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Neurological Surgery No Shinkei Geka Volume 19, Issue 10 （October 1991）

Neurological Surgery 脳神経外科 19巻10号（1991年10月発行）

Japanese English

症例

密封小線源治療を行った大脳基底核部Germinomaの1例 Basal Ganglia Germinoma Treated with Interstitial Brachytherapy; Case report 松本健五 ¹ , 小野田恵介 ¹ , 津野和幸 ¹ , 重松秀明 ¹ , 松久卓 ¹ , 前城朝英 ¹ , 三島宣哉 ¹ , 古田知久 ¹ , 西本詮 ¹ Kengo MATSUMOTO ¹ , Keisuke ONODA ¹ , Kazuyuki TSUNO ¹ , Hideaki SHIGEMATSU ¹ , Takashi MATSUHISA ¹ , Tomohide MAESHIRO ¹ , Nobuya MISHIMA ¹ , Tomohisa FURUTA ¹ , Akira NISHIMOTO ¹ ¹岡山大学脳神経外科 ¹Department of Neurological Surgery, Okayama University Medical School キーワード： Basal ganglia , Germinoma , CT , MRI , Interstitial brachytherapy Keyword: Basal ganglia , Germinoma , CT , MRI , Interstitial brachytherapy pp.985-989

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

DOI https://doi.org/10.11477/mf.1436900343

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Abstract 文献概要
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I．はじめに

　頭蓋内原発germ cell tumorは全脳腫瘍中3.3％を占めるが^20），その殆どは松果体部，鞍上部などの頭蓋内正中部に発生する^8）．大脳基底核部に発生するgerm celltumorは，全頭蓋内germ cell tumor中3-10％と比較的発生頻度が低く^17），また，CT所見が他の部位のそれと異なる事などが報告されており^15,25），これらの理由から，術前診断が困難な事が多い．今回われわれは，stereotactic biopsyにて組織診断を確定した後，密封小線源を用いた放射線組織内照射（interstitial brachythe—rapy^16）を行い，腫瘍の消失をみた大脳基底核部germi—nomaの1例を経験したので，その診断及び治療を中心に若干の文献的考察を加え報告する．

Abstract

A case of primary intracranial germinoma in the left basal ganglia treated with interstitial brachytherapy was reported. A 15-year-old boy was ref erred to our hospital for evaluation of right hemiparesis. A CT scan showed a slightly hyperdense mass with multiple cystic low density in the left basal ganglia. The mass was heterogeneously enhanced after intravenous administra-tion of contrast material. T1 weighted image showed a slightly hyperintense mass with cystic components and the mass was heterogeneously enhanced with Gd-DTPA. T2 weighted MR image showed a mixed in-tensity mass and peritumoral edema. Stereotactic needle biopsy and implantation of 3 catheters for interstitial brachytherapy were performed simultaneously using BRW CT guided stereotactic apparatus. After the histo-logical diagnosis was confirmed to be two cell pattern germinoma, 9 iridium-192 seeds were inserted into the catheters and maintained for 10 days to give 35Gy of irradiation at the tumor periphery. Subsequent CT scans showed marked tumor regression and the clinical symptoms were improved.

Germinoma originating in the basal ganglia is rare and hard to diagnose previous to biopsy. Histological confirmation is essential before initiation of treatment because germinoma is commonly thought to be radiosensitive tumor.

The interstitial brachytherapy enables selective irra-diation of the tumor and actually causes no complica-tions such as bone marrow suppression or cerebral atrophy. The neuroradiological findings, especially of CT scan and MRI, were presented and the strategy for treatment of germinoma in basal ganglia was discussed.