老人脳腫瘍の臨床的研究

A CLINICAL STUDY ON BRAIN TUMOR IN AGED PERSONS

　経済成長と医学の進歩は，わが国における平均寿命の延長と人口構成の老令化をもたらし，さらに人口増加は老人層の増加を一層著しいものにして来ている^22）。この老年層の増加とともに，老令患者数，さらに老令者手術症例数も年々増加して来ており^{14）16）21）24）}，脳神経外科においても，その例外ではない。よつて老令疾患の今後の重要性の中で，われわれの扱つた脳腫瘍の症例を検討してみた。

　統計的には老人の脳腫瘍は極めて稀とされているが^{15）17）26）40）45）}，種類別にしてみると，さほど稀なものではないし^31）45），全体としても，われわれの症例では増加の傾向にある（第1表）。

The incidence of brain tumor in the aged is recently not so rare, but rapidly increasing.

A series of 38 patients over 60 years of age, treated in our clinics in the years 1955 to 1971, is presented.

In the first group of 17 patients admitted on foot, three of 14 operated patients (21.4%) died and none of 3 nonoperated ones died in the course of hospitalization. In the second group of 21 patients admitted on stretcher, six of 13 operated ones (46.1%) died and 6 of 8 nonoperated ones (75.0%) died in the course.

Of 15 patients who died in the hospital, six died of original disease or extension of tumor, three died of gastrointestinal hemorrhage, three of posto-perative brain edema, two of cerebrovascular acci-dent and 1 of pneumonia.

The most common tumor was metastatic one which was followed by glioblastoma multiforme, meningioma and others in order. The metastatic tumor was found in 10 patients and 7 of them (six males and 1 female) were from lung cancer. These tumors on the whole were observed more commonly in men than in women, by a ratio of 3 : 1.

Mortality rate was higher in patients without choked disc rather than in those with it and also very high in those with advanced angiosclerosis of retina.

About a half of 21 patients, whose lumbar tap was performed shortly after hospitalization, showed a normal value of CSF pressure, and cell count, protein and sugar contents were normal in a few cases of them. EEG was interpreted as normal in several cases, particularly on the paramedian and posterior fossa locations.

Concerning the symptoms and signs of the brain tumor in the aged, the following clinical features should be emphasized ; (1) such a patient is of ten misdiagnosed as vascular accident or encephalitis, (2) signs of increased intracranial pressure occurs rather rarely, but mental symptoms frequently, (3) choked disc in the aged is noted less than that in the young, (4) occasionally the shift of midline structure is not apparent on x-ray film, probably because of the presence of enough free space sur-rounding the expanded mass.

In this study mortality rate was intimately re-lated to the general condition of patient. We emphasized an early diagnosis and treatment should be done, taking care of some features as above, while the general condition of old patient remained well yet.