透明中隔腔嚢胞の外科的治療について

SURGICAL TREATMENT OF CYST OF THE CAVUM SEPTI PELLUCIDI

I．はじめに

　透明中隔腔に関する解剖学上の記載はすでに15世紀，Sylvius以前にみられ，1851年Andrea Verga^2）は最初の剖検例を報告し，1930年Ernst Meyer^1）によつて気脳写像のうえではじめて嚢胞様に拡大した透明中隔腔が認められて以来，多数の報告がみられる。本邦では内村^3）が1931年に1例を報告して以来，文献上19例の報告例をみており，その病態の解析，治療などについては，佐野^4），石井^5），館林^6），矢部^7）によつてくわしく論じられてきた。

　私どもは最近3例の透明中隔腔嚢胞を経験し，その1例にたいして定位脳手術法を用いて治療し，好成績をおさめえたので，各症例を報告するとともに，外国文献および本邦文献例をもととして考察を加え，その病態，外科的治療の適応，方法などについて一定の見解を得るにいたつたので，ここに卑見をのべて諸賢の御批判を仰ぎたいと思う。

Three cases of cyst of the cavum septi pellucidi are reported.

Case 1. An 11-year-old boy had a history of an episode of frequent attack of slight or severe headache, nausea and vomiting. Funduscopic examination re-vealed bilateral papilloedema and admitted to our hospital with a suspicion of brain tumor. PVG demon-strated the dilatation of the bilateral lateral ventricles and the lateral divergence of the anterior horns from each other in A-P view. Tumor of the septum pel-lucidum or cyst of the cavum septi pellucidi was sus-pected. Cyst was identified by injection of air thro-ugh a needle inserted to this region. He was treated by stereotaxic intraventricular drainage of the cystic fluid. Communication between the cyst and the bila-teral lateral ventricles was made by stereotaxic des-truction of the cyst. At present, a half year after the operation he is alive and well without symptoms of raised intracranial pressure. It is believed therefore that in this patient the cyst of the cavum septi pellu-cidi took a significant part in building the clinical entity with raised intracranial pressure.

Case 2. A 9-year-old boy with complaints of generalized convulsive attack, agressive character and mental retardation was stereotaxically treated by pos-erior hypothalamotomy against his agressiveness. During the operation PVG revealed a small cyst of the cavum septi pellucidi. Seven days after the ope-ration he was dead of gastroduodenal bleeding and panperitonitis following perforation of gastroduodenal ulcer.

Case 3. A 5-month-old infant with retardation of growth and abnormal large head was suspected of internal communicated hydrocephalus. PVG performed prior to the ventriculoauricular shunt operation re-vealed a small cyst of the cavum septi pellucidi.

In the last two cases, the cyst of the cavum septi pellucidi was a coexistent of other abnormalities of the brain, and the cyst did not take a significant part in building a clinical entity.

Reviewing literatures, significant mechanism of the cyst of the cavum septi pellucidi for building a clinical entity is an obstruction of the foramen of Monro to cause a raised intracranial pressure whether it is a communicating type or non-communicating type. For relieving the symptoms of raised intracranial pressure it is preferable to communicate the cyst to bilateral ventricles and or third ventricle by making the large fistula so as not to cause a valve action. For this purpose a stereotaxic intraventricular drainage by destructing the wall of the cyst under the roentgen controled procedure is the most preferable simple operation because of its small damage of the brain tissue and little interference of the brain function.