側頭葉内巨大類上皮腫の1例—特に実質内発生に関して

A Case Report of Giant Epidermoid in the Temporal Lobe:Considerations of the Occurrence of IntramedullaryEpidermoids

I．はじめに

　類上皮腫の発生部位については，既に数々の報告があるが，その一つとして大脳半球実質内も挙げられている．一般に類上皮腫は炎症作用が強く，周囲組織を溶解，破壊しながら増大することがあり，巨大化したものでは最初の原発巣の特定が困難なことも少なくない．今回われわれの経験した症例も側頭葉内に主座をおくものであったが，同時に小脳橋角部にも交通しており，大脳半球実質内発生に関して一つの示唆を与えたので，若干の文献的考察を交え報告する．

A case of giant epidermoid which was mainly located in the right temporal lobe was presented. The intracra-nial epidermoid is commonly located in the CSF space, such as the cerebello-pontine (C-P) angle, parasellar re-gion, middle cranial fossa and ventricles. The intra-medullary epidermoid is extremely rare. We report the case of a 51-year-old female suffering from generalized convulsions. Having fallen into a semicoma due to the convulsions, she was referred to our department on Au-gust 5, 1992. Neurological examination revealed slight dementia but no other deficits. The tumor was mainly located in the temporal lobe but communicated with the CSF space of C-P angle through a narrow channel shown on MRI. She underwent an operation for tumor removal and left the hospital with no neurological de-ficits.

Several cases of intracranial intramedullary epider-moid have been reported in the literature, but none of them proved to be completely intramedullary. On op-eration or on CT and MRI, all of them were shown to communicate with the CSF space. The possible occur-rence of an epidermoid from medullary substance was discussed.