急速な視力視野障害を呈した80歳の頭蓋咽頭腫に対して可及的摘出術と放射線療法が奏効した1例

An Elderly Case of Craniopharyngioma ： Treatment by Limited Surgery and Radiation Therapy

Ⅰ．はじめに

　頭蓋咽頭腫は全脳腫瘍の3.5％を占め，5～15歳の小児と40～60歳の成人に好発し¹⁷⁾，その治療方針は「小児は全摘をめざし，成人は可及的摘出にとどめる」と一般に認識されている^4,5,8,12,13)．一方，高齢で発症する頭蓋咽頭腫は稀で，特に80歳以上の高齢者の発症は日本脳腫瘍統計でも頭蓋咽頭腫1,823例中9例と全体の0.5％を占めるに過ぎず，一施設の経験数も少なく，高齢者頭蓋咽頭腫に対する治療方針については明らかではない．

　今回われわれは，急速な視力視野障害を呈した80歳頭蓋咽頭腫の稀な症例に対し可及的摘出術と放射線療法を行い良好な結果を得たので，高齢者頭蓋咽頭腫に対しての手術適応，手術方法に関する考察を加え報告する．

Craniopharyngioma accounts for approximately 3.5％ of all intracranial neoplasm and may occur at any age. However craniopharyngioma in the elderly was rare. We report a rare case of craniopharyngioma in an elderly patient,who was treated by radical surgery successfully.

　An 80-year-old male was admitted to our hospital with a history of visual disturbance and bitemporal hemianopsia. CT scan of the brain revealed a hypodense cystic mass with calcification in the suprasellar area. MRI demonstrated the optic chiasm was displaced superiorly. Her symptom deteriorated day short time of her hospitalized life. We decided to removal tumor radically because of saving her visual function.

　Subtotal removal of the suprasellar lesion was performed,followed by radiotherapy to the residual lesion. A visual impairment was improved after surgery. No recurrences had been detected on MRI eighteen months after the initial operation. Based on previous report and the clinical course of our case,radical surgery is sometimes needed for saving visual function in spite of elderly patient. However,in this case,sparing hypothalamic and pituitary function is essential for good prognosis.