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Shinkei Kenkyu no Shinpo Volume 50, Issue 2 （April 2006）

神経研究の進歩 50巻2号（2006年4月発行）

Japanese English

特集脳浮腫研究の進歩―基礎と臨床

髄膜腫周囲脳浮腫の発生 Peritumoral brain edema in intracranial meningiomas 田宮隆 ¹ , 小野恭裕 ² , 大塚真司 ² , 長尾省吾 ¹ Takashi Tamiya ¹ , Yasuhiro Ono ² , Shinji Otsuka ² , Seigo Nagao ¹ ¹香川大学医学部脳神経外科 ²岡山大学医学部脳神経外科 ¹Department of Neurological Surgery, Kagawa University School of Medicine ²Department of Neurological Surgery, Okayama University Medical School キーワード： brain edema , meningioma , VEGF , VEGF receptor Keyword: brain edema , meningioma , VEGF , VEGF receptor pp.259-269

発行日 2006年4月10日 Published Date 2006/4/10

DOI https://doi.org/10.11477/mf.1431100134

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髄膜腫に対する周囲脳浮腫は，一般に約60％の症例に認められ，vasogenic brain edemaと考えられているが，その発生の詳細な原因や機序については未だ解明されていない。その発生機序に関しては，（1）Cerebral compressive theory（Ischemia），（2）Vascular compressive theory（Stasis），（3）Secretory-excretory phenomenon, hormone theory，（4）Hydrodynamic theoryなどの仮説が挙げられる。また上記の機序を推測するために，腫瘍のサイズ，発生部位，組織型，腫瘍陰影，栄養血管，腫瘍に関係した静脈灌流閉塞などの関連する因子の検討が行われてきたが，一定の見解は得られていない。ここでは，髄膜腫における腫瘍周囲脳浮腫の発生について，筆者らの臨床的および分子生物学的研究をもとに，最近の知見について述べる。

In patients with meningioma, peritumoral brain edema（PTBE）is a well-known and interesting phenomenon, but its exact pathogenesis is not clearly understood. Several hypotheses have been proposed：1）Cerebral compression theory（Ischemia caused mechanically by tumor compression）, 2）Vascular compressive theory（Stasis induced by tumor in venous drainage areas followed by venous congestion）, 3）Secretory-excretory phenomenon or hormone theory（Excretory-secretory phenomenon in which substances produced by tumor appear in adjacent brain tissue that then induces edema）, and 4）Hydrodynamic theory（Hydrodynamic processes whereby extravasates from meningiomas appear in the surrounding brain tissue, for which leptomeningeal disintegration represents a prerequisite）. Various causative factors have been discussed, including the tumor size and location, histological differentiation, vascularity, tumor-related venous obstruction and the pial blood supply on brain-tumor interfaces. We examined the radiological and histological factors and the expression of vascular endothelial growth factor（VEGF）and its two major receptors, Flt-1 and Flk-1, on the development of PTBE in patients with intracranial meningiomas. Our data suggested that tumor infiltration into adjacent brain parenchyma and a pial-cortical blood supply were critical factors for the development of PTBE. Furtheremore the expressions of VEGF and VEGF receptors positively related to each other and to the formation of PTBE in patients with meningiomas. In addition, we discussed about various factors causing PTBE in patients with meningiomas described in literature.