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Brain and Nerve No to Shinkei Volume 45, Issue 9 （September 1993）

Brain and Nerve 脳と神経 45巻9号（1993年9月発行）

Japanese English

症例報告

正常圧水頭症を呈した馬尾神経鞘腫の1例 Neurinoma of the Cauda Equina Associated with Normal Pressure Hydrocephalus 菅谷睦 ^1,2 , 野口信 ¹ , 堤裕 ¹ Mutsumi Sugaya ^1,2 , Makoto Noguchi ¹ , Yutaka Tsutsumi ¹ ¹東京逓信病院脳神経外科 ²自衛隊中央病院脳神経外科 ¹Department of Neurosurgery, Tokyo Teishin Hospital キーワード： hydrocephalus , spinal tumor , NPH（normal pressure hydrocephalus） , neurinoma , CSF protein Keyword: hydrocephalus , spinal tumor , NPH（normal pressure hydrocephalus） , neurinoma , CSF protein pp.871-875

発行日 1993年9月1日 Published Date 1993/9/1

DOI https://doi.org/10.11477/mf.1406900536

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Abstract 文献概要
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　症例は59歳女性で，見当識障害，歩行障害および尿失禁にて発症した。CTにて脳室拡大（NPH），脳槽シンチにてRIの腰部貯溜がみられた。髄液は濃黄色で混濁し，蛋白は4073mg／dlと高値を呈した。MRIにてL₁椎体後部にmass（馬尾腫瘍）が認められた。

　NPHは馬尾腫瘍による二次的なものと考え，腫瘍摘出によるNPHの改善を期待した。Th12，L1の惟弓切除のうえ，腫瘍を全摘した。病理は神経鞘腫であった。NPHの症状は術後約3週間でほぼ改善した。髄液蛋白は術後8週間で274mg／dl％以下に減少した。CT上脳室は術後4ヵ月で若干縮小し，1年半後には明らかな縮小をみた。

　脊髄腫瘍に伴った正常圧水頭症（NPH）が，シャント手術を施行せずに，腫瘍摘出のみによって治癒した報告は，本例を含め僅か10数例に過きない。脊髄腫瘍によって水頭症が発生する機序には，髄液蛋白（主にその増加）が関与しているものと考えられた。

Hydrocephalus associated with spinal tumors is a well known but not common phenomenon. Over 80 such cases have been reported since 1931 by Kiri-eleis. Most of those cases present features of raised intracranial pressure, for instance papilledema. The histological diagnosis of the tumors is ependy-moma (1/2), neurinoma (1/4) and malignant astro-cytoma (1/4).

On the other hand dementia as a symptom of spinal tumors has been reported only 13 times. In 11 of 13 cases presented with signs of NPH, mental status improved only by removal of the tumors without shunt operation. The histological diagnosis of the tumors is neurinoma (9 cases) , ependy-moma (2) and meningioma (2) . Ours is the 14th case.

A 59-year-old woman presented a 6 month his-tory of memory disturbance, gait disturbance and urinary incontinence. CT scan showed ventricular dilatation. RI cisternography revealed a block at lumbar region. CSF obtained by lumbar puncture was deep yellow and turbid. CSF protein level was markedly elevated to 4073 mg/dl. MRI of the spinal cord demonstrated cauda equina mass. Total removal of the spinal tumor was preformed. The histological diagnosis was neurinoma. Within 3 weeks the patient's symptoms had dramatically improved. The decrease in ventricular size was noted on CT 18 months after operation.

We think one of the most important factors by which spinal tumors develop NPH is elevation of the CSF protein content. In our case, postoperavtive protein level decreased from 4073 to 274 mg/dl. It is considered elevation of the CSF protein disturbs absorption of CSF and causes arachnoiditis. Un-usual protein constituents may lead to hydroce-phalus. But the pathophysiology is still unclear. NPH should be considered as a cause of dementia. We can treat dementia, as a sign NPH associated with spinal tumor, not by shunt operation but only by removal of the tumor.