アライ　ナオユキ   Arai Naoyuki   新井　直幸    所属   医学部 医学科（附属足立医療センター）    職種   講師
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Aggressive internal and external decompression as a life-saving surgery in a deeply comatose patient with fixed dilated pupils after severe traumatic brain injury: A case report
掲載誌名	正式名：Surgical Neurology International ISSNコード：2152-7806
掲載区分	国外
巻・号・頁	11,pp.181
著者・共著者	Ebise Hiroki†, Kubota Yuichi*, Ohbuchi Hidenori, Arai Naoyuki, Inazuka Mayuko, Chernov Mikhail, Kasuya Hidetoshi
発行年月	2020/07/11
概要	Background: To maximize control of the intracranial pressure in deeply comatose patients with malignant cerebral swelling, combination of the surgical techniques for internal and external brain decompression may be reasonable, as demonstrated in the presented case. Case description: A 55-year-old man was admitted with Glasgow Coma Scale (GCS) score 4, maximally dilated pupils, and absence of the pupillary light and vestibulo-ocular reflexes. Head CT revealed massive acute subdural hematoma, prominent brain shift with subfalcine and transtentorial herniation, and diffuse subarachnoid hemorrhage. Large size decompressive craniectomy and evacuation of subdural hematoma were done, however, prominent swelling of the brain and its protrusion through the bone defect remained. Therefore, extensive temporal lobectomy and removal of the bulk of temporal muscle were additionally attained followed by lax duraplasty. Gradual recovery of the patient was noted from the 1st postoperative day, and on the 70th day, his GCS score was 4T4. Three months later, his condition corresponded to the Glasgow Outcome Scale score 3 (severe disability). Conclusion: Aggressive internal and external decompression with combination of large size craniectomy, extensive temporal lobectomy, removal of the bulk of temporal muscle, and lax duraplasty should be considered as possible life-saving option in cases of neurosurgical emergencies with malignant cerebral swelling.
DOI	10.25259/SNI_271_2020