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Neurological Surgery No Shinkei Geka Volume 23, Issue 8 （August 1995）

Neurological Surgery 脳神経外科 23巻8号（1995年8月発行）

Japanese English

症例

クモ膜嚢胞に対し，Cyst-cisternal Shuntが有効であった複合脳奇形の1例 A Case of Complex Brain Anomaly with Arachnoid Cyst Treated Well by Cyst-cisternal Shunt 須賀俊博 ¹ , 後藤英雄 ² , 佐野光彦 ³ , 吉岡邦浩 ⁴ , 菊地憲一 ⁴ Toshihiro SUGA ¹ , Hideo GOTO ² , Mitsuhiko SANO ³ , Kunihiro YOSHIOKA ⁴ , Kenichi KIKUCHI ⁴ ¹釜石市民病院脳神経外科 ²岩手県宮古病院放射線科 ³盛岡友愛病院神経内科 ⁴せいてつ記念病院放射線科 ¹Department of Neurosurgery,Kamaishi Municipal Hospital ²Department of Radiology, Iwate Prefectural Miyako Hospital ³Department of Neurology, Morioka Yuai Hospital ⁴Department of Radiology, Seitetu Memorial Hospital キーワード： Arachnoid cyst , Schizencephaly , Polymicrogylia , Heterotopic gray matter , Cyst-cisternal shunt Keyword: Arachnoid cyst , Schizencephaly , Polymicrogylia , Heterotopic gray matter , Cyst-cisternal shunt pp.717-721

発行日 1995年8月10日 Published Date 1995/8/10

DOI https://doi.org/10.11477/mf.1436901069

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Abstract 文献概要
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I．はじめに

　われわれは，裂脳症，多小脳回症，異所性灰白質，透明中隔欠損症および右中頭蓋窩クモ膜嚢胞を合併した一例を経験した，裂脳症，多小脳回症や異所性灰白質は，胎生3-5カ月頃の神経細胞の移動期の障害と考えられている^1-4,11-13）脳奇形の診断においては，解剖学的な描出に優れ，多方向断面も容易に得られ，信号の差により灰白質と白質の分離も良好なMRIは，診断に極めて有用な情報を与えてくれる^1-4,11-13）．

　クモ膜嚢胞の手術には，嚢胞開放術および嚢胞腹腔シャントが行われているが，両手技の優劣には，結論が得られていない^8-10）．われわれは，当患者に対し，嚢胞開放術とともに，嚢胞内と悩底槽髄液腔をstraight sili—corle tubeで短絡したcyst-cisternal shuntを試み，良好な結果を得た．生体適合素材の開発により，優れたsili—cone tubeが供与されている現在^7,8），cyst-cisternal shuntは，クモ膜嚢胞手術の第一選択となりうると考えられた．文献的考察を含め，報告する．

A rare case of complex anomaly, composed of schizencephaly, polymicrogyria, heterotopic gray mat-ter, agenesis of the septum pellicidi and arachnoid cyst at the right middle cranial fossa was encountered.

A 38-year old man, complaining of epileptic seizure, was admitted to our department. His past history in-cluded cerebral palsy. Plain skull roentgenogram showed protrusion of the right temporal bone and thin-ning of the ipsilateral sphenoidal wing. CT revealed arachnoid cyst and parietal crest surrounded by cortical layer on the right side. MRI also demonstrated the arachnoid cyst, parietal crest and agenesis of septum pellicidi. MRI, especially proton density weighted im-age, well demonstrated cortical layer surrounding the parietal crest, right opercular polymicrogyria and left heterotopic gray matter. The crest was diagnosed as schizencephaly. The arachnoid cyst was treated by cyst-cisternal shunt with a silicone tube (Sapporo shunt^®) after fenestrating the cyst. The tube was in-serted into the sylvian fissure from the cyst and sutured to the inner wall of the cyst. Despite slight intra-tumoral hemorrhage in the CT at 1.5months after the operation, the cyst markedly decreased in size. As to the diagnosis of the brain anomaly, MRI gives extremely useful information. Particulary for the dia-gnosis of anomalies of migration of neuronal cells, MRI, especially proton density weighted image, has been regarded as an indispensable examination. In the operation of subarachnoid cyst, to maintain the flow between the inside of its cyst and the basal cistern, cyst-cisternal shunt with a silicone tube had satisfactory results. In the present state, excellent sili-cone tubes have been provided, cyst-cisternal shunt should he considered as the first choice operation for subarachnoid cyst.