Optic Glioma放射線治療15年後に発生したHypothalamic Gliomaの全摘出例

Total Removal of Hypothalamic Glioma 15 Years after Irradiation of Right Optic Glioma

I．はじめに

　Optic gliomaは全頭蓋内腫瘍中0.6-1.2％^9）と比較的稀であり，眼窩内視神経から視交叉までに限局するanterior typeと視交叉から視索，視床下部に発生するposterior typeの二つに分けられる^17）．

　われわれは，1歳11ヵ月時にanterior typeのopticgliomaに対して放射線治療が行われ，15年後に視床下部にgliomaが発生した1例を経験し，bifrontal inter—hemispheric trans-lamina terminalis approach^15）により全摘した．hypothalamic gliomaの全摘の可能性に関して，文献例も含めて手術アプローチを中心に検討し報告する．

Abstract

Hypothalamic glioma was found in a 17 year old male patient 15 years after irradiation of right optic glioma. It was totally removed by surgery.

He was first admitted to Ryukyu University Hospital at the age of 1 year and 11 months, with right ex-ophthalmos and visual disturbance. Diagnosis was anterior type of right optic glioma. This was treated by irradiation (47Gy) . Follow-up CT scans revealed no re-growth in intraorbital and intracranial regions.

At the age of 17 years, CT scan and MRI showed an enhanced mass in the hypothalamus above the sup-rasellar cistern. Total removal was performed by bi-frontal interhemispheric trans-lamina terminalis approach. Histological diagnosis was pilocytic astrocy-toma. Postoperatively, consciousness remained disturb-ed for 3 weeks because of infarction in the bilateral me-dial nucleus of the thalamus.

Radical excision of hypothalamic glioma was re-viewed in the literature. We concluded that such exci-sion has a potentially good outcome, and should be attempted when circumstances indicate its feasibility.