翼口蓋窩に発生した巨大神経鞘腫の1症例

A Large Neurilemmoma in the Pterygopalatine Fossa:Report of a Case

　はじめに

　神経鞘腫はSchwann鞘から由来すると考えられている外胚葉系の腫瘍で，遠城寺ら^1）による良性軟部組織腫瘍の統計では，血管腫，脂肪腫に次いで多く発現し，部位別にみると頸部，頭部に多いが，翼口蓋窩に発生する頻度は比較的まれであるとされている。今回われわれは左翼口蓋窩から左側頭下窩にかけて発生した巨大な神経鞘腫の1症例を経験したので報告する。

A 52-year-old man, who complained of a swelling of the left cheek, showed a mass in the left pter-ygopalatine fossa extending to the cheek. The mass was diagnosed as neurilemmoma by an incisional biopsy through the oral cavity. CT revealed theextension of the tumor from the left pterygopalatine fossa into the major ossis sphenoidalis. Axial CT also revealed a protruding of the posterior wall of the left maxillary sinus, called a bowing sign. Under general anesthesia, the tumor was successfully removed through the transpterygoid approach. The tumor was 43g in weight and 65×40×40 mm in size. The transpterygoid approach was found useful for the surgical treatment of a large tumor in the pterygopalatine fossa.