Deep Sylvian Meningiomaの1小児例

Deep Sylvian Meningioma:A case report of a child

I．はじめに

　小児の髄膜腫は成人に比べ比較的まれな腫瘍であり，小児脳腫瘍のうち1.0-2.9％^4,5,14,15）を占めるのみである．しかも，硬膜，脳室脈絡叢に付着を持たないものはさらにまれである．しかし，このような髄膜腫は成人よりも発生頻度が高い^4,14）と報告されている．われわれは，硬膜，脳室脈絡叢と付着部を持たずシルビウス裂内に発生したいわゆるdeep sylvian meningiomaの小児例を経験したので，その診断，手術等に関して，これまでの文献報告例を含めた検討を行い報告する．

A case of deep sylvian meningioma without dural attachment in a 12-year-old boy was reported. He had been suffering from severe headache for a month. Neurological examination was normal. CT scan and MR images showed a well-enhanced 7cm mass lesion with small cysts, located in the left sylvian fissure. Peri-tumoral edema was slight and the midline structures were minimally shifted in spite of its large size. A fron-to-temporal craniotomy was made and the tumor was grossly totally removed. The tumor had no dural attachment and existed in the left sylvian fissure, in-volving the middle cerebral artery and its branches.The histological diagnosis was transitional meningioma without malignancy. The postoperative course was un-eventful except for transient mild left oculomotor palsy for several days. He is doing well now one year after the surgery and follow-up MR images showed no re-currence. Intracranial meningioma is rare in children. According to the literature, meningioma in children is slightly more frequent in males. There is a higher inci-dence of lack of dural attachment and cystic tumors than in adults. Deep sylvian meningioma without dural attachment is also very rare. Including our case, 13 cases of deep sylvian meningioma were reported in the literature. Four of them were under 20 years old. We report this case in detail with other cases reported pre-viously.