脈絡叢乳頭腫/乳頭癌7例の検討

Choroid Plexus Tumors : Report of 7 Cases in a Single Institution

Ⅰ．は じ め に

　脈絡叢乳頭腫/乳頭癌（choroid plexus tumor: CPT）は全頭蓋内腫瘍の0.4～1.0%程度といわれる稀な腫瘍である^3,15,22,24)．その好発年齢は2歳以下が全体の70%を占めると報告されており^3,5)，小児に多い^8,11,25)．好発部位は小児と成人で異なり，小児では側脳室，成人では第4脳室で多い²⁵⁾．脳室内に発生することがほとんどだが，稀に脳室外発生も報告されている^12,19)．治療に関しては，手術による全摘出の可否が予後にかかわるといわれるが^5,8,18,25)，補助療法については議論が分かれている．これまで単一施設での治療成績についてはいくつか報告があるが^{2,3,6,8,13,15,16,18,22)}，日本国内においては症例報告を散見するにとどまる^12,14)．本稿では当施設においてMRI導入以降の1989年より治療したCPT 7症例の臨床経過について検討し，過去の文献的考察を加えて報告する．

The management of seven patients with choroid plexus tumors,4 adults and 3 children (mean age 17.5 years) at our institution was reviewed. There were 4 cases of papilloma and 3 of carcinoma located in the lateral ventricle in 1 case,the third ventricle in 1 case,and the fourth ventricle in 5 cases. Total surgical excision was attempted in all patients. Total resection was achieved in three patients,resulting in no deficit in two and persistence of preoperative dysphagia in one. There was no recurrence after total resection. Subtotal resection was achieved in four patients,one of whom underwent second surgery resulting in total resection,and one patient died of respiratory disturbance after the third operation because of regrowth of the tumor. Complete excision could not be achieved in 3 of the 5 tumors located in the fourth ventricle because of extension to the brainstem. The median survival was 59.5 months for patients with papilloma,and 67.7 months for those with carcinoma. Adjuvant therapy was also required for carcinoma,one patient was treated by radiotherapy,and two by radiotherapy plus chemotherapy. Only one patient with papilloma was treated by radiotherapy plus chemotherapy postoperatively.