頸静脈孔症候群で発症した脊索腫の1例

REPORT OF A CHORDOMA PRESENTING JUGULAR FORAMEN SYNDROME AS THE INITIAL SIGNS AND SYMPTOME

はじめに

　頭蓋に発生する脊索腫（Cranial chordoma）は，全頭蓋内腫瘍の0.1〜O．3％（著者等O．3％）といわれ，稀な腫瘍ではあるが，その報告例は少くない。しかし，これらの報告にみられる症例の多くは，斜台部，下垂体部，鼻咽腔等の正中線上に発したものか，或いはこれらが著しく進展して，複雑な症状を示して来たもので，一側の頸静脈孔症候群のみを呈した症例の記載は，著者等が渉猟し得た限りでは，Vandor^1）（1958）が頸静脈孔のレントゲン診断について記載した論文の中に1例をみるに過ぎない。

　著者等は，特異な頭痛に始まり，発症の比較的初期より左頸静脈孔症候群を呈した脊索腫で，手術的に確認し得た1例を経験したので，以下の点につき，著者等の経験に文献的考察を加えて報告する。

A case of chordoma initiating from the involve-ment of the left jugular foramen is presented.

Such a chordoma might be considered to originate from one of the branches of notochord which dis-tribute in the parapharyngeal space.

Chronologically, this tumor can be differentiated from the glomus jugular tumor, in most of which some otological symptoms and signs will be followed by those of the lower cranial nerves.

The two steps of operative procedure seen to be best for the treatment of this tumor. Firstly, the suboccipital extracranial approach will be car-ried out for the partial removal of the posterior portion of the tumor. Thereafter, several weeks later, the second operation will be performed through the transpalatal way for the extirpation of the remained tumor.

The effect of X-irradiation, total dosis of 7000 to 8000 R or more, might be expected in the case of remaind tumor, which cannot be completely extirpated by the above operative procedures.

Our revised classification of the chordoma is described from the points of its symptoms, localiza-tion and treatment.