症例報告
内視鏡支援下小開頭血腫除去術がシャントチューブの温存に有効であった脳室腹腔短絡術後患者に発生した急性硬膜下血腫の１例
2020 年 43 巻 2 号 p. 80-83
詳細
2020 年 43 巻 2 号 p. 80-83
An 85–year–old woman who had suffered a fall in a care facility had sustained a head injury that resulted in a consciousness disorder. The patient was transported to our hospital by an ambulance. Ventricular abdominal shunting was performed for normal pressure hydrocephalus. Upon arrival at the hospital, the patient had Japan Coma Scale (JCS) and Glasgow Coma Scale (GCS) scores of 20 and 8, respectively. Computed tomography (CT) of the head showed a 22–mm–thick subdural hematoma and midline deviation on the side of the shunt tube. To preserve the shunt tube, we performed endoscopy–assisted craniotomy for the removal of a small hematoma. After surgery, intracranial pressure ⁄ cerebral perfusion pressure was monitored to prepare for increased intracranial pressure due to rebleeding and cerebral edema. No shunt tube ligation was performed, and the shunt valve pressure was set to the maximum value of 200 mmH2O; postoperative rebleeding and cerebral edema were not observed. The patient’s JCS score gradually improved from 20 to 2, and she was transferred to a rehabilitation hospital on the 38th day of hospitalization.
Endoscopy–assisted minicraniotomy for the removal of an acute subdural hematoma on the ipsilateral side of the ventriculoperitoneal shunt tube was performed in a small craniotomy area, and no shunt tube damage or infection was observed.
If bleeding can be reliably stopped under the endoscope, rebleeding can be prevented by changing the shunt valve set pressure to high pressure without shunt tube ligation.
