トルコ鞍内から鞍上部に存在した上衣腫の1例

Ependymoma of the Sella Turcica and Suprasellar Region

Ⅰ．はじめに

　上衣腫は小児，若年者に発症することが多く，脳室壁を形成する上衣細胞から発生する腫瘍である．トルコ鞍から鞍上部に上衣腫を認める症例は非常に稀である．今回，高齢者においてトルコ鞍から鞍上部に上衣腫を認め，経鼻内視鏡手術により予後良好であった1例を報告する．

　An ependymoma of the sella turcica and the suprasellar region has been described by only 10 reports in the available literature. We describe similar pathology in a 70-year-old woman who presented with dementia and visual disturbance. Magnetic resonance imaging with gadolinium revealed a mixed contrast-enhanced lesion（maximum diameter 3.5 cm）in the sella turcica and suprasellar area associated with a noncommunicating hydrocephalus. The patient was preoperatively presumptively diagnosed with a craniopharyngioma. The lesion was adherent to the hypothalamus, and the third ventricular floor was completely resected via an endoscopic endonasal transsphenoidal approach. Histopathological findings confirmed an ependymoma. Although her visual disturbance improved, the patient developed postoperative panhypopituitarism. She has had no recurrence for 7 years postoperatively. An ependymoma of the sella turcica and the suprasellar region is extremely rare; establishing the preoperative diagnosis is challenging in such patients. Maximum tumor resection and long-term follow-up are essential for good prognosis.