43年間にわたりくも膜下出血を繰り返した松果体細胞腫の1例

A Case of Pineocytoma Causing Repetitive Subarachnoid Hemorrhage for 43 Years

Ⅰ．はじめに

　今回われわれは，原因不明のくも膜下出血（SAH）として43年間経過観察されていた松果体部腫瘍に対し，摘出術を行うことでSAHの発症を制御できた症例を経験した．脳動脈瘤破裂以外のSAHの出血源としては，動脈解離，硬膜動静脈瘻（AVF），動静脈奇形（AVM），静脈，凝固障害，下垂体卒中などが知られている．本例のSAHの原因となった松果体腫瘍の出血，すなわち松果体卒中は，1976年のApuzzoらの報告以降散見されるが，頻度は稀で詳細は必ずしも明らかでない^1,3,10)．本症例の詳細について文献的考察を加え報告する．

　A 61-year-old woman had suffered from severe headache and nausea over 20 times during the last 43 years. An subarachnoid hemorrhage (SAH) was detected by spinal puncture in some other hospitals, but the source of hemorrhage remained unknown in spite of repeated angiography. At the age of 61, she was diagnosed as having normal pressure hydrocephalus, and received a ventriculo-peritoneal shunt. She suffered from sudden headache 12 days after surgery. A CT scan showed a SAH and enlargement of the pineal mass. The tumor was totally removed via the occipital interhemispheric transtentorial approach and was diagnosed histologically as a pineocytoma. She has been free from SAH for three years since removal of the tumor. Pineal apoplexy should be considered as a cause of SAH.