両側側脳室脈絡叢乳頭腫—2自験例の検討と文献的考察

BILATERAL CHOROID PLEXUS PAPILLOMAS OF THE LATERAL VENTRICLES:REPORT OF TWO CASES AND REVIEW OF LITERATURES

　抄録　きわめて稀な小児の両側側脳室脈絡叢乳頭腫を2例報告した。いずれも中枢神経系の奇形を合併しており，それらの水頭症の発生機序には複数の要素が関与していると思われた。又，両側乳頭腫の場合CTによる診断も慎重であるべきことを示唆した。症例1：8歳男児。2歳時に原因不明の水頭症にてV-Ashuntを行ない，以後順調に発育していたが，突然昏睡に陥り入院。shunt不全が認められ脳室drainageを設けたところ，大量のCSF流出が見られ52時間後に死亡した。剖検にて両側側脳室に乳頭腫が確認されたが，生前のCTでは腫瘍を同定し得なかつた。症例2：1歳女児。7ヵ月時頭囲拡大を主訴に来院。CTにて交通性水頭症が見られ，V-P shuntを施行したところ腹部膨隆し，　V-A shuntとするも次第に意識低下，大泉門膨隆を見て脳室drainageとした。この頃CTにて両側乳頭腫が確認されたため，根治手術を行なつた。術後もV-Pshuntが必要となつたが，経過は良好である。

Two rare cases of bilateral papillomas of the choroid plexus located in both lateral ventricles in childhood were reported and literatures were reviewed. Both cases accompanied other malfor-mations of the central nervous system, one of which was holoprosencephaly (abortive type) and the other dysgenesis of frontal and temporal lobes. In childhood, papillomas often originate from the left lateral ventricle, but in rare instan-ces they raise bilaterally. Case 1 was an 8-year-old hydrocephalic boy who had grown up normally with the aid of a shunt for six years. He suddenly fell into comatous state and admitted to our hospital. Shunt dysfunction was suspected and a ventricular drainage was performed. Soon after that, enormous amount of cerebrospinal fluid began to flow out rapidly and continuously causing the death of the patient 52 hours later. Papillomas of the choroid plexus of bilateral ventricles were encountered at autopsy, but CT scan taken before the death failed to demonstrate the existence of them. Case 2 was an 1-year-old girl who had an episode of progressing enlargement of the head size. She was admitted to our hospital in her 7 th month. CT scan showed the dysgenesis of frontal and temporal lobes with markedly dilated vent-ricles. A ventriculo-peritoneal shunt was perfor-med, but another episode of enlargement of the head size and progressive abdominal bulging occured and then it was changed to a ventriculo-atrial shunt. Later an enhanced CT scan revealed papillomas of the choroid plexus in both lateral ventricles and they were resected totally. Post-operative course was uneventful, and although another ventriculo-peritoneal shunt was needed, she became well developed since then. Possible causes of hydrocephalus with these cases were discussed and several probable factors were elicited. They were overproduction of cerebro-spinal fluid, subarachnoidal space blocking and malabsorption of CSF, respectively. CT scan must be carefully analysed in such case as bilateral tumors, although it is said mostly available for the diagnosis of papillomas.