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Neurological Surgery No Shinkei Geka Volume 18, Issue 11 （November 1990）

Neurological Surgery 脳神経外科 18巻11号（1990年11月発行）

Japanese English

症例

放射線治療により主幹脳動脈の広範な狭窄性変化と多発性脳梗塞をきたした髄芽種の1例 Diffuse Stenotic Change in Large Intracranial Arteries Following Irradiation Therapy for Medulloblastoma; Case report 山上岩男 ^1,3 , 菅谷雄一 ¹ , 佐藤政教 ¹ , 大里克信 ² , 山浦晶 ² , 牧野博安 ² Iwao YAMAKAMI ^1,3 , Yuichi SUGAYA ¹ , Masanori SATO ¹ , Katunobu OSATO ² , Akira YAMAURA ² , Hiroyasu MAKINO ² ¹鹿島労災病院脳神経外科 ²千葉大学学脳神経外科 ³君津中央病院脳神経外科 ¹Department of Neurological Surgery, Kasima Rosai Hospital ²Department of Neurological Surgery, Chiba University キーワード： Radiation therapy , Arterial stenosis , Medulloblastoma , Cerebral infarction Keyword: Radiation therapy , Arterial stenosis , Medulloblastoma , Cerebral infarction pp.1035-1039

発行日 1990年11月10日 Published Date 1990/11/10

DOI https://doi.org/10.11477/mf.1436900165

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Abstract 文献概要
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I．はじめに

　脳腫瘍に対する放射線治療後，脳内の細小動脈や毛細血管に限らず，内頸動脈や中大脳動脈などの主幹脳動脈に閉塞・狭窄性病変が発生することが，最近注目されている^2,3,7,9）．しかし，放射線治療後の主幹脳動脈の閉塞・狭窄性病変は，ほとんどがトルコ鞍近傍の比較的良性な脳腫瘍に合併したものであり，髄芽腫や膠芽腫などの悪性脳腫瘍に合併したという報告はいまだない³）．今回，われわれは髄芽腫に対する放射線治療後，両側性の広範な主幹脳動脈の狭窄性病変と，それに起因すると思われる多発性の脳梗塞を合併した女児例を経験したので報告する．

We reported a case of a patient who developed a dif-fuse stenotic change in the large intracranial arteries and repreated episodes of cerebral infarction after irra-diation therapy for medulloblastoma.

A three-year-old girl underwent the subtotal removal of cerebellar medulloblastoma and the subsequent irra-diation therapy in the whole brain and spine (30 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine). Two years later, she again underwent surgery and irradiation therapy because a recurrence of medulloblastoma had manifested itself in the frontal lobe; (40 Gy in the whole brain, 20 Gy in the local brain, and 25 Gy in the whole spine.) One and half years after the second irradiation, she started suffering from frequent and refractory cerebral ischemic attacks. Cerebral angiography revealed a diffuse narrowing, and multifocal stenoses in the bilateral anterior and middle cerebral arteries. Computerized tomography demon-strated multiple cerebral infarctions. Her neurological condition deteriorated because of recurring strokes and she died at ten years of age.

Most of the reported cases of patients who developed stenotic arteriopathy were children in the first decade of their life, and who were irradiated for parasellar brain tumor of low malignancy. Stenotic arteriopathy after irradiation has rarely been recognized in patients with malignant brain tumor. However, life expectancy is increasing even for those with malignant brain tumor, and it may make stenotic arteriopathy after irra-diation recongnized more commonly in patients with malignant brain tumor. Careful irradiation and subse-quent angiographical examination should be required even in patients with malignant brain tumor.