Optociliary shunt vesselsを伴ったうっ血乳頭がみられた中間型松果体実質腫瘍の1例

A case of pineal parenchymal tumor of intermediate differentiation with bilateral papilledema with optociliary shunt vessels as the initial manifestation

要約　目的：初診時に慢性うっ血乳頭があり，松果体実質腫瘍と診断された1例の報告。症例：20歳女性が両眼の視力低下で近医を受診し，乳頭浮腫が発見された。所見：矯正視力は右1.0，左0.6で，右眼に−4.5D，左眼に−6.0Dの近視があった。複視はなく，うっ血乳頭とoptociliary shunt vesselが両眼にあった。MRIで，水頭症と松果体腫瘍があり，内視鏡による第三脳室底開窓術と腫瘍生検を行った。中間型松果体実質腫瘍と診断された。開頭による摘出術を追加し，腫瘍をほぼ全摘出した。頭蓋内圧の正常化に伴い，optociliary shunt vesselは消退し，矯正視力は右1.5，左1.0に改善した。手術4年後の現在まで再発はない。結論：本症例は緩慢に進行したと推定される中間型松果体実質腫瘍で，慢性のうっ血乳頭で発見された。

Abstract.　Purpose：To report a case of pineal parenchymal tumor with chronic papilledema as the initial manifestation. Case：A 20-year-old woman with impaired visual acuity in both eyes was diagnosed with papilledema and was referred to us. Findings：Visual acuity was 1.0 right and 0.6 left when corrected for −4.5D and −6.0D respectively. Both eyes showed papilledema and optociliary vessels. Diplopia was absent. Magnetic resonance imaging（MRI）showed hydrocephalus and pineal tumor. The patient received biopsy and fenestration of third ventricle, leading to the diagnosis of parenchymal pineal tumor of intermediate differentiation. Resection of the tumor with normalization of intracranial pressure was followed by disappearance of optociliary vessels and improved visual acuity of 1.5 right and 1.0 left. There has been no recurrence of tumor for 4 years until present. Conclusion：The present case was pineal parenchymal tumor of intermediate differentiation with chronic papilledema as the initial manifestation.