眼窩腫瘍に対する経頭蓋的摘除術の成績

Transfrontal removal of orbital tumors

　1971年より1983年の間に千葉大学付属病院および関連施設において，30例の眼窩腫瘍に対して，経頭蓋的眼窩腫瘍摘除術を施行した．患者は男性16例，女性14例で最若年者は2歳，最高齢者は76歳であった．病理組織学的には悪性腫瘍10例，良性腫瘍20例であった．術後経過観察が可能であった27例（悪性腫瘍10例，良性腫瘍17例）につき，術後合併症，後遺症の検討を行った．

　腫瘍の再発は悪性腫瘍4例，良性腫瘍1例に認められた．

　術後合併症は，以下のごとくであった．

（1）限瞼下垂：21例（84％）（全例回復）．（2）眼球運動障害115例（62.5％）（3例回復せず）．（3）瞳孔異常：4例（19％）（2例回復せず）．（4）視神経萎縮：1例．（5）死亡：5例（3例全身転移）．

We evaluated the results of transfrontal orbitoto-mv in 30 cases with orbital tumor over a 13-year period through 1983. The cases included 16 males and 14 females with ages ranging from 2 to 76 years. Histologically, 10 cases were malignant and 20 cases benign. The former included adenoid cystic carcinoma 3 cases, malignant mixed tumor of the lacrimal gland 2 cases, malignant lymphoma 4 cases and hemangioendothelioma 1 case. The latter included inflammatory pseudotumor 5 cases, hemangioma or meningioma 3 cases, neurofibroma 2 cases, and 1 case each of optic glioma, orbitalvarix, eosinophilic granuloma and arachnoid cyst.

A long-term follow up was possible in 27 cases. Recurrence of the tumor occurred in 4 cases of malignant and 1 case of benign tumor. Four cases died due to intracranial or systemic metastasis. Blepharoptosis was a major postoperative complica-tion and was observed in 21 cases. It was temporary in all the cases as full recovery set in in 1 week to 10 months. Disturbance of ocular movement occurred in 15 cases. Recovery set in in 12 cases during 10 months. Dilatation of the pupil occurredin 4 cases. It recovered in 2 cases within 8 months. Optic atrophy developed in one case. Our findings indicate that transfrontal orbitotomy is a safe and effective procedure for orbital tumors when performed under the op.7.rating microscope and with the cooperation of neurosurgeons.