小脳梗塞における減圧術の適応とタイミング

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A Clinical analysis has been made in 9 cases of cerebellar infarction in whom both of massive edema of cerebellar hemisphere and internal hydrocephalus were observed on CT scans and/or angiograms. Five cases of them underwent decompressive suboccipital craniectomy and survived except for one case who died of perforation of duodenal ulcer after remarkable postoperative improvement. The other four cases were treated conservatively and deid soon. Consequently, surgical treatment is apparently effective in cases of massive cerebellar infarction. However, survivor's outcomes were quite different according to the mode of onset. One patient who became comatous rapidly after the onset remained totally disabled postoperatively. On the other hand, satisfactory recovery was obtained in the patients who were almost alert in the early stage and became gradually comatous, i. e. lucid interval. Then, surgical treatment is indicated for the cases who have lucid interval.<BR>There were five cases who had lucid interval. The speed of deterioration was more rapid in the two cases of hemorrhagic infarction than in the three cases of anemic infarction. One of the former deteriorated too rapidly to be operated upon. In the other four cases, the shorter the time between the initiation of loss of consciousness and surgery, the sooner the recovery. Consequently, operation is recommended to start as soon as possible if the consciousness is disturbed, although the cases of hemorrhagic infarction might be operated upon before the consciousness is disturbed.

小脳梗塞における減圧術の適応とタイミング

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