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  • ―被殼部出血―
    小松 伸郎, 小暮 哲夫, 小川 彰, 佐藤 智彦, 桜井 芳明, 鈴木 二郎
    医療
    1983年 37 巻 1 号 83-86
    発行日: 1983/01/20
    公開日: 2011/10/19
    ジャーナル フリー
    脳卒中の外科研究会で提唱された被殻部出血のNeurological Grade及びCT分類による保存的治療成績の検討が, いまだ, 十分に行われていないことから, 今回は著者らの経験した症例を対象にその検討を行つた. その結果, 生命予後に関する保存的療法の適応の限界は, Neurological Grade 2, CT分類IIIa付近までと考えられた. なお, この結果を参考に外科的治療の適応についても検討し考察した.
  • 眞下 俊一
    日本循環器病學
    1936年 1 巻 10 号 442-444
    発行日: 1936/01/01
    公開日: 2019/02/05
    ジャーナル フリー
  • 神野 哲夫, 佐野 公俊, 柴田 太一郎, 片田 和広, 藤本 和男, 戸田 孝
    脳卒中の外科研究会講演集
    1978年 7 巻 58-63
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    The mortality of the hypertensive intracerebral ganglionic hematoma is still high. One of its reasons is that the treatment of very serious cases is difficult by either conservative therapy or surgical therapy.
    The purpose of this paper is to seek the possibility to save this very serious case. The results are following;
    1) In the past three years since CT was available, 100 cases of intracerebral ganglionic hematoma were treated surgically. Among these cases, 22 serious cases of which CT showed a large volume of hematoma even in the ventricles were involved.
    2) In these serious cases, the hematoma completed its spread within three hours after the attack which was verified with CT examination.
    3) At the same time when the hematoma spread during CT examination, most of the serious cases developed the severe vomiting and high blood pressure usually more than 200 mmHg.
    4) The serious cases devided into two sub-groups according to the way of hematoma spreading. The first group should be called“thalamic sparing group”of which the original bleeding point was located in putamen. The second group should be called“thalamic non-sparing group”of which the original bleeding point was located in thalamus. The thalamic sparing group did not spread into thalamus even if a large volume of hematoma was noted in all ventricles. Therefore, so-called“combined type”corresponded to the spreading type of the thalamic hemorrhage, whereas the putaminal hemorrhage did never become the combined type.
    5) We applied the following surgical method to treat these serious cases.
    (1) insertion the thick catheters into the bilateral posterior horns to wash out the clots in the ventricles.
    (2) remove the main hematoma by the transsylvian fissure approach.
    (3) remove the clots in the fourth ventricle, if necessary.However, by this surgery, only 3 cases in the thalamic sparing group and 2 cases in the thalamic non-sparing group were saved.
    6) To improve the operative results, the hematoma removal within three hours after the attack may be recommended, and also to decrease the number of the serious cases, the hypotension therapy and anti-emetic therapy just at the attack may be useful.
  • -脳室洗浄, 両側持続脳室ドレナージの効果-
    佐藤 進, 古沢 善文, 村上 直人, 今村 均, 山田 修久, 谷村 憲一
    脳卒中の外科研究会講演集
    1977年 6 巻 59-64
    発行日: 1977/10/20
    公開日: 2012/10/29
    ジャーナル フリー
    Hemorrhages from the thalamus and caudate nucleus are associated not infrequently with severe symptoms apparently in disproportion to a relatively slight damage to the brain substance. This is because rupture of a resultant hematoma into the ventricle, in spite of its producing an effect of mass evacuation, causes the ventricles to be filled in with blood, leading to circulatory disturbances of the cerebrospinal fluid. In such an instance, it is recommendable to perform ventricular irrigation first so as to remove bloody CSF and blood clots from the ventricles soonest possible and then proceed with bilateral ventricular drainage which is aimed at relieving an acute increase in intracranial pressure. Where blood clots are just too much to be cleared off by means of irrigation it is advisable to open the ventricles by transcallosal approach upon craniotomy and then perform continuous drainage after the elimination of blood clots by irrigation. This ventricular irrigation permits to forestall obstruction to the drain by clots and deleterious effects of the long persistence of blood in CSF and thus proves to be more beneficial when combined with drainage than when drainage alone is performed.
