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Neurological Surgery No Shinkei Geka Volume 32, Issue 9 （September 2004）

Neurological Surgery 脳神経外科 32巻9号（2004年9月発行）

Japanese English

症例

特異なMRI所見を呈した頸髄glioblastomaの頭蓋内播種 Unusual MR Appearance of Intracranial Dissemination from Cervical Glioblastoma 川島文子 ¹ , 笹嶋寿郎 ¹ , 菅原卓 ¹ , 高橋和孝 ¹ , 鈴木明 ¹ , 東山巨樹 ¹ , 木内博之 ¹ , 溝井和夫 ¹ Ayako KAWASHIMA ¹ , Toshio SASAJIMA ¹ , Taku SUGAWARA ¹ , Masataka TAKAHASHI ¹ , Akira SUZUKI ¹ , Naoki HIGASHIYAMA ¹ , Hiroyuki KINOUCHI ¹ , Kazuo MIZOI ¹ ¹秋田大学医学部脳神経外科 ¹Department of Neurosurgery,Akita University School of Medicine キーワード： spinal glioblastoma , intracranial dissemination , MRI Keyword: spinal glioblastoma , intracranial dissemination , MRI pp.937-944

発行日 2004年9月1日 Published Date 2004/9/1

DOI https://doi.org/10.11477/mf.1436100481

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Abstract 文献概要
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　Ⅰ．はじめに

頭蓋内原発のglioblastomaが脊髄へ播種性に転移することはよく知られているが，脊髄glioblastomaは原発性脊髄腫瘍の1.4％にすぎず¹³⁾，自然経過で頭蓋内播種を来すことは極めて稀である^9,11,18,35)．

　最近，病初期から頭蓋内へ播種したと思われる小児頸髄glioblastomaの1例を経験したので，その多彩な画像および病理所見を中心に，若干の文献的考察を加えて報告する．

　We reported a rare case of cervical glioblastoma with intracranial dissemination at an early stage of clinical course and reviewed the literature.

　An 8-year-old girl presented with failure of vision 3 months prior to admission to our hospital. Neurological examination on admission disclosed no definitive abnormalities except for bilateral visual disturbance and optic atrophy. Cranial MR images revealed a homogeneously enhancing tumor in the left sylvian fissure. Multiple spotty T2-hyperintensity lesions without contrast enhancement were also disclosed in bilateral cerebellum. Spinal MR images showed an enhancing tumor at C7 and tiny enhancing lesions on the surface of T11. The patient underwent an uneventful excision of the exophytic tumor at C7. The histological diagnosis was glioblastoma. The enhancing tumor in the left sylvian fissure treated by Linac stereotactic radiotherapy with a marginal dose of 38.4Gy in 12 fractions has diminished,whereas the residual tumor at C7 remained unchanged after radiation of 44Gy. In contrast,the multiple spotty lesions without contrast enhancement dispersedly spread in the cerebellum and infiltrated into brain stem despite 4 courses of chemotherapy using ifosfamide,cisplatin,and etoposide. Stereotactic biopsy of the multiple spotty lesions in the cerebellum was performed. Histological examination revealed anaplastic astrocytoma. The patient died 2 weeks after the biopsy despite additional chemotherapy and focal irradiation to the cerebellum.

　Early detection and selection of optimal therapeutic strategies are important in management of spinal glioblastoma with subarachnoid dissemination,since neuroradiological findings and therapeutic sensitivity are varied according to differentiation of disseminated tumors.