乳児頭蓋内奇形腫

INTRACRANIAL TERATOMA IN EARLY INFANCY

はじめに

　小児脳腫瘍に関する報告は枚挙に暇がなくその診断及び治療も他の脳神経外科領域の進歩とともに漸次向上の一途をたどつてはいる。しかしこの中にあつて1歳未満の乳児脳腫瘍は稀な疾患と考えられており，またその診断は必ずしも容易ではなく，たとえ発見され外科的治療が加えられたにしろその予後は悪く，したがって学問的興味を除けば，臨床上では余り問題にならないあきらめの疾患とさえいわれてきた。たしかにその発生頻度は全脳腫瘍の1％弱とされており，その摘出術も困難なものが多く，様々な補助療法をもつてしてもその遠隔は惨怛たるものであつた。しかし現今の発達した小児神経学及び小児脳神経外科学の知識を駆使し，乳児脳腫瘍の性格をよく把握するならば，その治療成績の向上も期して待つべきものがあると考える。

　さてこれら1歳未満の乳児脳腫瘍の中で，小児脳腫瘍には先天性腫瘍が多いといわれているのに反し，頭蓋内奇形腫は欧米での脳外科臨床ではその発生頻度は少ないようである。すなわち西欧では最多例数を誇るKoos^1）の19例の1歳未満乳児脳腫瘍には奇形腫は1例もなく，Jellinger^2）の18例では，僅か1例に奇形腫を認めるにすぎない。

Intracranial teratoma in early infancy under 1 year old is rare, especially in European countries, namely, only 1 cases can be found out of 18 cases of intracranial tumor under 1 year old by Jellinger, and no case out of 19 cases by Koos.

On this paper, 3 cases of intracranial teratoma out of 12 cases of intracranial tumor in early in-fancy were reported with the presentation of a successful removal case. In these 3 cases, (2 cases of male, 1 case of female), tumor were located on supratentorial, central neural axis, and were very huge, 270 g in average.

The surgical removal of this tumor was very difficult because of its deep location, large growth.

In our 3 cases 1 case died without surgery 7 days after birth, 1 case was lost 10 days after sub-total removal. One of them 5 months aged male with huge teratoma, 320 g in weight at the bilateral frontal base was successfully treated by total re-moval without any damage to the brain. There have been few report of successful removal of such a huge intracranial teratoma as far as we know.

The symptom and diagnosis of intracranial te-ratoma in early infancy were also discussed.