重篤な脳挫傷に対する一つの考え方について(<特集>脳と神経の研究V)

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It has been the general policy of most neurosurgeons to evacuate the intracranial hematoma as soon as possible, and to treat the cerebral contusion conservatively without any surgical intervention. In many cases of intracranial hematoma, especially of acute subdural hematoma, cerebral contusion of considerable degree is coexistent. Even for such cases, the hematoma is evacuated through multiple burr holes which has no beneficial effect upon the underlying contusion. These attitudes are based on the concept that the already damaged structures of the brain in contusion connot be surgically repaired and that the accompanying cerebral edema and swelling is a matter of medical treatment. Recent advances in conservative management of acute head injuries with hypertonic diuresis (urea and Mannitol), hypothermia and steroids certainly decreased the mortality of severe cerebral contusion. However, as long as the total intracranial space is limited, further progress connot be expected without surgically enlarging the intracranial cavity to protect the brain stem against compression. In the past two years, our attitude has been to perform a unilateral, or bilateral if indicated, large decompressive craniotomy for severe cerebral contusion with or without hematomas. A large dural opening is covered with fascia or silicone gauze to increase the dural surface for its relaxation. Results of such treatments have been encouraging as compared to the previous methods of management.
千葉大学の論文

重篤な脳挫傷に対する一つの考え方について(<特集>脳と神経の研究V)

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