後頭蓋窩内で天幕を極度に挙上して発育した巨大な骨肉腫の全摘成功例

A CASE OF A HUGE OSTEOSARCOMA ELEVATING THE TENTORIUM OF THE POSTERIOR CRANIAL FOSSA WITH SUCCESSFUL TOTAL EXTIRPATION

はじめに

　頭蓋骨に発生せる骨肉腫は一般に神経学的所見を呈する程巨大になる事は稀であつて，転移にて死亡する事が多いといわれている^3）が最近桂外科において巨大なる石灰化像を有する骨肉腫が後頭蓋窩を殆んど占拠し，その先端は松果体附近迄にも及んでいた稀有なる症例の全摘出例を経験したので報告する。

A case of an 11 year old boy with a huge osteosarcoma elevating tentorium of the pos-teiror cranial fossa was presented.

The chief complaints were vomiting and staggering gait.

The primary operation was done under hypothermic anesthesia. However, the bleeding was so severe that the tumor was resected only partially. Microscopical exami-nation of the specimen showed it to be osteo-sarcoma composed of spindelshaped cells with some new bone formation. After then, irradiation therapy using Radiogold 198 and Co 60 (3600) was carried out for 6 weeks.

The secondary operation was done at 3 weeks after the completion of irradiation therapy under hypothermic anesthesia.

The bleeding was less than that at the primary operation and a huge osteosarcoma was extirpated successfully.

Though the histological findings of the surface of the tumor showed hyaline dege-neration and necrosis, the central part of the tumor revealed only slight necrosis or hyaline degeneration.

The deep tip of tumor was attached to the pineal region and almost the entire posterior fossa was filled with the tumor.