視力・視野障害を初発症状とした脊索腫の2例

Disturbed vision and visual field as initial signs in two cases with chordoma

　視力・視野障害を初発症状とした脊索腫chordomaの2症例を報告した．

　症例　1　38歳男子は右眼耳側の半盲性暗点，症例2　65歳男子は左眼下方の半盲性暗点を認めた．2例とも頭部単純X線撮影とCTにより，トルコ鞍部にchordomaに特徴的な所見が認められ，経蝶形骨洞腫瘍摘出術を行った．症例1は腫瘍はほぼ全摘出可能であったため，術後の視機能に改善がみられたが，約1年後再発し視機能は再び悪化した．症例2は腫瘍部分摘出にとどまり，術後の視機能は悪化した．

　Chordomaは骨を破壊しながら進展する腫瘍であり，放射線感受性も低いため，良好な視機能の回復のためには，完全摘出が可能な早期に発見することが重要と考えられた．

Two cases of intracranial chordoma manifested reduced visual acuity and field defect as initial signs of the disease. Both were males, aged 38 and 65 years each. Right temporal hemianoptic scotoma developed in the first case and left inferior hemianoptic scotoma in the second. In both cases, skull roentgenogram and CT scan revealed characteristic features of chordoma. Both were treated by surgery through transsphenoidal approach. An improvent in visual functions resulted in the first case as the extradural tumor could be com-pletely resected, to be followed by aggravations due to recurrence of the tumor one year later. The visual functions in the second case deteriorated further as the tumor could be resected only partially. Early recognition and total resection seemed to be essential for the preservation of vision as the tumor invades destroying the skull base and is notoriously radio-resistant.

Rinsho Ganka (Jpn J Clin Ophthalmol) 40(7) : 823-829,1986