高血圧性基底核部血腫のCT分類と予後, 特にDescending tentorial herniation (DTH) の意義

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概要

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• 1. Our experienced 57 cases of hypertensive basal ganglionic hematoma with CCT were classified into 3 types (L, M and C). Prognosis of each type was as follows: <BR>Working (I+II)…L-type (40%), M-type (20%) and C-type (0%) <BR>Death (V) L type (40%), M-type(70%) and C-type (100%)<BR>2. Descending tentorial herniation (DTH) by CCT indicates the secondary brain stem damage (rostral-caudal deterioration). It was classified into 4 stages: DTH-0 (no deterioration), DTH-1 (impending tentorial herniation), DTH-2 (actual herniation) and DTH-3 (advanced stage).<BR>3. The stage of central syndrome secondary to hematoma correlates well with the stage of DTH and prognosis. The results were as follows:<BR>4. Ventricular penetration of hematoma was classified into 4 groups by CCT-findings: V1 (no penetration), V2 (lateral ventricle casting), V3 (3rd ventricle casting) and V4 (4th ventricle casting). Prognosis of each group is showed as follows:<BR>5. Maximal diameter of hematoma correlates with the stage of DTH. 4.5cm in L-type or 2.5cm in M-type is critical point of prognosis (morbidity Vth).<BR>6. Profile histogram from hematoma-edge toward brain stem is valuable to evaluate rostral-caudal deterioration secondary to hematoma. It reveals characteristic curve of attenuation numbers corresponding with each stage of DTH.<BR>7. DTH is useful to determine the operative indication for L-type hematoma and our policy is summarized as follows:

• The Japanese Society on Surgery for Cerebral Strokeの論文

著者

• 上村 孝臣

  栃木県脳卒中センター佐野厚生総合病院脳神経外科

• 宇根岡 啓基

  栃木県脳卒中センター・佐野厚生病院 脳神経外科

• 佐々木 知明

  足利日赤病院 脳神経外科

• 峯 徹

  足利日赤病院 脳神経外科

• 高橋 正晁

  上都賀病院 脳神経外科

• 上村 孝臣

  栃木県脳卒中センター・佐野厚生病院 脳神経外科

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• 高血圧性基底核部血腫のCT分類と予後, 特にDescending tentorial herniation (DTH) の意義

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