雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 21, Issue 3 （March 1993）

Neurological Surgery 脳神経外科 21巻3号（1993年3月発行）

Japanese English

研究

髄膜癌腫症の臨床的考察—頭蓋内圧分析を中心とした検討から Clinical Assessment of Meningeal Carcinomatosis—From the viewpoint of the analysis of intracranial pressure 武田泰明 ¹ , 鬼塚俊朗 ¹ , 原岡襄 ² , 古場群巳 ¹ , 伊東洋 ² , 三輪哲郎 ³ Yasuaki TAKEDA ¹ , Toshiaki ONITSUKA ¹ , Jo HARAOKA ² , Tomomi KOBA ¹ , Hiroshi ITO ² , Tetsuro MIWA ³ ¹社会保険中央総合病院脳神経外科 ²東京医科大学脳神経外科 ³厚生中央病院 ¹Department of Neurosurgery, Social Health Insurance General Hospital ²Department of Neurosurgery, Tokyo Medical College ³Department of Neurosurgery, Kosei Chuo General Hospital キーワード： Meningeal carcinomatosis , Intracranial pressure , Intraventricular pressure , Pressure wave Keyword: Meningeal carcinomatosis , Intracranial pressure , Intraventricular pressure , Pressure wave pp.213-220

発行日 1993年3月10日 Published Date 1993/3/10

DOI https://doi.org/10.11477/mf.1436900611

PDF(8848KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　髄膜癌腫症Meningeal Carcinomatosis（以下MC）は，1870年のEberthの報告^3）に始まり，最近の脳腫瘍全国統計では転移性脳腫瘍の5.5％を占めるとされている24）．一般に多彩な臨床症状や高度の頭蓋内圧亢進等を呈し，急速に進行，予後不良な重篤な疾患群として知られている．これまで多くの臨床病理学的報告^{10,12,13,22）}があるが，最近は早期診断や治療法の工により生存期間の延長も報告されている^{11,17,18,21）}．しかしながら本病態の頭蓋内圧分析による報告はきわめて少なく，経過中に出現する頭蓋内圧亢進の様相は単に漠然と理解されているにすぎない．今回われわれは，MCの頭蓋内環境を解明する一助として持続頭蓋内圧測定を行い，その圧分析の検討を中心に臨床的考察を行ったので報告する．

Meningeal carcinomatoses (MC) have been mainly studied from the viewpoint of the analysis of intracra-nial pressure (ICP). From the CT findings, ten patients were divided into two groups: group I, six patients showed characteristics of MC; group II, four showed normal characteristics. Ventricular fluid pressure (VFP) was continuously measured by a controlled ventricular drainage tube using a Spectramecl P-10EZ at 3.1 ± 2.1 months after the onset of the neurological symptoms.At the same time as VFP monitoring, the CBF by 1“3Xe method was measured in 5 cases and RI cisternography was performed in 9 cases.

”A“ wave was observed in 5 cases of group I and in 3 cases of group II. ”B“ wave was observed in all cases of both groups. In all 10 cases, the occurrence rate of both A and B waves (OR_A, OR_B) were high, averaging 2.34±0.54 times/hour, 74.0±16.6% time, respectively. Mean resting pressure(R) and mean peak pressure(P) tended to be high, averaging 28.8±12.2mmHg, 58.9 13.7mmHg, respectively. Mean cerebral perfusion pres-sure corresponding with R and P (CPP_R, CPP_p) was markedly reduced, averaging 79.1±15.9mmHg, 50.9± 12.7mmHg, respectively. Both OR_A and OR_B in group Iwere higher, and both CPP_R and CPP_p in groupl were lower, than in group II. Statistically, this is significant. Both R and P in Group I tended to be higher than in group II. This has no statistical significance. CBF in all 5 cases averaged 34.8±8.4mI/100g/min. No significant difference in the impairment of CBF was found between both groups. RI cisternography showed delayed clearance in all 9 cases. This was espe-cially evident in group I.

As to the clinical aspects, the neurological symptoms appeared earlier, and were more various in group I than in group II. In contrast to these, concerning the marked increase of CSF-protein content, the degree of ventricu-lar dilatation on CT scan, and the clinical outcome, the difference between both groups was scarcely signifi-cant.

In conclusion, MC is presumed to be ”tight brain" characterized by the elevation of resting pressure, the frequent occurrence of pressure wave, and the reduc-tion of cerebral perfusion pressure. Great care is de-manded for accurate diagnosis of MC, and the need for treatment is urgent. This is so because whether or not CT scan discloses pathognomonic findings it is not at all uncommon that MC has already developed to a condition with disorder of CBF and CSF flow dyna-mics. Additionally, the degree of the progression on CT findings does not always parallel the change of im-paired ICP and CBF. Furthermore, the pathophysiolo-gy of MC must be analyzed more minutely, and ther-apeutic guidelines based on multilateral evaluation methods remain to be established in the future.