特発性脊髄硬膜外血腫の治療成績

抄録

  Objective : Spontaneous spinal epidural hematoma (SSEH) is still a rare entity, in spite of the recent advances in diagnostic radiology. We will summarize the treatment outcomes of our 9 cases of SSEH.

  Patients and methods : We retrospectively analyzed 9 cases (4 men and 5 women) of SSEH treated in our facility. The patients' age were ranged from 65 to 84 years (averaged 71.9±8.2 years). All patients were diagnosed by MRI and evaluation of their past medical history, neurological symptoms, radiographical findings (distribution of hematoma, rate of intra-spinal occupation), treatment procedure (surgical, conservative), clinical status, and outcome. We used the NCSS (Neurosurgical Cervical Spine Scale) for the estimation of neurological symptoms.

  Results : All patients were suffered from painful complaints (3 in the neck, 3 in the shoulder, 2 in the back and 1 headache) at the onset of SSEH. There were no patients with coagulopathy in their initial examination of blood coagulation. Six patients were demonstrated epidural hematoma in the cervical and 3 in the cervico-tholacic region. Surgical removal of the hematomas was performed in 6 (emergently in 5) and conservatively treated in 3 of the patients with rapid clearance of the hematoma. Patients treated conservatively had a tendency of long distribution of hematoma and low rate of intra-spinal occupation of hematoma, compared to others treated surgically. Finally, all patients experienced a significant recovery in their neurological deficits.

  Conclusion : Treatment outcomes of patients with SSEH were quite good. Surgical indication should be decided carefully with reference of the intra-spinal distribution and rate of occupation of the hematoma.