著者

渡邉 瑞也 北村 高之 藤田 修英 鈴木 皓晴 杉山 夏来 清水 勇三郎 徳川 城治 中尾 保秋 山本 拓史

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷 (ISSN:24343900)

巻号頁・発行日

vol.39, no.1, pp.37-40, 2016-08-10 (Released:2020-04-27)

参考文献数

16

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A patient over 60 years old who had suffered gunshot wound to the head was transported to our hospital by emergency medical helicopter service. Computed tomography (CT) revealed the bullet had entered from the right parietal region, penetrated the brain, and lodged in the left parietal bone, leaving numerous bone and metal fragments scat-tered within the brain. Acute subdural hematoma (ASDH) on the left side had caused midline shift. Emergency decompressive craniectomy was performed to remove the hematoma and extract the bullet. Acute brain swelling occurred during dural closure, so evacuation of the necrotic brain and extensive duroplasty with artificial dura were also performed. Unfortunately, the patient died of central herniation the day after surgery. As gun ownership is strictly regulated under the Firearms and Swords Law, gunshot wounds are extremely rare in Japan. In particular, treatment of gunshot wounds to the head is hardly ever experienced. ASDH is rare after gunshot wound to the head, with only one case on the entry side, but the present case occurred on the opposite side to the point of entry. In general, ASDH is caused by tearing of the bridging veins in the subdural space and/or bleeding from the contusional brain. In the present case, the subdural hematoma on the opposite side to the point of entry was caused by continuous bleeding from the left parietal bone fracture extending into the subdural space through the dura tear.Knowledge of the treatment of patients with gunshot wounds to the head may become more important in the future in Japan. We report this case along with a review of the pertinent literature.

著者

森 健太郎 和田 孝次郎 大谷 直樹 長田 秀夫 戸村 哲 山本 拓史 中尾 保秋

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.42, no.2, pp.116-121, 2014 (Released:2014-06-26)

参考文献数

13

被引用文献数

1

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Basilar artery and internal carotid paraclinoid aneurysms are still surgically challenging. We performed 31 clipping surgeries (basilar tip aneurysm 6, basilar artery-superior cerebellar artery aneurysm 8, and internal carotid aneurysm 17) via the extradural temporopolar approach. After the frontotemporal craniotomy, the meningo-orbital band was incised and the dura propria of the temporal lobe was peeled from the lateral wall of the cavernous sinus. The anterior clinoid process was removed extradurally. The distal dural ring and falciform ligament were incised for mobilization of the internal carotid artery and optic nerve. The temporal lobe was retracted posteriorly with the dura mater. The aneurysm clipping was performed through the relatively wide operative trajectory over the opened cavernous sinus. Postoperative outcome was modified Rankin Scale (mRS) 0 in 28 patients and mRS in three patients with visual deficits. No temporal lobe contusion occurred. The extradural temporopolar approach is a useful skull base technique for deeply situated aneurysms.