Neurological Surgery 脳神経外科47巻4号

2019年04月発行

テクニカル・ノート

再発慢性硬膜下血腫症例への手術におけるexoscope使用経験

著者： 藤本隆史¹ 諸藤陽一¹ 高平良太郎¹ 郡家克旭¹ 出雲剛¹ 鎌田健作¹ 松尾孝之¹

所属機関： ¹長崎大学病院脳神経外科学講座

ページ範囲：P.429 - P.434

Ⅰ．はじめに
　慢性硬膜下血腫は脳神経外科医にとって頻繁に経験する疾患であり，穿孔洗浄術を行い良好な経過を得ることが多いが，再発に遭遇する機会も少なくない^{2,4,10,16,17,28)}．さらに，再発を繰り返す難治性慢性硬膜下血腫も存在し，治療に難渋することがある^{3,6,8,18-20,24)}．
　近年，神経内視鏡を用いた穿孔術や小開頭術が施行され，良好な治療成果が報告されている^9,11,12,27)．しかし，内視鏡下では視野の確保が十分でなく，さらに局所麻酔下に手術する際の患者の体動に伴う脳損傷のリスクがある．2016年4月より長崎大学病院では体外視鏡（exoscope）であるVITOM（the video telescope operating monitor）teleccope（Karl Storz，トゥットリンゲン，ドイツ，Fig.1）を導入し脳神経外科手術に応用している．今回，われわれは隔壁を有する難治性慢性硬膜下血腫に対し，exoscopeを用いた小開頭手術を行い，良好な治療成績を得た症例を経験したので文献的考察を加え報告する．

参考文献

1) Altinel F, Altin C, Gezmis E, Altinors N：Cortical membranectomy in chronic subdural hematoma：report of two cases. Asian J Neurosurg 10：236-239, 2015

2) Baechli H, Nordmann A, Bucher HC, Gratzl O：Demographics and prevalent risk factors of chronic subdural haematoma：results of a large single-center cohort study. Neurosurg Rev 27：263-266, 2004

3) Berghauser Pont LM, Dirven CM, Dippel DW, Verweij BH, Dammers R：The role of corticosteroids in the management of chronic subdural hematoma：a systematic review. Eur J Neurol 19：1397-1403, 2012

4) Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E：Chronic subdural haematoma in elderly patients：a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir 154：1549-1554, 2012

5) Carlucci C, Fasanella L, Ricci Maccarini A：Exolaryngoscopy：a new technique for laryngeal surgery. Acta Otorhinolaryngol Ital 32：326-328, 2012

6) Chihara H, Imamura H, Ogura T, Adachi H, Imai Y, Sakai N：Recurrence of a refractory chronic subdural hematoma after middle meningeal artery embolization that required craniotomy. NMC Case Rep J 1：1-5, 2014

7) Imaizumi S, Onuma T, Kameyama M, Naganuma H：Organized chronic subdural hematoma requiring craniotomy-five case reports. Neurol Med Chir（Tokyo）41：19-24, 2001

8) Iorio-Morin C, Blanchard J, Richer M, Mathieu D：Tranexamic Acid in Chronic Subdural Hematomas（TRACS）:study protocol for a randomized controlled trial. Trials 17：235, 2016

9) Ishikawa T, Endo K, Endo Y, Sato N, Ohta M：Neuro-endoscopic surgery for multi-lobular chronic subdural hematoma. No Shinkei Geka 45：667-675, 2017

10) Leroy HA, Aboukaïs R, Reyns N, Bourgeois P, Labreuche J, Duhamel A, Lejeune JP：Predictors of functional outcomes and recurrence of chronic subdural hematomas. J Clin Neurosci 22：1895-1900, 2015

11) Mahmood SD, Waqas M, Baig MZ, Darbar A：Mini-craniotomy under local anesthesia for chronic subdural hematoma：an effective choice for elderly and for patients in a resource strained environment. World Neurosurg 106：676-679, 2017