    Emphasis is placed on the fact that the above mentioned procedure can bring about marked clinical improvement in interacerebral hemorrhage of medial type even where there are symptoms severe enough to make physician hesitate to conduct treatment with forward posture attitude.
  • 久保 道也, 桑山 直也, 岡本 宗司, 堀 恵美子, 柴田 孝, 梅村 公子, 堀江 幸男, 田中 耕太郎, 黒田 敏
    脳循環代謝(日本脳循環代謝学会機関誌)
    2016年 27 巻 2 号 281-286
    発行日: 2016年
    公開日: 2016/07/29
    ジャーナル フリー

    富山県では

    脳出血
    死亡率が最近10 年間に男女とも漸増傾向にある.こうした背景を踏まえて,最近6 年3カ月間に当院脳卒中センターに入院した急性期
    脳出血
    患者(連続892 例)について,抗血栓療法の有無に分けてその関連因子と転帰を中心に検討した.抗血栓療法中の
    脳出血
    発症患者が全体の22.2%を占めており,抗血栓療法患者の方が非抗血栓療法患者に比べて有意に血腫増大傾向が高く(18.7% vs 3.2%: p<0.01),また抗血栓療法中患者の転帰の方が不良であった.抗血栓療法中患者の血腫増大を部位別に見ると,被殻出血が圧倒的に多く53.7%に達した.さらに,無症候性脳梗塞や慢性虚血性変化に対する安易な抗血栓療法や心房細動患者への抗血小板剤投与例が散見された.抗血栓療法患者の
    脳出血
    予防のためには,厳重な血圧管理・安易な抗血小板剤投与の回避・心原性脳塞栓症予防のための適切な薬剤選択の3 点に焦点をおいての,かかりつけ医との連携が必須と考えられた.

  • -脳室穿破例の検討-
    曽我部 紘一郎, 行天 徹矢, 増田 勉, 本藤 秀樹, 松本 圭蔵
    脳卒中
    1982年 4 巻 2 号 85-93
    発行日: 1982/06/25
    公開日: 2009/09/03
    ジャーナル フリー
    従来より高血圧性脳内出血で血腫の脳室内穿破をみる例は一般的に予後不良であると考えられがちであった.しかし, なかにはこの考えと矛盾する非常に良好な経過をとる脳室穿破例のあることも経験される.そこで我々は脳室内穿破例でその予後を左右する因子につき, 主としてCT所見を中心として, 自験例をもとに検討した.対象はCTの精度の向上した最近3年間 (昭和53年1月~55年12月) に経験したテント上出血219例中脳室内に血腫の穿破をみた104例 (47%) である.これらについて検討したところでは, 血腫が脳室内穿破をし, 第III, 第IV脳室内に及ぶものでも, それが直接的に予後不良となる原因とはならないようであった.むしろCT上予後不良を示唆する因子は, 1) 血腫径が3×3cm以上の場合, 2) 急性脳室拡大, 迂廻槽の消失, 血腫の視床下部進展などが重複してみられた場合, 3) 第III, 第IV脳室内に鋳型血腫がみられた場合, と考えられた.もし, これらの所見がみられない場合は, たとえ脳室内に血腫の一部の流入をみてもそれが予後を直接左右する因子とはならないわけで, したがって, 脳室内の血腫をみることのみでは血腫除去を目的とした脳室ドレナージの適応とはならないと思われた.むしろ脳圧亢進なく, その他一般的臨床症状もよければ, 脳室内に血腫があっても経時的CTにより厳重な観察を行いつつ手術侵襲を避けるべきであろうとの結論をみた.
    高血圧性
    脳出血
    による脳室内穿破例の予後について検討を加え以下の結論を得た.
