術後髄液管理に難渋しakinetic mutismを来した脳室内髄膜腫の1例

A Case of Intraventricular Meningioma Manifesting Akinetic Mutism after Complicated Management of Hydrocephalus

Ⅰ．はじめに

　脳室内腫瘍は摘出の困難さに加えて術後の髄液管理に難渋することが多い．われわれは大きな脳室内髄膜腫の術後に脳室の拡大と縮小を繰り返した症例を経験した．その経過中にakinetic mutismと思われる意識障害が出現し，bromocriptineを投与したところ意識の改善が得られた．最終的な髄液管理も含めその経過を報告する．

　A 26-year-old male with large intraventricular meningioma developed acute hydrocephalus postoperatively, which was difficult to manage. After a repeated course of dilated and slit-like ventricle, he gradually presented a disturbance of consciousness, which was recovered by the use of bromocriptine, suggesting akinetic mutism. At the chronic stage, he suffered from symptoms of hydrocephalus again. Time-slip MRI revealed the stasis of CSF flow around the third ventricle. Neuroendoscopy disclosed that the foramen of Monro was occluded with membrane. After endoscopic third ventriculostomy as well as penetration of the foramen, the symptoms disappeared and hydrocephalus was resolved. This is a rare case of akinetic mutism after complicated management of hydrocephalus associated with intraventricular meningioma.