12) Májovský M, Masopust V, Netuka D, Beneš V：Flexible endoscope-assisted evacuation of chronic subdural hematomas. Acta Neurochir（Wien）158：1987-1992, 2016

13) Mamelak AN, Danielpour M, Black KL, Hagike M, Berci G：A high-definition exoscope system for neurosurgery and other microsurgical disciplines：preliminary report. Surg Innov 15：38-46, 2008

14) Mamelak AN, Nobuto T, Berci G：Initial clinical experience with a high-definition exoscope system for microneurosurgery. Neurosurgery 67：476-483，2010

15) Marzano E, Piardi T, Soler L, Diana M, Mutter D, Marescaux J, Pessaux P：Augmented reality-guided artery-first pancreatico-duodenectomy. J Gastrointest Surg 17：1980-1983, 2013

16) Matsumoto H, Matsumoto S, Yoshida Y：Concomitant intracranial chronic subdural hematoma and spinal subdural hematoma：a case report and literature review. World Neurosurg 90：706. e1-706. e9, 2016

17) Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, Tominaga S, Miyaji K, Yamaura I, Yoshida Y, Yoshida K：Clinical investigation of refractory chronic subdural hematoma：a comparison of clinical factors between single and repeated recurrences. World Neurosurg 107：706-715, 2017

18) Matsumoto H, Hanayama H, Okada T, Sakurai Y, Minami H, Masuda A, Tominaga S, Miyaji K, Yamaura I, Yoshida Y：Which surgical procedure is effective for refractory chronic subdural hematoma? Analysis of our surgical procedures and literature review. J Clin Neurosci 49：40-47, 2018

19) Mino M, Nishimura S, Hori E, Kohama M, Yonezawa S, Midorikawa H, Kaimori M, Tanaka T, Nishijima M：Efficacy of middle meningeal artery embolization in the treatment of refractory chronic subdural hematoma. Surg Neurol Int 1：78, 2010

20) Neidert MC, Schmidt T, Mitova T, Fierstra J, Bellut D, Regli L, Burkhardt JK, Bozinov O：Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma：associations with initial presentation and clinical outcome. J Clin Neurosci 28：82-86, 2016

21) Nishiyama K：From exoscope into the next generation. J Korean Neurosurg Soc 60：289-293, 2017

22) Ntourakis D, Memeo R, Soler L, Marescaux J, Mutter D, Pessaux P：Augmented reality guidance for the resection of missing colorectal liver metastases：an initial experience. World J Surg 40：419-426, 2016

23) Oertel JM, Burkhardt BW：Vitom-3D for exoscopic neurosurgery：initial experience in cranial and spinal procedures. World Neurosurg 105：153-162, 2017

24) Sato M, Iwatsuki K, Akiyama C, Kumura E, Yoshimine T：Implantation of a reservoir for refractory chronic subdural hematoma. Neurosurgery 48：1297-1301, 2001

25) Shirzadi A, Mukherjee D, Drazin DG, Paff M, Perri B, Mamelak AN, Siddique K：Use of the video telescope operating monitor（VITOM）as an alternative to the operating microscope in spine surgery. Spine（Phila Pa 1976）37：E1517-E1523, 2012

26) Tyson G, Strachan WE, Newman P, Winn HR, Butler A, Jane J：The role of craniectomy in the treatment of chronic subdural hematomas. J Neurosurg 52：776-781, 1980

27) Van Der Veken J, Duerinck J, Buyl R, Van Rompaey K, Herregodts P, D' Haens J：Mini-craniotomy as the primary surgical intervention for the treatment of chronic subdural hematoma--a retrospective analysis. Acta Neurochir（Wien）156：981-987, 2014

28) Weigel R, Schmiedek P, Krauss JK：Outcome of contemporary surgery for chronicsubdural haematoma：evidence based review. J Neurol Neurosurg Psychiatry 74：937-943 2003