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Neurological Surgery No Shinkei Geka Volume 20, Issue 1 （January 1992）

Neurological Surgery 脳神経外科 20巻1号（1992年1月発行）

Japanese English

研究

癌性髄膜炎の検討—診断と治療 Study of Cases with Meningeal Carcinomatosis:Diagnosis and treatment 中川秀光 ¹ , 村澤明 ¹ , 中島伸 ¹ , 中島義和 ¹ , 泉本修一 ¹ , 久保重喜 ¹ , 早川徹 ² Hidemitsu NAKAGAWA ¹ , Akira MURASAWA ¹ , Shin NAKAJIMA ¹ , Yoshikazu NAKAJIMA ¹ , Shuichi IZUMOTO ¹ , Shigeki KUBO ¹ , Toru HAYAKAWA ² ¹大阪府立成人病センター脳神経外科 ²大阪大学医学部脳神経外科 ¹Department of Neurosurgery, The Center for Adult Diseases ²Department of Neurosurgery, Osaka University Medical School キーワード： Meningeal carcinomatosis , Intrathecal chemotherahy Keyword: Meningeal carcinomatosis , Intrathecal chemotherahy pp.31-37

発行日 1992年1月10日 Published Date 1992/1/10

DOI https://doi.org/10.11477/mf.1436900380

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Abstract 文献概要
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I．はじめに

　近年，悪性腫瘍に対する積極的な集学的治療にて，多くの腫瘍でその生存期間の延長が認められるようになるにつれ，中枢神経系への転移特に癌性髓膜炎の報告^11,16，^20,21）が増加して来ている．癌性髄膜炎は，腫瘍細胞のleptomeningesへのびまん性あるいは播種性転移であり，固形腫瘍の1-5％におこると報告されており^5,21），髄膜刺激症状に多彩な神経症状と多発脳神経障害を示し，髄液中に悪性細胞が検出されることを特徴とし予後はきわめて悪い^11,17）．今回の調査で，その診断と治療の面より検討したので報告する．

Thirty-four patients with meningeal carcinomatosis were treated at The Center for Adult Diseases, Osaka, from 1984 through 1990. The major origin of meningeal carcinomatosis was carcinoma of the lung (14 cases) and breast (8 cases). The most frequent histological type of carcinoma was adenocarcinoma (23 cases). Twenty cases still had active lesions and/or primary le-sions in the lung, liver or bone at the time of diagnosis of the meningeal carcinomatosis. The primary lesions were treated surgically in 22 cases, with chemotherapy in 4 cases and with radiotherapy in 2 cases. Metastatic brain tumors were treated by surgical removal followed by chemo-radiotherapy in 12 cases, and with radiother-apy alone in 2 cases. The interval from the time of dia-gnosis of the primary lesion to the time of diagnosis of the meningeal carcinomatosis varied from one month to eight years, and the interval between surgical remov-al of metastatic brain tumors and the diagnosis of meningeal carcinomatosis ranged from 0 to 3 years. With regard to the diagnosis of meningeal carcinomato-sis, positive cytology was seen in initial standard lum-bar puncture in 32 of the 34 patients. CT scan showed abnormal findings in 28 of the 34 patients, including ventricular dilatation only (12 cases), and small enhanc-ing lesions along the CSF space (12 cases). The EEG showed abnormal patterns in 14 of 15 cases.

Intrathecal chemotherapy with methotrexate alone or combined methotrexate with cytosine arabinoside via the Ommaya reservoir or standard lumbar puncture alternately with or without radiation therapy was suc-cessful as treatment, and 22 of 29 treated patients showed symptomatic improvement of the meningeal irritation. Improvement of cranial nerve impairment was confirmed in 10 of the 29 treated patients. The CSF cytology also became negative in 10 of the 29 treated cases after a full course of intrathecal che-motherapy.