Conray脳室撮影の経験

EXPERIENCE WITH CONRAY VENTRICULOGRAPHY

はじめに

　頭蓋内疾患の診断上，X線による補助診断は心要欠くべからざるものであり，ことに最近の脳血管撮影の進歩により大脳半球の占拠病変などでは脳血管写のみで手術適応，手術法の決定に何ものにも勝る貴重な資料が得られる。

　しかし第三脳室周辺や後頭蓋窩に病変がある場合，どうしても診断確定のためには脳室写にたよらねばならないことが多い。脳室撮影は1918年Dandy^1）が陰性造影剤ともいうべき空気を用いて造影に成功し注目されて以来，頭蓋内疾患の診断に重要な役割をはたすようになり，気脳撮影，空気脳室撮影が繁用されてきている。一方1923年Sicardら^2）によって陽性造影剤による脳室撮影が報告されてから，Lipiodol, Thorotrast，その他の油性ヨード造影剤が相ついで用いられ^3），最近では主にMyodil （Pantopaque）が使用されるようになった^{4）5）6）7）}。

Central ventriculography at present is a very important procedure for accurate diagnosis of mass lesions near the third ventricle and in the posterior cranial fossa.

Forty-seven ventriculographies with water-soluble contrast medium, 60% Conray (methylglucamine iothalamate), were carried out on 39 patients with intracranial diseases by the procedure of direct catheterization to the third ventricle. Catheteri-zation to the third ventricle could be carried out with a fair ease, 1) on the basis of prior measure-ment of Foramen Monro position on plain film of the skull according to Fischer's method or on venogram of the brain and 2) by the use of image-amplifier at the time of catheterization. Descrip-tion was made on the detail of our procedure of central ventriculography.

The results were excellent for the diagnosis of intracranial mass lesions and several representative ventriculograms were shown.

Fever, headache, vomiting and convulsion were noted as side effects of central ventriculography with 60% Conray, however there was no death case by this procedure. Convulsion is the most dangerous side effect, so that fairly small amount of Conray, priorly diluted with CSF, should be used for the purpose of preventing this side effect.