Putaminal Hemorrhage のCTと機能予後ならびにAnterior Insular Approach
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概要
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There are two directions in the mode of hematoma extention which determine the overall outcome of motor function in putaminal hemorrhage. One of these is directed medially toward the internal capsule and the other upwardly toward the corona radiata (Fig. 1). Accordingly, the authors have classified 28 CT scans of putaminal hemorrhage into 4 groups with their ADL (Fig. 2). In group I (Fig. 2, I) the hemorrhage occupies mainly the claustrum (Cl.). All cases showed full recovery, except for one case with large hematoma (case T.I.) who was treated conservatively & ended up with ADL II (Table 1).<BR>In group II (Fig. 2, II), hemorrhage occures in putamen (P.) and is in close contact with the posterior portion of internal capsule (posterior limb). Globus pallidus (G.) is spared and in most cases anterior portion of the putamen is also spared. Hemorrhage mainly expands antero-posteriorly. Cases of small hemorrhage with conservative treatment showed complete recovery (ADL I), but those of large hemorrhage with surgical treatment resulted in ADL II-III (Table 2). This means that the large hematomas extend upwardly and damage the corona radiata.<BR>In group III (Fig. 2, III), hemorrhage involves globus pallidus and has a tendency to extend toward the midportion of the internal capsule (posterior limb). Hematomas in this group are apt to show irregular patterns. Even cases with small hemorrhage resulted in ADL IV (Table 3). This means the degree of medial extension to the internal capsule determines the functional damage.<BR>In group IV, hemorrhage extends beyond the internal capsule toward the thalamus (T.) (Fig. 2, IV). All cases resulted in ADL IV (Table 4).<BR>Fig. 3 shows author's operative approach (anterior insular approach). Sylvian fissure is separated in its beginning and the anterior pole of insula is exposed. The hematoma cavity is approached along its longitudinal (antero-posterior) axis between middle cerebral artery and the striate arteries. Both the bleeding point and the site of ventricular rupture can be easily identified. If necessary, external ventricular drainage can be placed after the removal of clot from the foramen Monro.
著者
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藤津 和彦
横浜市立大学脳神経外科
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桑原 武夫
横浜市立大学脳神経外科
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細田 浩道
横須賀共済病院脳神経外科
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藤津 和彦
横浜市立大学 脳神経外科
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増田 肇
横浜市立大学脳神経外科
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篠永 正道
横須賀共済病院脳神経外科
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桑原 武夫
横浜市立大学 脳神経外科
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