  • 手術群と非手術群との比較
    安藤 隆, 篠田 淳, 平田 俊文, 坂井 昇, 山田 弘
    脳卒中
    1989年 11 巻 1 号 60-67
    発行日: 1989/02/25
    公開日: 2009/07/23
    ジャーナル フリー
    高血圧性被殻出血 (222例) を手術群 (146例), 非手術群 (76例) に分け生命予後および機能予後について比較検討した.1) 神経学的分類によるgrade I は原則として保存療法でよく, grade Vは両群とも予後不良で手術適応外である. grade IVは生命予後の面から手術群が良好であった.2) 毛様体脊髄反射消失などの眼症状を認めても, 手術により十分救命しうる可能性がある.3) CT上血腫径4cm, 第III脳室偏位6mm, 上下への進展4cm以上のものは予後不良であった.又, 脳室穿破はあきらかに生命予後を不良にする.4) 非優位側血腫例は優位側に比し機能予後は良好であるが, 生命予後には差を認めなかった.5) 手術時期については必ずしも早期程良好とはいえない.しかしながら, 待機中の増悪例を救命するには超早期手術が必要である.6) 機能予後については, 筋力高度障害例では両群とも回復困難例が多いが, やや手術群で良好である.しかし中等度~軽度障害例では両群間に差がみられなかった.
  • 湯川 英機, 佐藤 紀嗣, 山口 一彦, 金谷 春之
    脳卒中の外科研究会講演集
    1977年 6 巻 13-16
    発行日: 1977/10/20
    公開日: 2012/10/29
    ジャーナル フリー
    The level of consciousness in a patient with mild hypertensive intracerebral hemorrhage is usually alert or somnolent. In such a patient, surgical treatment is still a matter of discussion. By reviewing retrospectively 113 patients with hypertensive intracerebral hemorrhage treated surgically in the Department of Neurosurgery at Iwate Medical University Hospital, we studied the proper treatment for mild cases of the disease.
    Our conclusion is that, as a rule, mild cases should be treated conservatively. However, in the following cases, the surgical treatment should be indicated;
    1. Patients showing progressive neurological deficits within 24 hours following the ictus.
    2. Patients becoming somnolent from clear consciosness within 3 hours following the ictus.
    3. Patients showing mass signs in angiograms or CT-scans.
  • ―高血圧性外側型脳出血166例の検討―
    保坂 泰昭, 金子 満雄, 村木 正明, 岩本 邦憲
    Neurologia medico-chirurgica
    1980年 20 巻 9 号 907-913
    発行日: 1980年
    公開日: 2006/11/10
    ジャーナル フリー
    In 1967 we proposed, in cases of hypertensive intracerebral hemorrhage, that operative treatment be carried out in the per-acute stage or surgery within 7 hours after ictus, and stressed the importance of the time factor. Now, after sufficient time has elapsed for observation, we would like to reevaluate the result of surgery in the peracute stage as compared to other operative series in the later stage and to non-operative series.
    During the past 7 years, 300 cases of hypertensive intracerebral hemorrhage, including 166 cases of the lateral type or putaminal hemorrhage, have been admitted. Operation in the per-acute stage was carried out in 84 cases presenting definite surgical indications. Delayed operations were performed in 36 cases. Operation was not indicated for the remaining 46 cases as some were too severe and the others too mild. A comparison was made of several items, such as neurological grading on admission and condition at discharge using ADL classification of functional recovery.
    As a result, the per-acute operation series was observed to have much better functional recovery as compared to the other series: 82% of all per-acute operation cases were discharged with ADL grade 3 or better, or they could at least walk with a cane. In the lateral type of hypertensive intracerebral hemorrhage series, 66% of the cases were discharged with ADL grade 3 or better. A more marked difference in the outcome was noted in the group of severe cases in which there was a state of semicoma or worse at admission: more than 60% in the per-acute operation series were discharged with ADL grade 3 or better, whereas only 30% in the delayed operation group could be discharged with ADL grade 3 or better.
    Eight patients in the per-acute operation series died: two with myocardial infarction, two with reaccumulation of hematoma, one of G. I. bleeding, and three of fulminant progression immediately before surgery.
    To conclude, this study reconfirmed that operation in the per-acute stage is advantageous in cases of the lateral type of hypertensive intracerebral hemorrhage.
