外傷性後頭蓋か血腫の臨床的特徴とＩＣＰモニタリングの重要性

Abstract

Clinical signs, skull X-P, computerized tomography (CT), continuous monitoring of intracranial pressure (ICP), and serial recording of auditory brainstem response (ABR) were examined in 22 cases of traumatic posterior fossa hematoma. Fifteen of the patients were male and seven were female. Their ages ranged from 3 to 86 years old (mean 35.2 years). The causes of the head injuries were traffic accidents in 13 cases and falls in 9 cases. The site of cranial impact was occipital in all cases but one. Sagittal impact was most common and skull fractures were found in the occipital regions in 19 cases. States of consciousness on admission as measured by the Glasgow coma scale (GCS) were GCS 15 in 2 cases, GCS 9-14 in 9 cases and GCS 3-8 in 11 cases. CT findings of posterior fossa included 10 cases of intracerebellar hematoma, 8 cases of epidural hematoma, 2 cases of combined epidural and intracerebellar hematoma and 2 cases of subdural hematoma. Associated CT findings of the supratentorial region were noted in 18 cases (82%), and most of them showed contrecoup injuries in the frontal region. Six cases of 8 epidural hematomas of the posterior fossa indicated combined epidural hematomas in the occipital region. ICP was monitored in 11 of the 22 cases. Pre-operative ICP monitoring (5 cases) indicated an operative decision. ABR was recorded in 5 cases. Serial ABR recording provides reliable information about brain stem function. The hematoma was evacuated in 15 cases. The Glasgow outcome scale administered 3 months after trauma indicated good recovery in 2 cases, moderate disability in 6 cases, severe disability in 2 cases, persistent vegetative state in 1 case and death in 9 cases. It has become obvious that there are many types of CT findings in posterior fossa hematomas, and that continuous ICP monitoring is very important to determine the timing of surgery and to protect against secondary brain damage caused by increased ICP.