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Brain and Nerve No to Shinkei Volume 37, Issue 2 （February 1985）

Brain and Nerve 脳と神経 37巻2号（1985年2月発行）

Japanese English

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原著

脳腫瘍におけるblood-brain barrier opening microcirculation BARRIER OPENING MICROCIRCULATION IN HUMAN BRAIN TUMOR 佐藤周三 ¹ , 戸谷重雄 ² , 大谷光弘 ² Shuzo Sato ¹ , Shigeo Toya ² , Mitsuhiro Otani ² ¹国立埼玉病院脳神経外科 ²慶応義塾大学脳神経外科 ¹Department of Neurosurgery, National Saitama Hospital ²Department of Neurosurgery, Keio University pp.109-113

発行日 1985年2月1日 Published Date 1985/2/1

DOI https://doi.org/10.11477/mf.1406205450

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Abstract 文献概要
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　抄録　高張液動注によるblood-brain barrier （以下BBB） opening chemotherapyの適応を検討するために，手術中にglycerolもしくはmannitolを浅側頭動脈より逆行性に動注し，経時的にfluorescein sodiumを動注し，顕微鏡に接続したカメラにて螢光連続撮影を行い，腫瘍表而のmicrocirculationの変化につき検討を行った。対象は多形性神経膠芽腫2例，星細胞腫2例，転移性脳腫瘍1例の計5例である。多形性神経膠芽腫においては，BBB opening後には灌流が増加しfluoresceinの漏出は主としてvenuleにおいて著明に見られたが，星細胞腫においては，5〜10μの血管への灌流が減少し，fluoresceinのvenuleよりの漏出も見られなかった。転移性脳腫瘍においては，BBB opening前にも腫瘍のarterial capillaryからvenouscapillaryにかけてfluoresceinの漏出が見られ，これがBBB opening後にはさらに増強した。結論：BBB　openingの効果は，悪性度の高い脳腫瘍のvenuleにおいて強く現れる傾向が認められ，low grade astro—cytomaに対する影響は少なかった。

The changes of the human tumor microcircula-tion after blood-brain barrier (BBB) opening was studied. BBB opening was performed by retro-grade injection of hyperosmotic solution, such as mannitol or glycerol, from superficial temporal artery in the operation procedure.

Serial fluorescein micro angiography of human tumor surface was taken by motor-driven camera equipped to surgical microscope. Two glioblast-omas, two astrocytomas and one metastatic tumor were studied.

In glioblastoma multiforme, after BBB opening, fluorescein sodium perfusion was increased with the enlargement of the venules and extravasation of fluorescein sodium was also observed from venules by the late venous phase of fluorescein microangiography.

In low grade astrocytoma, after BBB opening, fluorescein sodium perfusion was relatively de-creased in the vasculature which diameter was from 5μm to 10μm and no extravasation of fluorescein sodium was observed from the venules.

In metastatic brain tumor, extravasation of fluorescein sodium was observed, ever before BBB opening, especially from arterial capillary or venous capillary. After BBB opening, extravasation of fluorescein sodium from those capillaries was increased and the tumor staining of fluorescein sodium was observed after BBB opening.

But in low grade astrocytoma, BBB disruption was not observed. The effect of BBB disruption was more marked in malignant tumor, but little effect was observed in low grade astrocytoma and normal brain tissue. The degree of BBB dis-ruption is depend on the volume and speed of hyperosmotic solution. Using our methods of volume and speed, we could observed the different BBB disruption according to the malignancy of the tumor. The difference of BBB reaction to hyperosmotic solution between low grade astro-cytoma and malignant tumors is their stability of the BBB.

Judging from the different BBB reaction to hyperosmotic solution, the best indication to BBB opening chemotherapy is the tumor that BBB dis-ruption is observed after BBB opening such as glioblastoma, but low grade astrocytoma, which showed no reaction to blood-brain opening, is not a indication. Metastatic tumor which showed the strengthening of fluorescein sodium extarvasation is the relative indication of the BBB opening chemotherapy.