  • 乙供 通則, 鈴木 重晴, 岩淵 隆
    脳卒中の外科研究会講演集
    1977年 6 巻 33-38
    発行日: 1977/10/20
    公開日: 2012/10/29
    ジャーナル フリー
    Indication for neurosurgical treament in the early stage of moderate cases of hypertensive intracerebral hemorrhage seems to be widely accepted. However, in delayed cases with negligible disturbance of consciousness and hemiparesis and/or mild deficit palliative treatment is still common. This paper reports our experience with final results of surgery performed on 14 cases of this kind, in which 15 or more days elapsed since the stroke and symptoms were stationary.
    Postoperative neurological improvement was closely followed in all 5 cases with slight disturbance of consciousness, in the 3 cases with choked disc, and in 2 cases with oculomotor palsy. There was improvement in 7 of 8 cases with aphasia, in 10 of 14 cases with hemiparesis and in 2 of 5 cases with paresthesia. There was no improvement in 3 cases with defect of visual field. There were no deaths due to the operation in these delayed mild cases. We feel that the intracranial operation in these delayed (more than 15 days for all patients) cases of hypertensive intracerebral hemorrhage motivated alleviation of the stationary symptoms, and that it was worthwhile for that reason.
  • 白方 誠弥, 藤田 稠清, 玉木 紀彦, 藤田 勝三, 松本 悟, 千原 卓也, 野村 史郎, 新丸 精二
    脳卒中の外科研究会講演集
    1978年 7 巻 184-190
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    Timing of Surgery for the hypertensive intracerebral hematoma should be considered as soon as possible after onset. Especially in severe cases in which the conscious level is stupor, semicoma, and coma, an emergency operation should be undertaken.
    However, in mild cases in which the conscious level is alert or somnolent and survival is expected, surgical treatment is indicated for functional recovery. We have analized the surgical results in 33 mild cases of the lateral type of intracerebral hematoma. Surgery was undertaken 8-21 days after onset in 51%, and 22 days-5 months later in 24%. The functional recovery of extremities was satisfactory and considered to be effective in spite of the delayed operation.
    Intracerebral hematoma of the subacute or chronic stage appeared to be almost liquefied. Aspiration of the liquefied hematoma was tried by needle insertion into the hematoma cavity, and good recovery from hemiparesis was obtained.
  • 大野 喜久郎, 鈴木 龍太, 門間 誠仁, 松島 善治, 稲葉 穰
    脳卒中
    1988年 10 巻 2 号 118-123
    発行日: 1988/04/25
    公開日: 2009/09/03
    ジャーナル フリー
    高血圧性
    脳出血
    症例の血腫完成までの時間や血腫の増大あるいは止血の過程に関してはあまり知られておらず, 発症後数時間以内の急性期症例における小血腫がどのような運命を辿るかなどをその時点で判定することは難しい.われわれは, 自験220症例に基づき血腫完成時期を検討し, また統計学的に考察した.年間発症率は人口10万対42であり, 月別発症率では春と晩秋に多かった.脳梗塞や
    脳出血の既往をもつ人はそうでない人に比べ脳出血
    発生のリスクが高いと考えられた.血腫増大の有無を経時的に検索した74例では, 不変63例, 軽度増大7例, 著明な増大は4例のみであり, 後者の11増大例中9例は発症後1時間以内に検索し得た症例で, 他の2例も2時間以内の症例であった.また26劇症型重症例中19例では1時間以内に検索され, 巨大な血腫が見られた.この結果から, 血腫完成は2時間以内, 大多数では1時間以内に起こると推定された.
  • 佐野 公俊, 神野 哲夫, 柴田 太一郎, 片田 和広, 石山 憲雄, 藤沢 和久, 永田 淳二
    脳卒中の外科研究会講演集
    1978年 7 巻 144-149
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    The purpose of this report is to clarify the timing of surgery for removal of intracerebral hematoma.
    Sixty-four cases of putaminal hemorrhage were made an object of this study. But a case of postoperative reaccumulation of ICH, a woman of 87 years of age, and a case of a physically handicapped were excluded. Investigation was performed from both clinical and theoretical sides.
