脳室内出血を伴う視床出血に対する前頭部小開頭血腫除去術

Abstract

When thalamic hemorrhage is accompanied by severe intraventricular hematoma, the prognosis is poor. Spontaneous thalamic and intraventricular hemorrhage is usually treated by external ventricular drainage for obstructive hydrocephalus. However, drainage occlusion, meningitis and residual hematoma are often troublesome in actual clinical practice. For such severe cases, we performed direct hematoma evacuation by the frontal mini-craniotomy transcortical approach in recent years. The present study evaluated the outcome and complications in 14 patients with spontaneous thalamic and intraventricular hemorrhage treated by frontal mini-craniotomy hematoma evacuation with ventricular drainage and 16 patients treated by only external ventricular drainage. There were no significant differences between the 2 groups with respect to age, clinical grade, hematoma volume, hematoma location and postoperative epilepsy. There was also no significant difference in postoperative outcome between the 2 groups. However, patients treated by frontal mini-craniotomy were less likely to require days of ventricular drainage settlement, had suffered meningitis less frequently and had good hematoma evacuation rate compared with those undergoing only external ventricular drainage. Frontal mini-craniotomy is a simple and effective method for hematoma evacuation that causes fewer complications.