松果体腫瘍にみられた異常血管—照射療法後の血管写所見の変化について

PATHOLOGIC VESSELS IN PINEALOMA:ANGIOGRAPHICAL CHANGES AFTER RADIATION THERAPY

Ｉ．はじめに

　松果体腫瘍，特にtwo cell pattern pinealomaの治療についてはこれまで多くの報告がなされてきた。一般に局在的，生物学的特徴により摘出手術の予後は必ずしも良くない。一方照射療法の有効な例の多いことが知られており，したがつてシャント手術と照射療法の併用，照射療法単独などの治療方法もひろく行なわれている^{1），4），5），6），9），10），13），15）}。

　その診断にあたつては依然として脳室撮影法が主力をなしており椎骨動脈撮影法の診断上の応用価値はそれほど重視されていなかつた。

It is generally accepted that two cell pattern pinealoma responds favorably to radiation therapy. We reported two cases of this type of pinealoma, which showed the marked figures of tumor vascu-larization and its disappearance after irradiation.

The first case was a 14-year-old boy, who was admitted because of visual disturbance, headache, vomiting, drowsiness and epileptic attacks. Pneu-moventriculography showed internal hydrocephalus and a huge filling defect in the third ventricle. Vertebral angiography revealed the tumor vascu-larization with feeding arteries and prominent draining veins into the internal cerebral vein in the posterior portion of the third ventricle. These proliferations of tumor vessels disappeared after radiation therapy with 6000 rads. This tumor could be diagnosed as two cell pattern pinealoma by epitheloid cells existing in the cerebrospinal fluid.

The second case was a 17-year-old boy, who was admitted because of double vision, nausea, vomiting and tinnitus. Conray ventriculography showed a huge filling defect in the posterior two thirds of the third ventricle. Vertebral angiography revealed the tumor vascularization and feeding arteries in the same portion. He was irradiated with 6000 rads, 'then the pathologic vessels disappeared with good clinical recovery.

The disappearance of pathologic vessels after radiation therapy may show that the occlusion of tumor vessels also increases the effectiveness of irradiation.