    According to the print out data of CT findings, hematoma is changeable within 3 hours, then becomes stable between 3 and 6 hours. Perifocal edema appears after 6 hours and becomes the maximum between 3 days and a week. Therefore, the timing of surgery is theoretically within 3 hours which means before enlargement of the hematoma, within 6 hours which means before the appearance of the perifocal edema, and within 3 days which means before the maximum of the edema.
    Clinically the limit of the timing of surgery is different depending on the size of the hematoma. Considering about conscious level, when the patient is in somnolence, surgery should be done within 2 days. If the patient in stupor, surgery should be performed within 11 hours. If the patient is in semicoma, surgery should be performed within 6 hours.
    Considering the size of the hematoma by CT (see later report No.40: CT grading of lateral type of ICH). Surgery should be performed within 2 days in the case of grade III. The timing of surgery is within 6 hours in the case of grade IV. In the case of grade V, it is difficult to save life, but hematoma can increase from grade III to grade V within 3 hours, so that the only way to save the patient of grade V is to prevent increasing the hematoma within 3 hours.
    Comparing between theoretical and clinical and clinical data, the timing of the surgery is within 3 hours for grade V, which means before enlargement of the hematoma, within 6 hours for grade IV or semicoma and stupor, which means before appearance of the perifocal edema, and within 2 days for grade III or somnolence, which means before the maximum of edema.
  • -発症3時間以内血腫摘出について-
    樋口 紘, 新妻 博, 関 博文, 園部 真, 小川 彰, 石崎 敬
    脳卒中の外科研究会講演集
    1978年 7 巻 113-119
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    Sixty cases of hypertensive putaminal hemorrhage were operated on in our clinic over a period from January, 1974 to December, 1977. Thirteen cases fell into comatose state within 3 hours after the adoplectic attack. These operated fulminant cases were studied.
    Five cases discharged on foot without any support. Two cases became vegetative state, and six cases were died. The patients fell into comatose state in 140 minutes in survival cases and in 93 minutes in fatal cases, on an average respectively. Carotid angiography was performed in 12 cases. Extravasation of the contrast media from the lenticulo-striate artery was seen in 9 cases. Blood pressure on admission was 230/126 mmHg in the cases with extravasation and 183/110mmHg in the cases without extravasation, on an average respectively. Blood pressure must be controlled for the prevention of extravasation.
    Six fatal cases were autopsied. The cause of the death was trans-tentorial or tonsillar herniation. The hematoma penetrated to lateral ventricle in all the 6 cases. The fourth ventricle was filled with the hematoma in 3 cases. Thalamus was destroyed in 4 cases. The hematoma extended as far as the frontal subcortex in one case.
    The light reflex was remained just before the operation in 5 recovered cases. In one case out of them, the light reflex had disappeared on admission and re-appeared by Mannitol rain-drops. On the other hand, the light reflex had disappeared in vegetative and fatal cases.
    In survival cases, continuous ventricular drainage was performed in 3 cases, and V-P shunt was performed,in 2 cases. External decompression craniotomy was not necessary.
    The life saving of the patients was possible by surgical treatment in peracute stage or within 3 hours after the apoplectic attack even in the cases of fulminant putaminal hemorrhage. For that purpose, establishment of emergency system must be achieved as soon as possible.
  • 三神 柏, 田仲 基宏, 泉 周雄
    医療
    1977年 31 巻 3 号 212-217
    発行日: 1977/03/20
    公開日: 2011/10/19
    ジャーナル フリー
    13例の高血圧性脳内出血患者に血腫除去と減圧術を行つたが, 8例61%の救命率が得られた. 出血部位, 手術時期, 年令と術後経過を検討する.
    1. 皮質下出血, 外包被殻出血は血腫除去の対象となり, 良い成績が得られた. 視床脳室内出血は脳内水腫に発展するためドレナージを試みたものもあつたが救命率が低く, 社会復帰した例は得られていない.
    2. 手術時期は出血後4-6時間以内が良く, 回復も十分なものがあつた. 8病日以降の安定期の手術は術後死亡率は明らかに減少するが, 欠落症状の回復の点では, 保存的治療によるものと差が少なくなる.
    3. 年令的には60才をこえると併発症も増加するため良い状態に回復する率は低下する.
