Neurological Surgery 脳神経外科49巻5号

2021年09月発行

特集 頭部外傷診療アップデート—ガイドラインを読み解く Ⅱ　外科的治療と神経集中管理・治療

頭蓋内圧亢進に対する減圧開頭術

著者： 大谷直樹¹ 吉野篤緒¹

所属機関： ¹日本大学医学部脳神経外科学系神経外科学分野

ページ範囲：P.964 - P.975

Point
・減圧開頭術（DC）による転帰は内科的治療と比べて致死率は減少するが，機能予後は不変である．
・重症頭部外傷で脳ヘルニア徴候や開頭術の適応がある症例，特に若年症例ではDCを施行してもよい．
・DCを施行する場合には，大開頭による前頭側頭頭頂開頭（12×15 cm以上，あるいは直径15 cm以上）が勧められる．

参考文献

1）Cooper DJ, et al；DECRA Trial Investigators；Australian and New Zealand Intensive Care Society Clinical Trials Group：Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364：1493-1502, 2011

2）Hutchinson PJ, et al；RESCUEicp Trial Collaborators：Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med 375：1119-1130, 2016

3）Li LM, et al：Outcome following evacuation of acute subdural haematomas：a comparison of craniotomy with decompressive craniectomy. Acta Neurochir（Wien）154：1555-1561, 2012

4）Rush B, et al：Craniotomy versus craniectomy for acute traumatic subdural hematoma in the United States：a national retrospective cohort analysis. World Neurosurg 88：25-31, 2016

5）Phan K, et al：Craniotomy versus decompressive craniectomy for acute subdural hematoma：systematic review and meta-analysis. World Neurosurg 101：677-685.e2, 2017

6）Kolias AG, et al：Primary decompressive craniectomy for acute subdural haematomas：results of an international survey. Acta Neurochir（Wien）154：1563-1565, 2012

7）van Essen TA, et al：Neurosurgical treatment variation of traumatic brain injury：evaluation of acute subdural hematoma management in Belgium and the Netherlands. J Neurotrauma 34：881-889, 2017

8）Kolias AG, et al：Decompressive craniectomy following traumatic brain injury：developing the evidence base. Br J Neurosurg 30：246-250, 2016

9）Reithmeier T, et al：Relevance of ICP and ptiO2 for indication and timing of decompressive craniectomy in patients with malignant brain edema. Acta Neurochir（Wien）147：947-951；discussion 952, 2005

10）Jiang JY, et al：Efficacy of standard trauma craniectomy for refractory intracranial hypertension with severe traumatic brain injury：a multicenter, prospective, randomized controlled study. J Neurotrauma 22：623-628, 2005

11）Qiu W, et al：Effects of unilateral decompressive craniectomy on patients with unilateral acute post-traumatic brain swelling after severe traumatic brain injury. Crit Care 13：R185, 2009