幼児に発生した巨大な急性後頭蓋窩硬膜下血腫の救命例

概要

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Acute subdural hematoma of the posterior fossa is rare, occupying 0.5% to 1.6% of all acute subdural hematomas. In children, it is extremtely rare. There has been only 11 cases reported in the literature, excluding neonatal cases. Herein a case was reported of an acute subdural hematoma of the posterior fossa in a child who survived after an emergent surgical exploration. A 6-year-old female was involved in a motor vehicle accident. She fell to the ground, hitting the left occipital region. After a semi-lucid interval several hours, her consciousness deteriorated and she was brought to the hospital. On examination, the patient was comatose, and showed decerebrate posture with bilateral pin-point pupils. Computed tomography scan revealed a huge hematoma which occupied the left posterior fossa and moderate obstructive hydrocephalus. A left suboccipital emergency craniectomy was performed, and an occipital bone fracture was confirmed. Then, subdural hematoma was confirmed, which seemed to be caused by bleeding from a cerebellar cortical small artery. Most of the clots were removed, and hemostasis was achieved. The postoperative course was favourable. The patient became alert 2 weeks later, and was discharged with a very mild ataxic gait 2 months later. No post-traumatic hydrocephalus is seen as yet.
日本脳神経外科学会の論文
1986-11-15