松果体部腫瘍

TUMORS OF THE PINEAL REGION

はじめに

　Cushing^2）以来，最も難かしい手術の一つに数えられている，松果体部腫瘍の手術に関しては，シャント術と放射線治療が最も適切な治療法であると主張する人達^4）も多い。

　しかし，我々が現在までに経験した多数の症例をふり返つてみると，やはり各々最良の治療法があり，画一的な方法論では，松果体部腫瘍の治療を誤るおそれがある。

Seventy one cases of pineal tumors have been seen at our clinic up to Sept. 1971. We examined signs & symptoms of these tumors comparing with operative findings and pathological report. The purpose of this report is to establish the best way to treat each tumor case by case before operation analizing signs & symptoms.

Conclusion :

1) Although initial signs & symptoms of intra-cranial hypertension are popular among the lesion, cases with initial symptoms & signs other than intracranial hypertension are found 66 %, especially cases which start with ocular sign & symptom are 36%. So initial ocular signs & symptoms are characteristic of tumor of this region.

2) Precocious puberty is pathognomonic for tera-toma.

3) Tumor of cases exhibiting polyuria & poly-dipsia or amenorrhea is thought to be protruding toward the anterior third ventricle, influencing the hypothalamo-hypophysial system. The prognosis is poor if without irradiation.

4) Tumor of those presenting cerebellar sign is thought to be extending to the posterior direction.

5) Tumor of those displaying multiple signs & symptoms is thought of infiltrative.

6) Tumor of those without intracranial hyper-tension is regarded as infiltrative.

7) Tumor of those with onset other than intra-cranial hypertension is again infiltrative.

8) Although teratoma is classified to benign tumor, our result was poor, because most patients have reached very poor conditon before operation.

9) Regarding the prognosis about pinealoma and glioma, there are great difference between those with and without postoperative irradiation.

With these conclusion, we must predict the histo-logy and extent of the tumor before operation, and choose the best therapy. But with these results only, we can not tell the histology exactly. Recent-ly we devised ventriculofiberscope. With this we can see directly the pineal region and tumors, and we can take out a piece of tumor. This small fragment is examined histologically, and plan of therapy will be established. Additionally we exa-mined the pineal calcification, and difference bet-ween pineal tumor group and outpatient group is presented. The difference of both group is re-markable up to thirty years of age. If we can detect pineal calcification in a young boy, we must consider pineal tumor.