脳室内および近傍腫瘍に対する神経内視鏡手術―生検術と水頭症治療における意義と今後の課題

Neuroendoscopic Surgery for Intra- and Para-ventricular Tumors:Impacts on Biopsy and Hydrocephalus Treatment

Ⅰ．はじめに

　脳室内・脳室近傍腫瘍に対する神経内視鏡手術は，腫瘍生検術のほか合併する水頭症に対する神経内視鏡的第三脳室開窓術（endoscopic third ventriculostomy：ETV）や透明中隔開窓術（septostomy），囊胞性腫瘍に対する囊胞開放術など多岐にわたる^2,10)．さらに，近年では神経内視鏡手術の普及や手術器具の発展に伴い，その手術方法も徐々に変遷している．

　今回，われわれは，側脳室～第三脳室内および近傍の腫瘍に対して神経内視鏡を用いて実施した腫瘍生検術の結果を検証するとともに，その課題についても検討したので報告する．

　In this report, the authors retrospectively review and discuss their results for neuroendoscopic surgery for intra- and para-ventricular tumors. This study included 28 patients who were admitted to our hospital for intra- or para-ventricular tumors between January 2005 and March 2013. There were 17 males and 11 females, and their age varied widely from 1 to 75 years. Using a neuroendoscopic technique, tumor biopsy was attempted in all 28 patients. Biopsy was possible in 25 patients（89.3%）but not in the other 3（10.7%）because of hypervascularity or tumor bleeding. Of these 25 patients, pathological diagnosis was possible in 23（92%), but not in other 2（8%）because of incomplete sampling. In 18 of 28 patients, various forms of hydrocephalus were observed. Neuroendoscopic procedures were quite useful to improve cerebrospinal fluid dynamics in 13 of these patients, including endoscopic third ventriculostomy（ETV）in 9（except for 1 patient with ETV failure), septostomy with ventriculoperitoneal shunting（VPS）in 3, and cystostomy in 1. Simple VPS was performed in the other 4 patients. These results suggest that neuroendoscopic surgery is valuable as a minimally invasive procedure for pathological diagnosis and hydrocephalus treatments in patients with intra- and para-ventricular tumors. Further development of neuroendoscopic equipment is warranted to accurately diagnose tumors with hypervascularity and subependymal tumors.