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Neurological Surgery No Shinkei Geka Volume 46, Issue 11 （November 2018）

Neurological Surgery 脳神経外科 46巻11号（2018年11月発行）

Japanese English

症例

急激な画像変化を呈した副鼻腔粘液囊胞合併下垂体腫瘍の1例 Acute Changes in the Computed Tomography Findings of Mucocele Combined with Pituitary Adenoma:A Case Report 原田直幸 ¹ , 栄山雄紀 ¹ , 野手康宏 ¹ , 小此木信一 ¹ , 上田啓太 ¹ , 安藤俊平 ¹ , 桝田博之 ¹ , 近藤康介 ¹ , 根本匡章 ¹ , 周郷延雄 ¹ Naoyuki HARADA ¹ , Yuki SAKAEYAMA ¹ , Yasuhiro NODE ¹ , Shinichi OKONOGI ¹ , Keita UEDA ¹ , Shunpei ANDOH ¹ , Hiroyuki MASUDA ¹ , Kosuke KONDO ¹ , Masaaki NEMOTO ¹ , Nobuo SUGO ¹ ¹東邦大学医学部医学科脳神経外科学講座（大森） ¹Department of Neurosurgery（Omori), School of Medicine, Faculty of Medicine, Toho University キーワード： pituitary adenoma , mucocele , Hounsfield Unit , orbital apex syndrome Keyword: pituitary adenoma , mucocele , Hounsfield Unit , orbital apex syndrome pp.1013-1020

発行日 2018年11月10日 Published Date 2018/11/10

DOI https://doi.org/10.11477/mf.1436203856

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Abstract 文献概要
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参考文献 Reference

Ⅰ．はじめに

　Computed tomography（CT）は，magnetic resonance imaging（MRI）よりも頭蓋底領域における骨破壊や出血を把握することが容易である．また，病変の変化を追跡し，治療の適応や治療時期を決定するのに有用である⁹⁾．一般的に頭部病変のCT値が急激に高くなる場合，出血に起因することが多い．一方，短期間でのCT値の低下は，浮腫や髄液流入，空気の混入などが考えられる．今回われわれは，副鼻腔粘液囊胞が急性増悪し，囊胞部位のCT値が異常高値から突然に低下した症例を経験した．また，本症例は下垂体腫瘍合併例で，同時期に下垂体出血も併発していた．このように特異な画像所見と経過を示した症例について，文献的考察を加えて報告する．

　INTRODUCTION:We report a rare case in which a pituitary tumor co-occurred with a giant mucocele. The mucocele's computed tomography（CT）values fell markedly when it collapsed, and we report the associated considerations.

　CASE:This case involved a 42-year-old male patient. For 20 years, his visual acuity had progressively declined, and it suddenly rapidly worsened over a month. Cranial CT revealed a massive tumor in the sphenoid sinus and a pituitary tumor. A region of high absorption extended from the paranasal sinus to the skull base. Two days after the patient's initial presentation, he experienced a sudden loss of vision. Therefore, we performed an urgent re-examination. The CT value of the paranasal lesion was found to have sharply declined. The sinus lesion was diagnosed as a mucocele. Emergent endoscopic surgery was performed. Actinomyces meyeri was detected in the samples cultures.

　DISCUSSION:The causes of mucocele exhibiting abnormally high signal intensity on CT include the accumulation of hemosiderin due to repeated bleeding in the cyst. Furthermore, we inferred that the Actinomyces meyeri had been taking up metallic elements in vivo for a long time. The marked reduction in the lesion's CT value was considered to have been due to the destruction of the mucocele. The contents of the mucocele flowed out and were replaced with newly produced mucus, which exhibits low absorption values.

　CONCLUSION:We treated a patient with a giant mucocele involving distraction of the frontal base and a pituitary adenoma. In such cases, surgery should be performed when visual acuity deteriorates suddenly.