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Neurological Surgery No Shinkei Geka Volume 40, Issue 3 （March 2012）

Neurological Surgery 脳神経外科 40巻3号（2012年3月発行）

Japanese English

研究

類上皮腫に対する外科的治療と長期治療成績 Long-Term Outcomes of Surgical Treatment for Epidermoid 菊地善彰 ¹ , 竹村直 ¹ , 久下淳史 ¹ , 佐藤慎哉 ¹ , 嘉山孝正 ^1,2 Zensho KIKUCHI ¹ , Sunao TAKEMURA ¹ , Atsushi KUGE ¹ , Shin-ya SATO ¹ , Takamasa KAYAMA ^1,2 ¹山形大学医学部脳神経外科 ²国立がん研究センター ¹Department of Neurosurgery,Yamagata University Faculty of Medicine ²Division of Neurosurgery,National Cancer Center Hospital,Tokyo,Japan キーワード： epidermoid , surgery , long-term outcome Keyword: epidermoid , surgery , long-term outcome pp.211-219

発行日 2012年3月10日 Published Date 2012/3/10

DOI https://doi.org/10.11477/mf.1436101667

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　類上皮腫は，これまで，部分摘出とすれば高率に再増大し，術後の水頭症の合併も多いと考えられてきており，Yaşargilら⁹⁾やSamiiら⁶⁾に代表されるように，全摘出が勧められてきた．しかし，しばしば脳神経や血管との癒着が強い腫瘍であり，morbidityは決して低くはない．また，近年では残存する腫瘍の再増大率は比較的高くなく，増大する場合でもその増大速度は非常に遅いという報告が散見されるようになってきている⁷⁾．

　類上皮腫に対する当科の手術方針は，腫瘍被膜とその周囲のくも膜を可能な限り鋭的に剝離し，可及的摘出を原則としているが，剝離不能な場合はmorbidityを来さぬことを第一義とし，無理な摘出は控え意図的に亜全摘や部分摘出としてきた．

　今回，当科の類上皮腫に対する長期治療成績を検討したので，文献的考察を加え報告する．

　Objective: Surgical strategies for epidermoids in our department is that the tumor capsule and surrounding arachnoid membrane should be sharply dissected and resected as much as possible. However,if total resection is not possible,because of the danger of surgical morbidity,partial resection should be carried out. The present study reports on long-term outcomes of surgical treatment for intracranial epidermoid in our department.

　Methods: Since 1994, intracranial epidermoids have been resected in 13 patients in our department. The mean age at the time of surgery was 50.2 years and the mean postoperative follow-up period was 75.8 months. Surgical outcome, postoperative morbidity, Karnofsky Performance Status (KPS) during long-term follow-up, hydrocephalus, and regrowth rate were investigated.

　Results: Among the 13 patients, 5 underwent total resection, 5 subtotal resection, and 3 partial resection. No permanent morbidity occurred and KPS did not worsen postoperatively in any of the patients. Surgery for hydrocephalus was performed in 3 patients. However, hydrocephalus had been suspected before surgery in each patient. Regrowth occurred in 1 patient, showing malignant transformation 1 year after total resection. No regrowth during long-term follow-up was observed in the other 12 patients, and none showed exacerbation of KPS.

　Conclusion: The present study indicates that regrowth does not necessarily occur in patients with epidermoids. Although total resection is ideal,to avoid any surgical morbidity is even more important. Partial resection should be performed if total resection is impossible.