脳幹gliomaの症状

NEUROLOGIC SIGNS AND SYMPTOMS OF PONTINE GLIOMAS

I．はじめに

　橋，延髄に原発する髄内腫瘍（glioma）いわゆる脳幹glioma （brain stem glioma）の診断には，臨床神経学的検査が最も重要である事は云う迄もない。さらに今日，各種神経放射線学的診断法の進歩によつて，これら腫瘍のより正確な補助診断が確立されつつある。

　しかし神経症状によつて脳幹部病変が疑われても，その性質がはたして腫瘍性病変であるか否かと云う事が問題となる。又この部位の腫瘍は，一般に根治手術はもとより生検標本すら採取出来ない場合が少なくない。しかも髄液圧亢進を示す事が比較的少ないので，吻合術などの姑息的の手術的治療の適応さえない場合もある。したがつてこれらの治療は現在の所，主として放射線療法，化学療法などにたよらざるを得ない状態である。そして稀にはこれらの治療が著効を奏する事もあり，この様な場合に組織診断が確認されていなければ，予後が良好ということでむしろ腫瘍性病変を否定する様な事さえありうる。

The clinical material in this series consists of 21patients with pontine glioma who were seen overthe last fifteen years at the Department of Neuro-surgery, Toranomon Hospital, and Kyorin Universi-ty Hospital.

1) Neurologic symptoms and signs of the patientswere analysed. At the onset of their illness, gaitdisturbance and double vision were the most commoncomplaints.

All patients showed evidence of disturbance inone or more cranial nerves at the time of theiradmission to the hospital. The sixth and seventhcranial nerves were the ones most frequently in-volved. Among other neurologic signs, pyramidaltract signs, cerebellar signs, and nystagmus weredetected most frequently.

In most cases, unilateral cranial nerve disturbancewas detected. But in pyramidal tract signs, bilateraldisturbance was detected in 43% of the cases.

2) Based upon autopsies of ten of the twenty-one patients, the neurologic signs of pontine gliomashowed direct changes due to the tumor's invasion,bleeding, necrosis and softening rather than indirectchanges.

3) The clinical course of all twenty-one patientswas of a slowly progressive type.

4) Differential diagnosis was discussed in regard tovascular, degenerative, and infectious disease of pons,and tumors of the skull base, and meningeal car-cinomatosis which showed similar neurologic signs.