前頭開頭術後に生じた前頭蓋底粘液囊胞の2例

Two cases with frontal mucoceles that developed long after frontal craniotomy

はじめに

　前頭開頭術はクモ膜下出血や前頭蓋底腫瘍に対して行われる脳神経外科領域の標準術式である^1）。この術式では前額から頭蓋内にアプローチするため，前頭洞の発育の程度によっては，術中に創部に前頭洞が開放され，頭蓋内と鼻副鼻腔が交通することがある。その場合，前頭洞粘膜を鼻前頭管に充塡し，頭蓋内と副鼻腔を遮断する方法が行われる場合が多いが，術後に粘液囊胞を生じうることが問題となる。

　今回，われわれは前頭開頭術後に生じた粘液囊胞を内視鏡下鼻副鼻腔手術（ESS）で開放した2症例を報告する。

　We report two cases of frontal mucoceles that developed long after frontal craniotomy. Case 1 was of an 84-year-old woman who had undergone frontal craniotomy 23 years prior and presented with complaints of left eye protrusion and pain. Imaging examinations revealed a large frontal mucocele. Endoscopic surgery was performed, and the mucocele was marsupialized. Case 2 was of a 70-year-old woman who had undergone frontal craniotomy 11 years prior and presented with complaints of swelling in the forehead. Her CT scan revealed two cysts with a titanium mesh that had been placed during the craniotomy. An endoscopic modified Lothrop procedure（EMLP/Draf III）was performed to resect the two mucoceles.