脈絡叢腫瘍乳児例の検討

Choroid Plexus Tumors in Infancy

I．はじめに

　脈絡叢腫瘍（choroid plexus tumor, CPT）は頭蓋内腫瘍の中では0.5％前後を占める比較的まれな腫瘍であるが，小児原発性頭蓋内腫瘍の2ないし6％^{10,12,14,18,19）}，さらに乳児原発性頭蓋内腫瘍に限ればその20％を占め^2），astrocytoma, primitive neuroectodermal tumor（PNET），teratomaと並ぶ乳児期の代表的腫瘍である．乳児期の脳腫瘍はその好発部位，臨床症状，治療方法，治療成績等，種々の面で特殊性を持っており，他の年代とは別個に議論されるべき点が多々ある．CPTもその例外ではない．今回，われわれはCTおよび顕微鏡下手術導入以後治療されたCPT乳児例を対象に，その疫学，治療，臨床上の問題点等を検討し，いくつかの知見を得たので報告する．

　Twelve infants with choroid plexus tumors were reviewed retrospectively. Enlarging head circumference, bulging fontanelle, and vomiting were the major symptoms and signs appearing 2 to 5 weeks (mean = 3.7 weeks) before diagnosis. The average age at diagnosis was 7.7 months. Total removal was performed in 11 patients with choroid plexus papilloma, and partial removal was achieved in 1 patient with a choroid plexus carcinoma. A cerebrospinal fluid (CSF) diversionary shunt was placed temporarily in 6 infants and permanently in 4. Of the two patients not requiring CSF diversionary shunt, 1 needed a subdural-peritoneal shunt postoperatively. Histologically, 11 of 12 tumors were choroid plexus papillomas, and one was a choroid plexus carcinoma. All 12 patients were followed up for 4 months to 11 years (mean=5.6 years) . Eleven of 12 patients were alive at the time of their last check-up. All 11 survivors had normal psychomotor and neurological development. The treatment and outcome of choroid plexus tumors and management of associated hydrocephalus are discussed.