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Neurological Surgery No Shinkei Geka Volume 19, Issue 6 （June 1991）

Neurological Surgery 脳神経外科 19巻6号（1991年6月発行）

Japanese English

研究

テント及びテント近傍髄膜腫の臨床病理学的検討 Clinicopathological Study of Meningiomas of the Tentorium and its Surrounding Structures 福島武雄 ¹ , 溝口強美 ¹ , 土持廣仁 ¹ , 松田年浩 ¹ , 継仁 ¹ , 阪元政三郎 ¹ , 朝長正道 ¹ , 後藤勝弥 ² , 前原史明 ² Takeo FUKUSHIMA ¹ , Tsuyomi MIZOGUCHI ¹ , Hirohito TSUCHIMOCHI ¹ , Toshihiro MATSUDA ¹ , Hitoshi TSUGU ¹ , Seisaburo SAKAMOTO ¹ , Masamichi TOMONAGA ¹ , Katsuya GOTO ² , Fumiaki MAEHARA ² ¹福岡大学脳神経外科 ²福岡大学放射線科 ¹Departments of Neurosurgery School of Medicine, Fukuoka University, Fukuoka ²Departments of Radiology School of Medicine, Fukuoka University, Fukuoka キーワード： Meningioma , Tentorium , Cerebellopontine angle , Surgical approach Keyword: Meningioma , Tentorium , Cerebellopontine angle , Surgical approach pp.517-524

発行日 1991年6月10日 Published Date 1991/6/10

DOI https://doi.org/10.11477/mf.1436900270

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Abstract 文献概要
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I．はじめに

　テントおよびテント近傍髄膜腫は，その解剖学的特異性より臨床症状を呈した時には既に巨大な腫瘍として発見されることが多く，従ってその治療成績は必ずしも満足すべきものではない．腫瘍発生部位は，横静脈洞あるいはS状静脈洞に接するか，上錐体静脈洞にそったテント内側面か，あるいは錐体骨後面に接している場合が多く，脳幹，脳神経および深部主要血管と隣接する．従ってこれら重要横造物を残存し，腫瘍摘出を行うには解剖学的位置関係を術前充分に把握し術式を考慮する必要がある．私どもが経験したテントおよびテント近傍髄膜腫29例について臨床像，手術，予後を検討した．

Abstract

We report the clinical features, radiological studies, operative procedures and results, and follow-up data in 29 patients with meningiomas of the tentorium and its surrounding structures. The cases represented 22.5% of all the intracranial meningiomas operated on in a 15 year period and were divided into three groups, de-pending on their main attachments, tentorial, cerebello-pontine angle (dorsal aspect of the petrous ridge) and others.

Tumor size was generally large and 13 cases were larger than 5 cm. The most common tumor site was along or near the superior petrosal sinus and trans-verse-sigmoid junction in cases involving the tentorium, and medial to the porus acousticus in cases involving the cerebellopontine angle.

Different operative approaches to these tumors were carried out, depending on their location. The tumors in the lateral or medial petrous ridge were approachedmainly with a suboccipital craniectomy using a retro-mastoid incision. Total removal was carried out in 80% of the tentorial cases, in 46.2% of cerebellopontine angle cases, and in the 83.3% in the others. Total ope-rative mortality rate was zero. Follow-up periods ranged up to 5 years 5 months in the the tentorial cases, 4 years 6 months in cerebellopontine angle cases, and 7 years 1 month in the others. Long-term resultswere good in 21 cases (72A%), fair in 3 cases (10.3%) and poor in 2 (6.9%). Three patients died due to tumor recurrence. One of them suffered lung metastasis, and two of them suffered extensive local recurrences. We recommend the retromastoid approach combined with the petrosal approach, if the CPA tumor is large enough and extends to the retroclival region.