視床下部占拠性腫瘍（craniopharyngioma）の1例における脳幹の変化について

ANATOMO-CLINICAL STUDY IN A CASE OF CRANIOPHARYNGIOMA OCCUPYING THE HYPOTHALAMUS, WITH SPECIAL REGARD TO FIBER CONNECTIONS BETWEEN THE HYPOTHALAMUS AND THE BRAIN STEM

I．はじめに

　視床下部の線維結合は，近年多くの研究者の^{4）6）31）}により詳細に追究されてきたが，その大部分が動物実験に基づくものであり，ヒトにおける実態は依然として謎につつまれていると言つてよい。この問題を解きあかす上で，利用しうるあらゆる病的材料の精密な分析を積みかさねていくことは，1つの有力な手段となろう。私は，ほぼ選択的に視床下部を破壊しつくした人脳腫瘍の1例に遭遇したので，上に述べた観点からその脳幹における変化を検べた。

　組織学的検索には，中脳以上はWeil氏髄鞘染色およびCarazziのhematoxylin細胞染色による前額断50μ連続切片，脳幹はKluver-Barrera染色による20μ連続切片を用いた。また間脳部は病変がほぼ左右対称であつたので，右半球のみを組織標本にした。左半球は，腫瘍により高度の変形を蒙つた組織の巨視的関係を随時把握するのに用いた。なお対照標本には，中脳以上については胃癌で死亡した49歳の女予，脳幹については同じく胃癌で死亡した79歳の男子の，それぞれ同一染色標本を用いた。

A case of a 43 year-old-female with craniopharyn-gioma destroying almost exclusively the hypothalamus, was clinicoanatomically studied, especially with respect to fiber connections between the hypothalamus and the brain stem.

The patient first developed somnolence and amen-orrhea, and was admitted to our hospital with amnesic syndrome, vesical tenesmus, increased drinking, obesity, hyperglycemia, muscle hypotonia and other motor disturbances. She died about three and a half years after the onset of her illness.

For histological investigations, the diencephalic por-tions were embedded in celloidin, cut serially at 50 μ and were stained by the method of Weil and with hematoxylin. The brain stem embedded in paraffin was cut serially at 20 μ and every 5 th section was stained by the method of Kluver-Barrera.

Topographical study of the diencephalic lesions sho-ws, 1) disappearance of almost all the hypothalamic greys and their connecting fibers, 2) depletion of a small part of the medial and lateral thalamic nucleus, 3) demyelination and atrophy of the optic tract, 4) partial demyelination of the fornix and 5) superficial damages of the internal capsule. Moreover, there was found a certain degree of cortical atrophy, particularly at the level of frontal lobe.

The histological examination of the brain stem revealed minor secondary cellular degeneration, much slighter than might be expected, at the level of the dorsal subnucleus of central superior nucleus (Olszew-ski & Baxter) and of the substantia nigra. The former should be distinguished, from the standpoint of cytoarchitecture as well as from the standpoint of fiber connections, from the ventral or lateral subnuc-leus of superior central nucleus, and should constitute an intermediate nucleus of the periventricular fiber system. With regard to the degeneration of substantia nigra, those found in the medial part of their struc-ture might be caused by the destruction of mamillo-nigral fiber, as reported by several authors, while those in it's lateral part might have some connections with cortical atrophy, especially at the level of frontal lobe.