視力障害顕著な腦下垂体部腫瘍症例に対する改良経鼻手術成績

The Effects of the Operation"Rer-septal Mehtod"in Tumours of Pituitary Regions With Serious Disturbance of Vision

緒言

　脳下垂体部腫瘍の手術的療法は，その解剖学的位置の関係上今世紀初頭より開頭法，経鼻法の全く相異つた経路による二大手術法に分れ，両者の鎬を削る懸命の努力は幾多の迂路曲折を経たとは言え，必然的にこれが手術法の長足の進歩をもたらし，且又最近の抗生物質の発達と相俟ちその手術成績は輓近格段の上昇を遂げ我々をして刮目せしめるものがある。

　現在該部腫瘍の剔出手術は主に適応範囲の広い前頭開頭法によるのを常識とされている様である。曾て脳外科の泰斗Frazier,C．H．，Cushing，H．等をして脳下垂体腫瘍に対して開頭法より遙かに勝るとまで言わしめた経鼻法は，極く少数の耳鼻科医が特技的に行つているに過ぎない現状である。この経鼻法の改良進歩をもたらしめたO．Hirschの経鼻中隔法を，当耳鼻科教室の高橋良教授が更に改良する事により術野を充分に拡大し得て，その最初の第1例を1949年（昭和23年）に施行して以来経験を重ねるに従いその手術成績は漸次向上して来た。殊に最近の数例の手術経験では被膜内完全摘出も可能と見られるに至つたので，此処に従来迄の全16例，19回の手術成績を総括して考察を加え，本手術法による効果及び開頭法との比較等に就て述べて見たい。

Prof. R. Takahashi has improved the perseptal method originally introduced by Hirsch for the endonasal removal of tumours and has applied this method in all 16 cases or 19 times of pi-tuitary tumours. By the author its effects on the visual disturbance, visual field and endoc-rine disturbance etc. have been observed, and also a comparison with the cranial method co-ncerning its difficulty and prognosis has been made. This improved method requires a sho-rter time and is easier than the cranial meth-od. Furthermore, when a re-operation is ne-cessary, the second operation is more readily carried out, and when the tumour is located in an intrasellar position, a complete removal is possible. There has been no case up to date, in which the direct cause of death was due to this operation. The prognosis of visual acuity and visual field has been satisfactory providing that the optical fascicular atrophy was not re-markable and the tumour was non-malignant. Conclusion: Concerning the therapy of ocular disturbance caused by pituitary tumours, the endonasal method proved to be more easier and effective and demonstrated a more satisf-actory prognosis compared to the cranial me-thod provied that the tumour was located in an intrasellar position.