頭蓋内結核性疾患の脳神経外科的治療

SURGICAL TREATMENT FOR INTRACRANIAL TUBERCULOUS DISEASE

Ｉ．緒言

　第二次大戦後，本邦における結核死亡率は抗結核剤の進歩，結核対策の充実，生活条件の改善などにより急激に減少していることは周知の事実であるが^1）2），それとともに頭蓋内結核性疾患もまた激減の傾向をたどつてきた。わが教室においても昭和20年代に8例の頭蓋内結核腫症例を有していたものが，昭和30年代には1例のみでほとんど経験できなかった状態である。しかし最近にいたり，脳腫瘍ないしは髄膜炎様症状で来院した患者のなかで，頭蓋内結核性疾患であつた6症例を相ついで経験した。これらの事実はたまたま一つの偶然と考えるか，または一つの傾向と考えるか問題のあるところではあるが，これら症例を提示し脳神終外科的な見地より考察を加え報告する。

Fifteen cases of intracranial tuberculous disease has been experienced during the 28 years in our clinic. The frequency of the intracranial tuberculous disease has decreased remarkably since the use of antituberculous drugs and BCG vaccine exactly, but 6 cases were experienced and treated surgically in our clinic recently. On this paper the surgical in-dication for these cases were discussed by our ex-perience.

Continuous ventricular drainage and V-A shunt-ing operation were performed respectively in 2 cases of tuberculous meningitis which caused intracranial hypertention. Tuberculous granuloma at the right anterior cranial fossa and its granulomatous adhe-sion to right optic nerve and chiasma were removed in one case. Intracerebral hematoma due to tuber-culous arterial change showed abnormal net-like vessels on angiography.

Total extirpation of tuberculoma was made in two cases.