超音波照射によるMyodil乳化液の陽性脳室造影能に関する研究

STUDIES ON THE POSITIVE VENTRICULOGRAPHY WITH EMULSIFIED MYODIL SOLUTION BY ULTRASONIC IRRADIATION

I．緒言

　脳神経外科の発展は一面において診断技術の進歩と相まつている。綿密な神経学的検査が重要なことはいうまでもないが，実際の手術にあたつては補助診断法である脳血管写や脳室写像が手術適応や手術方法の決定になにものにも勝る貴重な資料となることがある。このように重要な意味をもつ脳血管写や脳室影の所見を，より鮮明で確実なものにしたいという希望はおそらく多くの脳神経外科医がもつていることと思う。

　従来，脳室造影は空気脳室写と油性造影剤による分画的造影が一般に行なわれている。ところがPortera-San—chez^1）2）（1964）がshaking methodによりPantopaqueを乳化していわゆるEmulsified Pantopaque ventriculo—graphyを発表して以来，本法は一つの新しい陽性脳室造影法として注目され，わが国では北村^3）らが報告している。私どもも本法を追試してみたが，本法では油性造影剤の乳化が不完全で，造影能の不足を感じた。そこで私どもはより濃厚で造影能，安定性，拡散性ともに優れた油性造影剤の乳化液を得るために超音波照射法を用いたところ，はぼその目的を達しえたので，本法によるMyodil乳化液の物理化学的性状，造影能ならびに副作用について検討してみた。ここにその結果を報告する。

Ventriculography is one of the important sup-plementary methods of diagnosis in the neurosurgery. Up to now, for ventriculography the pneumoven-triculography as well as the fractional ventriculo-graphy by means of an oil contrast medium has generally been practiced, but in the former the contrast obtained was in some degree insufficient to know minute changes in the ventricle, while in the latter the entire ventricle could not be visualized.

Thereupon, the trial to visualize the whole ven-tricle uniformly with an emulsion of Myodil emulsified in a physical process revealed that the ultrasonic irradiation excels most in emulsification. It was, however, as ascertained that its emulsification is restricted, since the Myodil cannot be emulsified perfectly with this ultrasonic irradiation alone. Then it became clear that it can he emulsified perfectly by adding as small quantity of the autoserum (0. 5 ml) regarded as having the least influence on the or-ganism to it.

From our experiences with the model ventricle, animal experiments and its clinical use it was found that the contrast of the ultrasonic emulsion of Myodil prepared in this way containing 15 ml of the cere-brospinal fluid, 3 ml of Myodil and 0. 5 ml of the autoserum or its double-diluted solution is able to visualize the ventricle thoroughly.

The physicochemical properties of this emulsion do not affect the chemical nature of Myodil, its particles are fine and uniform excelling in diffusion and stability, and its pH approximates that of the cerebrospinal fluid.

In order to investigate the reactions occurring at the time of injection the present emulsion into the ventricle, the ultrasonic emulsion was injected into the ventricle of dogs. The responsive effects evoked by the ultrasonic irradiation of emulsion alone or by the double-diluted solution of the condensed emulsion were slight. In conclusion, the emusified positive ventriculography executed in the ventricle of 4 clin-ical cases, suggested the excellency of this contrast. It produces almost no ill effects and seems to have a great diagnostic value. Nevertheless, in case of its clinical use the emulsion in the ventricle should be eliminated from it thoroughly by washing with physical saline solution after roentgenography and remained the ventricle drainage.