新生児急性硬膜外血腫に対する外科的治療法の検討

Abstract

Two cases of acute epidural hematoma in neonates are reported. They were full-term babies delivered by vaginal vertex with the aid of forceps in one case and an evacuum extractor following a difficult labor in the other. CT scanning revealed multiple extradural hematomas in the left frontoparietal and the right parietal regions in Case 1, in which the infant presented with persisting tonic clonic convulsions, and a single large extradural hematoma in the right parietal region in Case 2, in which the infant presented with disturbance of consciousness. Good recovery was achieved following surgery in both cases. Twenty reported cases including ours are reviewed and indications for surgery of extradural hematoma in infants are discussed. Acute extradural hematomas in the neonate are divided into three types, depending on the site and extension of the hematoma. For type 1a with a single supratentorial solid hematoma, type 2 with multiple supratentorial hematomas, and type 3 with an infratentorial hematoma, showing severe symptoms like convulsion, respiratory distress and disturbance of consciousness, surgical treatment is indicated. For type 1b with a single supratentorial liquid hematoma communicating with a cephalohematoma, aspiration by needle puncture may be tried, and conservative management might be possible.