髄膜腫摘出術後に遅発性血管攣縮を呈した1例

Delayed Vasospasm Complicated with the Postoperative Stage of the Meningioma: A case report

I．はじめに

　髄膜腫摘出術後における合併症の中で，術中にクモ膜下出血をきたさなかった場合においては，遅発性血管攣縮によって脳梗塞を発症する症例は稀であり，われわれが渉猟し得た限りにおいては認められない．今回われわれは，蝶形骨縁髄膜腫の摘出術後に脳梗塞をきたし，脳血管撮影所見からその発症機序に遅発性血管攣縮が関与したと考えた1例を経験したので，症例を紹介するとともに，血管攣縮の発現機序について文献的考察を試みたので報告する．

Though it has been reported infrequently that delayed vasospasm may appear in head-injured patients, it is rather rarer to see it as a complication arising from tumor removal. Such a case was presented and gave rise to spe-culation of a possible underlying pathophysiology. A 46-year-old female patient was admitted to our neurosurgic-al service, complaining of aching pain in the forehead. No neurological deficits were elicited on admission. CT scans as well as MR imagings confirmed the existence of a left sphenoid wing meningioma whose gross total remov-al was accomplished. She was doing well till the 3rdpostoperative day, when she developed transcortical motor aphasia.123 I-IMP SPECT revealed low perfusion over the left middle cerebral artery territory, and CT scans also showed low density areas in the same region, including the putamen, corona radiata and temporal lobe on the left side. Left carotid angiography disclosed dif-fuse arterial narrowings involving C1, C2, A1 and M1 por-tions. The authors suspect that indirect injury to those arteries and/or some kind of inflammatory process might have played a role.