Craniopharyngiomaの術後経過の検討

STUDIES ON POSTOPERATIVE COURSE OF CRANIOPHARYNGIOMA

緒言

　Cushing （1932）以来，幾多の脳神経外科医にかせられて来たCraniopharyngiomaの外科的治療に関する苦悩^1）〜8）は，視床下部，下垂体領域に対する外科的侵襲の限界への闘いとも言え，副腎皮質ホルモンの使用^9）を始め，手術法の工夫^{10）6）11）}，術後管理の進歩^12），放射線療法の併用^13）14）等により一歩一歩治療成績の向上をみてきてはいるが，未だ未解決の問題点も少なくないのが現状である。

　われわれの教室に於ける本腫瘍の治療成績は必らずしも良好とは言えず，その意味からも，今回は治療法及び術後経過を中心に当面する問題点を検討してみた。

(1) The surgical treatment of craniopharyngioma has been challenging problem for the neurosurgeons. It is the purpose of this paper to analyze the surgi-cal procedure and the postoperative course of 26 patients.

(2) 5 cases were treated by total removal of the tumor, 18 cases by subtotal and 3 cases by partial removal. Follow-up study showed that death had occured in 15 cases ; 58 per cent of the 26 patients. The operative and the hospital mortality were 27 and 46 per cent respectively.

(3) It was noted that 3 patients died of circula-tory collapse, presenting diabetes inspidus, variable serum sodium level and remission and exacerbation of consciousness. The other 3 cases died of adreno-cortical dysfunction following insufficient replace-ment therapy.

(4) Eleven cases : 42 per cent of the 26 patients, are known to be alive at the present time. The follow-up periods on these cases vary from 2 months to 6 years.

(5) Out of 11 cases who are alive, 5 patients show no or minimal residual symptoms while 4 patients have moderate residual and 2 patients areobligated to be bed-ridden.

(6) Abnormal serum sodium level, diabetes in-spidus and hyperchoresteremia in postoperative course were analyzed and discussed in detail.

(7) It is our conclusion that the tumors extend-ing to hypothalamus or causing disturbance of consciousness or presenting both should be restricted to aspiration of cyst or partial removal of the tumors for decompression followed by supplementary treat-ment and microsurgical technique should be more commonly applied.