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Neurological Surgery No Shinkei Geka Volume 22, Issue 8 （August 1994）

Neurological Surgery 脳神経外科 22巻8号（1994年8月発行）

Japanese English

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症例

Radiosurgery後に腫瘍出血を生じた転移性脳腫瘍の1例 Peritumoral Hemorrhage after Radiosurgery for Metastatic Brain Tumor:A case report 本崎孝彦 ¹ , 伴貞彦 ² , 山本豊城 ² , 浜崎昌丈 ³ Takahiko MOTOZAKI ¹ , Sadahiko BAN ² , Toyoshiro YAMAMOTO ² , Masatake HAMASAKI ³ ¹西宮市立中央病院脳神経外科 ²神戸市立中央市民病院脳神経外科 ³新須磨病院脳神経外科 ¹Department of Neurosurgery, Nishinomiya City General Hospital ²Department of Neurosurgery, Kobe City General Hospital ³Department of Neurosurgery, Shinsuma Hospital キーワード： Radiosurgery , Peritumoral hemorrhage , Brain metastasis , Hemodynamic change Keyword: Radiosurgery , Peritumoral hemorrhage , Brain metastasis , Hemodynamic change pp.789-793

発行日 1994年8月10日 Published Date 1994/8/10

DOI https://doi.org/10.11477/mf.1436900895

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Abstract 文献概要
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I．はじめに

　最近，わが国においても脳腫瘍や脳動静脈奇形に対してradiosurgeryが数多く実施されている．脳腫瘍に対しては当初は主に良性腫瘍が治療の対象となっていたが，転移性脳腫瘍に対しての報告^2-7）もしだいに増加し，その治療効果も認められつつある．

　しかし，radiosurgeryの合併症については，治療後の脳浮腫の増強による神経症状の増悪や遅発性の放射線壊死による新たな神経症状の出現等が報告^2,3）されているが，radiosurgeryに関連した腫瘍出血の報告は見当たらない．

An unusual case of peritumoral hemorrhage after radiosurgery for the treatment of metastatic brain tumor is reported. This 64-year-old woman had a his-tory of breast cancer and underwent right mastectomy in 1989. She remained well until January 1993, when she started to have headache, nausea and speech dis-turbance, and was hospitalized on February 25, 1993. Neurological examination disclosed right hemiparesis and bilateral papilledema.

CT scan and MR imaging showed a solitary round mass lesion in the left basal ganglia region. It was a well-demarcated, highly enhanced mass, 37mm in dia-meter. Cerebral angiography confirmed a highly vascular mass lesion in the same location.

She was treated with radiosurgery on March 8 (maxium dose was 20Gy in the center and 10Gy in the peripheral part of the tumor). After radiosurgery, she had an uneventful course and clinical and radiosurgical improvement could be detected. Her neurological symp-toms and signs gradually improved and reduction of the tumor size and perifocal edema could be seen one month after radiosurgery. However, 6 weeks after radiosurgery, she suddenly developed semicoma and right hemiplegia. CT scan disclosed a massive peritu-moral hemorrhage. Then, emergency craniotomy, eva-cuation of the hematoma and total removal of the tumor were performed on April 24. Histopathological diagnosis was adenocarcinoma. It was the same finding as that of the previous breast cancer. Histopathological examination revealed necrosis without tumor cells in the center and residual tumor cells in the peripheral part of the tumor.

It is postulated that peritumoral hemorrhage was caused by hemodynamic changes in the vascular-rich tumor after radiosurgery and breakdown of the fragile abnormal vessels in the peripheral part of the tumor.