最重症急性硬膜下血腫に対し，初療室小開頭での血腫除去にて救命し得た１例

抄録

The outcome of patients with comatose acute sub­dural hematoma (ASDH) with bilateral pupil dila­tion is generally devastating. Here, we report a case of ASDH in which a small craniotomy was suc­cessfully performed at the emergency room. An eighty–six–years–old man was brought to our de­part­ment due to impaired consciousness after a fall. On hospital arrival, Glasgow Coma Scale (GCS) of the patient was 6 (E1V1M4) and bilateral pupils were fully dilated. The head computed tomography (CT) revealed a right acute subdural hematoma with brain herniation. The outcome of this patient was expected to be poor, but we performed a small craniotomy at the emergency room instead of burr–hole craniotomy in order to remove hematoma immediately. The majority of hematoma was suc­cess­fully removed, and the bleeding point was controlled. The time for the surgery was 40 minutes. Postoperative CT showed that the hematoma had been removed with mild brain swelling. The patient’s postoperative course was good, and his conscious level improved to GCS of 14 (E4V4M6). The patient was discharged from hospital on day 49.

Small craniotomy at the emergency room can be an effective life–saving procedure for life–threatening severe ASDH.