electrical coagulation of active bleeding. Organized chronic subdural hematoma is generally treated by broad craniotomy under general anesthesia. Our case indicates that this method represents a feasible treatment option for elderly patients at high risk for general anesthesia who suffers from organized chronic subdural hematoma.