神経内視鏡にて囊胞内リザーバー留置を行った高齢者再発頭蓋咽頭腫の1例

Neuroendoscopic Placement of the Reservoir in an Elderly Patient with Recurrenced Craniopharyngioma ： Case Report

Ⅰ．はじめに

　頭蓋咽頭腫の治療は経頭蓋的に腫瘍摘出術が行われることが一般的である．しかし高齢者では基礎疾患を有する患者も多く，術後合併症の頻度も高い．そこで重篤な基礎疾患を有する高齢者の頭蓋咽頭腫患者ではできるだけ低侵襲での治療が望まれる．近年，神経内視鏡を応用した治療法も散見されるようになってきている^4-8)．今回，われわれは僧帽弁閉鎖不全症に伴う慢性心不全および心房細動の既往をもつ高齢者の再発頭蓋咽頭腫例に対し，局所麻酔下に神経内視鏡を用い良好な結果を得た．そこで症例を呈示し，高齢者頭蓋咽頭腫に対する治療戦略や手術手技を中心に報告する．

We report a case of recurrent craniopharyngioma in the third ventricle with obstructive hydrocephalus ,which was successfully treated by placement of the Ommaya reservoir by neuroendoscopic procedure. A 72-year-old male with disorientation and gait disturbance was adomitted to our hospital. He had been suffering chronic heart failure and arrhythmia due to mitral valve insufficiency,and panhypopituitarism after the first craniotomy for craniopharyngioma. MRI demonstrated obstructive hydrocephalus at the foramen of Monro by the cystic tumor. Cyst decompression and placement of Ommaya reservoir were successfully performed in local anesthesia. Postoperatively,his disorientation and gait disturbance were improvement ,and no chemical meningitis developed. Neuroendoscopic management for cystic craniopharyngioma with obstructive hydrocephalus was effective procedure for elderly patient with systemic risk factor.