    4. 以上のことから皮質下出血, 外包被殻出血で年令の若い症例は積極的に早期手術を行う必要があるが, 視床脳室内出血には手術方法・術後処置に更に研究を要すると思う.
  • -片麻痺の術後機能予後と体性誘発電位の検討で-
    宮崎 正毅, 石原 博文, 木矢 克造, 安東 誠一, 佐々木 潮, 島 健, 石川 進, 魚住 徹
    脳卒中の外科研究会講演集
    1978年 7 巻 157-164
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    Indication and timing of surgery for hypertensve putaminal hemorrhage were investigated in 30 patients on the basis of changes in SEP pattern and functional outcome of hemiplegia (ADL). The patients were classified into 5 grades according to estimation of clinical severity by Mizukami. Hematoma was removed in 20 patients and ventricular drainage was performed in 2 (Table 1). Five patients of grade I, 2 of grade II and one of grade V did not have definitive surgery.
    Seven patients of grade I showed normal or almost normal pattern of SEP, and restored normal walking and functional hands. Three of grade II, in whom N2-N3 components of SEP were preserved despite of a decrease in amplitude more than 6 hours after the ictus, made good recoveries following the surgery in the subacute as well as acute stage. They were evaluated in sufficient recovery to walk, and one of them restored a functional hand, the other 2 the supported hands. A patient of grade III having the similar pattern of SEP was treated conservatively, being evaluated to be in supported walk and abolished hand.A separate group of 7 patients of grade II and 4 of grade III, in whom SEP showed deficit of N2-N3 components or flat pattern, became able to walk with a cane, but lost function of the hand. Another 2 patients of grade III became totally disable. Despite of surgery within 6 hours after the ictus, prognosis of the patients of grade IV and V, who usually had flat SEP, was much poor.
    It may be concluded that:(1) SEP pattern is a good indicator for deciding indication of surgery and predicting functional recovery especially of the upper limb in the cases of hypertensive putaminal hemorrhage. (2) Preservation of N2-N3 components of SEP in the cases of grade II promises sufficient recovery, if hematoma is evacuated in the subacute stage. (3) Deficit of N2-N3 components or flat pattern of SEP in grade II patients means poor functional prognosis.
  • 神野 哲夫, 佐野 公俊, 柴田 太―郎, 片田 和広, 藤本 和男, 戸田 孝
    Neurologia medico-chirurgica
    1978年 18pt2 巻 7 号 569-578
    発行日: 1978年
    公開日: 2006/12/28
    ジャーナル フリー
    Mortality of the hypertensive intracerebral ganglionic hematoma is still high. One of its reasons is that the treatment of very serious cases is difficult by either conservative therapy or surgical therapy. The purpose of this paper is to seek the possibility to save this very serious case. The results were following;
    1) In the past three years since CT was available, 100 cases of intracerebral ganglionic hematoma were treated surgically. Among these cases, 22 serious cases of which CT showed a large volume of hematoma extending even into the ventricles were involved.
    2) In these serious cases, the hematoma completed its spread within three hours after the attack which was verified with CT examination.
    3) When the hematoma was seen spreading during CT examination, severe vomiting developed along with high blood pressure usually more than 200 mmHg.
    4) The serious cases were devided into two sub-groups according to the way of hematoma spreading. The first group should be called “thalamic sparing group” of which the original bleeding point was located in putamen. The second group should be called “thalamic non-sparing group, ” of which the original bleeding point was located in thalamus. The thalamic sparing group did not spread into thalamus even if a large volume of hematoma was noted in all ventricles. Therefore, the so-called “combined type” corresponded to the spreading type of the thalamic hemorrhage, whereas the putaminal hemorrhage did never become the combined type.
    5) We applied the following surgical method to treat these serious cases.
    (1) Insertion of big catheters into the bilateral posterior horns to wash out the clots in ventricles.
    (2) Removal the main hematoma by the transsylvian fissure approach.
    (3) Removal of the clots in the fourth ventricle, if necessary.
    However, by this surgery, only 3 cases in the thalamic sparing group and 2 cases in the thalamic non-sparing group were saved.
