うつ伏せ型頭蓋骨骨折が原因の急性皮質失明症を持つ小児の外科的治療

Surgical Treatment of a Child With Acute Cortical Blindness Caused by Depressed Skull Fracture.

• Vaner Köksal
• Ahmet Karkucak
• Mirsad Yalçinkaya

抄録

線状頭蓋骨骨折は小児では比較的よくみられるが、うつ伏せ骨折はまれである。本報告では、車内交通事故を経験し、全盲で救急外来に入院した7歳の男児の症例を詳述した。脳トモグラフィーの結果、後頭骨の島状の大きな骨片が視覚野と上矢状静脈洞に窪んでいることが確認された。単発性頭部外傷後に完全な視力喪失を呈することは非常に稀であり、既存の文献にも同様の症例はない。陥没頭蓋骨骨折に対する外科的適応の限界は、脳神経外科の診療において十分に確立されている。外傷後の初期段階で神経学的変化が発現した症例では特に、外科的介入を直ちに行うべきである。この患者は血管近傍に影響を与えずに失明を矯正するために緊急手術を受けた。陥没した頭蓋は元の位置に引き上げられた。術後間もなく患者が目を覚ました後、失明は完全に解消した。

Linear skull fractures are relatively common in children, however, it is rarer to see depressed fractures. This report details the case of a 7-year-old boy who was admitted to the emergency department with complete blindness after having experienced an in-car traffic accident. Brain tomography of the patient showed that a large, island-shaped piece of occipital bone was depressed on the visual cortex and superior sagittal sinus in the midline. Presentation of complete loss of vision after an isolated head trauma is very rare, and there are no similar cases in existing literature. The limits of surgical indications for depressed skull fractures are well established in neurosurgical practice. Surgical intervention should be performed immediately, especially in cases where neurological changes develop in the earliest stages after a trauma. The patient underwent emergency surgery to correct the blindness without affecting the vascular neighborhood. The depressed cranium was raised to its original position. The blindness had completely resolved shortly after the patient woke up during the postoperative period.