出血発症後,水頭症をきたした中脳背側海綿状血管腫の外科治療

  • 坪井 俊之
    社会医療法人清風会 五日市記念病院 脳神経外科
  • 梶原 洋介
    社会医療法人清風会 五日市記念病院 脳神経外科
  • 茶木 隆寛
    社会医療法人清風会 五日市記念病院 脳神経外科
  • 向田 一敏
    社会医療法人清風会 五日市記念病院 脳神経外科
  • 梶原 四郎
    社会医療法人清風会 五日市記念病院 脳神経外科

書誌事項

タイトル別名
  • Tectal Cavernous Malformation that Manifested as Post-hemorrhagic Obstructive Hydrocephalus: A Surgical Case Report

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抄録

<p>Brainstem cavernous malformations (BCMs) that present with hemorrhage are known to show a higher risk of rebleeding than that associated with cavernous malformations at other sites. We report a surgical case of a tectal cavernous malformation that manifested with post-hemorrhagic obstructive hydrocephalus in a 69-year-old-woman who presented with sudden headache and impaired consciousness. Computed tomography (CT) revealed tectal hemorrhage and acute hydrocephalus. Emergency ventricular drainage was performed; however, the patient's level of consciousness showed only slight improvement. CT performed on day 20 revealed a gradual increase in the size of the hemorrhagic area, suggestive of cavernous malformation-induced rebleeding. We performed microsurgical total resection of the midbrain mass via an occipital transtentorial approach, 5 weeks after onset. Postoperatively, the patient's level of consciousness and right hemiparesis recovered completely, her modified Rankin Scale score was 2, and she was independent at the time of discharge. Aggressive surgical resection is strongly recommended in patients with BCMs that manifest with hemorrhage, owing to the high risk of rebleeding and morbidity associated with this complication. This therapeutic strategy should be promptly considered using the appropriate approach based on the patient's health condition.</p>

収録刊行物

  • 脳卒中の外科

    脳卒中の外科 49 (5), 391-395, 2021

    一般社団法人 日本脳卒中の外科学会

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