    6) To improve the operative results, the hematoma removal within three hours after the attack might be recommended. To decrease the number of the serious cases, the hypotension therapy and anti-emetic therapy just at the attack might be useful.
  • 上野 一義, 布村 充, 蝶野 吉美, 野村 三起夫
    医療
    1984年 38 巻 11 号 1050-1054
    発行日: 1984/11/20
    公開日: 2011/10/19
    ジャーナル フリー
    脳出血
    に対して定位脳手術による血腫の吸引, 洗浄, ドレナージが行われるようになつた. われわれは定位脳手術によらずにCT上のorbito-meatal-lineと前額部正中からの距離により穿孔部位を決定し, 用手的に血腫の吸引のみを施行した. 手術時機は術中出血の危険性も少なく, 血腫の流動化する亜急性期(発症7日以後)としている, これまでに被殻出血3例, 視床出血4例に本法を施行したが, 被殻出血では全例に視床出血では2例に症状の改善をみた. 視床出血で改善率の悪いのは, 血腫による一次的脳損傷が強いためと思われる. われわれは被殻出血で完全片麻痺例には直ちに開頭術による血腫除去を, 不全麻痺例と視床出血に対してはまず保存的療法を行つている. 保存的療法で症状に改善のみられなかつた場合, 吸引療法を加えるわけである. 吸引療法を行うことにより
    脳出血
    の治療法は多様化され, 病態に応じた治療法を選ぶことが出来るようになつた
  • 後藤 利和, 坪川 孝志, 東 裕文, 富沢 憲民, 中村 三郎, 森安 信雄
    脳卒中の外科研究会講演集
    1978年 7 巻 90-94
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    Twenty eight cases of the hypertensive intracerebral hemorrhage were examined with a CT scanner at 3-5 days before operation and one week after operation. The CT findings were studied from the point of postoperative functional recovery and mortality retrospectively.
    1) The cases of putaminal hemorrhage, which showed excellent recovery in motor function, showed a round or oval hematoma on CT, which did not extend to the internal copsule and surrounded by low density area laterally and anteroposteriorly.
    2) On the contrary, the cases of putaminal hemorrhage which showed poor recovery in motor function, showed larger hematoma, over 30 mm in diameter, on CT which extended to the posterior part of the internal capsule and was surrounded totally by low density area. Moreover, the case which showed irregular shape of hematoma, often resulted in poor recovery in motor function.
    3) In the cases of caudate hematoma, when the hematoma localized in the nucleus, recovery of motor function was excellent even by conservative treatment, moreover, even when the hematoma extended posteriorly or penetrated into the ventricle, mortality was also low.
    4) The cases of thalamic or subcortical hemorrhage were also discussed from the CT findings.
  • 谷掛 龍夫, 衣川 一彦, 塩見 壮司, 宮本 誠司, 京井 喜久男, 内海 庄三郎
    脳卒中の外科研究会講演集
    1978年 7 巻 150-156
    発行日: 1978/10/17
    公開日: 2012/10/29
    ジャーナル フリー
    Indication for neurosurgical treatment in the early stage of hypertensive intracerebral hemorrhage seems to be widely accepted recently. However, early treatment has been concluded with only surgical results of the hemorrhage and no conclusive reports about surgical treatment of secondary changes after intracranial bleeding with CT scan, so far, has been reported. We have experienced 78 cases of the ganglionic hematoma from 6. 1976 to 12. 1977 with CT scan.
    The primary changes due to hemorrhage and secondary changes developing in the vicinity of the hematoma and in the ventricles were studied. The following results were obtained.
    1) The hematomas with high density on CT scanning view are completed within 3 hours after the hemorrhage attack.
    2) The low density area around the hematoma shows the brain edema. It appears immediately after onset and rapidly increases to the 7th day, and reaches the maximum about the 14th day after the onset.
    3) Ventricular dilation develops about 12 hours after the onset even in cases without intraventricular perforation. Those with perforation are followed by ventricular dilation within 3 hours.
    On clinical application of the above mentioned remarks, the operation should, in the case of intraventricular perforation, be performed as early as possible after the onset, and even in the cases without perforation surgical repair should be done within 12 hours after the onset. The prognosis in such cases will be fairly good.
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