後頭蓋窩慢性クモ膜炎の検討

CLINICAL STUDY ON THE CHRONIC ARACHNOIDITIS IN THE POSTERIOR FOSSA

I．はじめに

　後頭蓋窩慢性クモ膜炎は既に成書にも記載されてはいるが，日頃あまり関心も持たれず等閑視され過ぎている感がないでもない。

　今回我々は，手術所見により後頭蓋窩慢性クモ膜炎と確認し得た6例と，クモ膜下腔内空気注入により症状の改善が認められた6例の計12例の後頭蓋窩慢性クモ膜炎症例を経験したので共通の特徴点と思われる知見について最近の脳神経外科診療上の立場から再検討した。

In this paper, clinical study on 12 cases of chronicarachnoiditis in the posterior fossa is reported.

Six patients were operated on. Three cases dis-closed cystic formation, two cases exhibited thicken-ing and adhesion of the arachnoid membrane, andthe other had both changes in the lesion.

In all of them, the surgical removal of the cystsor detachment of arachnoiditis adhetive producedexcellent improvement.

On the other hand, Six nonoperative cases im-proved significantly and quickly after lumbar airinsuffiation for examination.

In this study, we discuss several points in theclinical manifestation, diagnosis, and therapeuticprocedure from our 12 cases.

1) Patients occasionally had postanamnesis of headtrauma, chronic suppurative infection, such as otitismedia, sinuitis et al.

2) The course of this disease was charachterizedby its sudden occurence and intermittent symptoms.

3) Adjacent cranial nerve involvement, especiallyin the cerebellopontine angle cranial nerves, dis-closed the variety and bilaterality of lesion. Re-markably, disturbance of bilateral vestibular andcochlear nerves were found in eleven cases out oftwelve.

4) In the oto-neurological examination, peripheralvestibular disorder and retrocochlear disturbancewere found commonly in our cases. Markedly, thecaloric test revealed canal paresis (CP) on the moreimpaired side, but there were no cases with noresponse.

5) Skull X-ray studies did not disclose any findingsof dilation or destruction of the internal meatus.

6) Pneumoencephalo-tomography was found to beof significant diagnostic value to detail the finechanges in this lesion.

7) Occasionally, the symptoms were relieved inthe course of pneumoencephalographic studies. Theevidence convinced us of the probability of arach-noiditis chronica in the patient.