Mori N, Nagao T, Nakahara A, Izawa M, Amano K, Kitamura K
No Shinkei Geka. 1982 Nov;10(11):1203-9.
In the literature, there has been no report of spontaneously growing calcified chronic subdural hematoma (C-C-SDH). The authors report a five-year-old boy with spontaneously growing C-C-SDH. The patient was admitted to author's department on July 24, 1979, because of progressive right hemiparesis, seizure and mental as well as physical retardation. He had a birth injury caused by forceps delivery resulting in skull fracture and subarachnoid hemorrhage. Three months after birth, gradual enlargement of his head circumference was noticed. A ventriculoperitoneal shunt was performed under the diagnosis of acute hydrocephalus. At the age of 17 months, he developed meningitis followed by right hemiparesis. When he was three years old, bilateral C-SDH was found on CT. The irrigation of hematoma was not successful because of the organization of hematoma. At the age of 4, calcification of the hematoma was found on CT and plain skull x-rays. Because of deterioration of the right hemiparesis, seizure and the enlargement of C-SDH, he was admitted to author's department on July 24, 1979. The left C-SDH was totally removed on August 10, 1979 by craniotomy. The extirpated C-C-SDH was 15 X 10 cm and 2 cm in thickness. Both inner and outer capsule were thick. The organized and partially calcified tissue was found between the two capsules. Sinusoidal blood vessels were also identified on the inner and outer capsules. Postoperatively, hemiparesis became improved. The second operation to the right C-C-SDH was performed from one year later after the first craniotomy. Surgical indication of C-C-SDH has to be determined on the basis of patient's age, symptoms and length of clinical course. It has been suggested that surgical treatment of C-C-SDH in children was not successful as compared with that in adults. The authors emphasize that C-C-SDH in children should be operated to encourage mental and physical development of the patients as well as to prevent hemorrhage and growth of C-C-SDH.
文献中尚无自发性生长的钙化性慢性硬膜下血肿（C-C-SDH）的报道。作者报告了一名患有自发性生长的C-C-SDH的5岁男孩。该患者于1979年7月24日因进行性右侧偏瘫、癫痫发作以及智力和身体发育迟缓入住作者所在科室。他因产钳助产导致出生时受伤，造成颅骨骨折和蛛网膜下腔出血。出生后三个月，发现其头围逐渐增大。在诊断为急性脑积水后进行了脑室腹腔分流术。17个月大时，他患上脑膜炎，随后出现右侧偏瘫。3岁时，CT检查发现双侧硬膜下血肿。由于血肿机化，血肿冲洗未成功。4岁时，CT和平片颅骨X线检查发现血肿钙化。由于右侧偏瘫、癫痫发作加重以及C-SDH增大，他于1979年7月24日入住作者所在科室。1979年8月10日通过开颅手术完全切除了左侧C-SDH。切除的C-C-SDH大小为15×10厘米，厚度为2厘米。内囊和外囊均增厚。在两个囊之间发现了机化且部分钙化的组织。在内囊和外囊上还发现了窦状血管。术后，偏瘫有所改善。在第一次开颅手术一年后对右侧C-C-SDH进行了第二次手术。C-C-SDH的手术指征必须根据患者的年龄、症状和临床病程长短来确定。有人认为，与成人相比，儿童C-C-SDH的手术治疗效果不佳。作者强调，儿童C-C-SDH应进行手术，以促进患者的智力和身体发育，并防止C-C-SDH出血和生长。
