頭蓋底部腫瘍における末梢性脳神経麻痺について

PERIPHERAL CRANIAL NERVE PALSY DUE TO TUMORS OF SKULL BASE

はじめに

　末梢性脳神経麻痺を来す疾患に関しては，もちろん単独の脳神経麻痺の場合も少なくないが，また一方では複数ないし両側の脳神経群が同時にまた逐次障害される事もあつて，その病因や病変の局在診断に関しては必ずしも容易でない。しかしその臨床的な脳神経症状の精細な分析により，病変の部位，診断が可能になる場合がある。

　そこで我々が過去13年間に経験した頭蓋骨腫瘍74例の中，頭蓋底部病変により末梢性脳神経麻痺を来した26例について，神経学的症状を主に検討を加えてみた。

During the past 13 years, 74 cases of skull tumor were treated at the Neurosurgical Department of Toranomon Hospital. Of these cases, peripheral cranial nerve palsy was found in 26 cases. We analysed these 26 cases from neurological point of view and obtained the following results.

(1) Clinical and pathological clanification of these 26 cases was as follows. Epipharynx and paranasal tumors were 13 cases (carcinoma 8, lymphepithe-lioma 3, sarcoma 2, unknown 1), metastatic tumors of the skull base were 6 cases (adenocarcinoma 3, sarcoma 2, neuroblastoma 1), primary tumors of the skull base were 4 cases (chordoma 2, fibro-sarcoma 1, chondrosarcoma 1) and the others were 3 cases (multiple myeloma 1, paraganglioma 1, histiocytosis 1).

(2) Initial symptoms of the epipharynx tumor were hyperesthesia of the face, double vision andswelling of the cervical lymphnode. At the early stage, epipharynx tumors showed paresis of the III rd, IV th, V th, VI th and VII th cranial nerves. And at the late stage, 3 of them showed the uni-lateral involvement of all cranial nerves,i.e., Garcin's syndrome.

Initial symptoms of the paranasal tumor were visual disturbance, headache and nasal bleeding. And during the course, visual disturbance was detected early in all cases. Five cases of the paranasal tumors showed the paresis of the II nd,III rd, IV th, V th and VI th cranial nerves or the orbital apex syndrome and exopthalmus was de-tected at 4 cases of them.

As most of the primary tumors of the skull base were found at the middle fossa, they showed the paresis of the II nd, III rd, IV th, V th, VII th and VIII th cranial nerves in high frequency.

Matastatic tumors showed a tendency of involve-ment of the II nd and VI th cranial nerves.