書誌事項
- タイトル別名
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- A case of acute epidural and subdural hematoma: Efficacy of TachoSil<sup>®</sup> tissue sealing sheet for extensive injury of superior sagittal sinus
- 症例報告 広範な上矢状静脈洞損傷に対してフィブリン添付コラーゲンシートによる止血が有用であった急性硬膜外・硬膜下血腫の一例
- ショウレイ ホウコク コウハン ナ ジョウヤジョウ ジョウミャクドウ ソンショウ ニ タイシテ フィブリン テンプ コラーゲンシート ニ ヨル シケツ ガ ユウヨウ デ アッタ キュウセイコウマク ガイ ・ コウマク カケッシュ ノ イチレイ
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抄録
<p>We experienced a case of acute epidural and subdural hematoma associated with superior sagittal sinus injury. Large laceration of the sinus sometimes induces huge bleed-ing with subsequent miserable outcome. The handling of the injured sinus depends on time and situation of the fracture.</p><p>An iron plate weighing 200 kg hit the head of 62-year-old man without a helmet. He was referred to our hospital with mild conscious disturbance (JCS: I-3) and right hemparesis. CT images revealed the left acute epidural hematoma, intracranial air, depressed fractures and sagittal suture diastases. His level of consciousness was deteriorated (JCS: II-30) and emergent surgery was performed. First, the craniectomy with the fractured bone on the injured sinus untouched to achieve the decompression of the brain tissue. Next, craniectomy was added to stop bleeding from the injured sinus. Huge bleeding was seen via the torn venous sinus, in spite of the elevated head position. TachoSil® tissue sealing sheet was applied manually to the injured outer wall of the sinus. Then, brain swelling was seen after stopping bleeding from the outer wall of the sinus. Immediately after that, dura was cut with subsequent hemostasis. After complete hemostasis from the injured sinus, dural plasty with fascia was performed. Fortunately the therapeutic course of the patient was excellent. At 3 months after injury, he received cranio-plasty with custom-made titanium mesh. He returned to his daily life without any neurological deficits. In order to obtain good hemostasis from the injured sinus, TachoSil® tissue sealing sheet is effective.</p>
収録刊行物
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- 神経外傷
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神経外傷 39 (1), 41-45, 2016-08-10
一般社団法人 日本脳神経外傷学会