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Neurological Surgery No Shinkei Geka Volume 23, Issue 11 （November 1995）

Neurological Surgery 脳神経外科 23巻11号（1995年11月発行）

Japanese English

症例

腹側髄外性発育を呈した脳幹部神経膠腫の1手術例 A Surgically Treated Case of Ventrally Exophytic Pontine Glioma 須賀俊博 ¹ , 内田桂太 ² , 香川茂樹 ³ , 後藤英雄 ⁴ , 吉岡邦浩 ⁵ , 佐野光彦 ⁶ Toshihiro SUGA ¹ , Keita UCHIDA ² , Shigeki KAGAWA ³ , Hideo GOTO ⁴ , Kunihiro YOSHIOKA ⁵ , Mitsuhiko SANO ⁶ ¹釜石市民病院脳神経外科 ²岩手県立宮古病院脳神経外科 ³岩手県立遠野病院脳神経外科 ⁴岩手県立宮古病院放射線科 ⁵せいてつ記念病院放射線科 ⁶盛岡友愛病院神経内科 ¹Department of Neurosurgery, Kamaishi Municipal Hospital ²Department of Neurosurgery, Iwate Prefectural Miyako Hospital ³Department of Neurosurgery, Iwate Prefectural Toono Hospital ⁴Department of Radiology, Iwate Prefectural Miyako Hospital ⁵Department of Radiology, