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Neurological Surgery No Shinkei Geka Volume 48, Issue 5 （May 2020）

Neurological Surgery 脳神経外科 48巻5号（2020年5月発行）

Japanese English

症例

腫瘍内出血と半球間裂急性硬膜下血腫で発症した大脳鎌髄膜腫の1例 Falx Meningioma Presenting with Intratumoral Hemorrhage and Interhemispheric Acute Subdural Hematoma:A Case of Report 佐藤慧 ^1,4 , 松尾彩香 ¹ , 日宇健 ¹ , 黒濱大和 ³ , 三浦史郎 ² , 伊藤健大 ¹ , 森塚倫也 ¹ , 本田和也 ¹ , 川原一郎 ¹ , 小野智憲 ¹ , 原口渉 ¹ , 牛島隆二郎 ¹ , 堤圭介 ¹ Kei SATO ^1,4 , Ayaka MATSUO ¹ , Takeshi HIU ¹ , Hirokazu KUROHAMA ³ , Shiro MIURA ² , Kakehiro ITO ¹ , Tomoya MORITSUKA ¹ , Kazuya HONDA ¹ , Ichiro KAWAHARA ¹ , Tomonori ONO ¹ , Wataru HARAGUCHI ¹ , Ryujiro USHIJIMA ¹ , Keisuke TSUTSUMI ¹ ¹国立病院機構長崎医療センター脳神経外科 ²国立病院機構長崎医療センター病理診断科 ³長崎大学原爆後障害研究所腫瘍・病理診断学 ⁴長崎大学病院脳神経外科 ¹Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center ²Department of Pathology, National Hospital Organization Nagasaki Medical Center ³Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University ⁴Department of Neurosurgery, Nagasaki University Hospital キーワード： falx meningioma , interhemispheric acute subdural hematoma , intratumoral hemorrhage , vein of Galen stenosis , superior sagittal sinus stenosis Keyword: falx meningioma , interhemispheric acute subdural hematoma , intratumoral hemorrhage , vein of Galen stenosis , superior sagittal sinus stenosis pp.413-422

発行日 2020年5月10日 Published Date 2020/5/10

DOI https://doi.org/10.11477/mf.1436204203

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Abstract 文献概要
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Ⅰ．はじめに

　非外傷性急性硬膜下血腫（acute subdural hematoma：ASDH）を伴って発症する髄膜腫^2,6)は散見されるが，半球間裂主体に発生した報告例は少ない^10,12,16,17)．今回われわれは，腫瘍内出血と半球間裂ASDHにより発症した大脳鎌髄膜腫の稀な1例を経験した．本例の出血機序や初期診療における問題点などについて，文献的考察を加えて報告する．

　A 68-year-old male with a sudden headache while defecation was transferred to our hospital. He was initially diagnosed with intracerebral hemorrhage in the right occipital lobe and acute subdural hematoma（ASDH）in the right interhemispheric fissure. A CT angiography（CTA）showed stenosis in the superior sagittal sinus（SSS）and the vein of Galen（VG）near the hematoma, which were considered to be due to compression of the hematoma. In the source image of CTA, the enhancement effect of the hematoma part was not clear. MRI revealed a heterogeneous mixed signal intensity in the hematoma area, suggesting a mixture of hematoma components that had bled at different times. Cerebral angiography performed two weeks after onset showed a tumor shadow imaged from the middle meningeal artery. Therefore, the presence of hemorrhagic meningioma was suspected. This was confirmed by contrast-enhanced MRI.

　One month after the onset, tumor resection was performed after the embolization of the feeding artery. Part of the tumor around the SSS and VG was left due to severe adhesion. Postoperatively, stenosis of the SSS and VG significantly improved. In this case, the increase in venous pressure may be related to the bleeding mechanism.

　Hemorrhagic onset meningioma with interhemispheric ASDH is extremely rare, and only 4 cases have been reported. It is easy to misdiagnose if only non-contrast CT is used. It should be noted that in cases of intratumoral hemorrhage, CTA may not show an enhancing effect in the acute phase. Since contrast-enhanced MRI may be useful for a definitive diagnosis, it should be performed at the time of initial imaging.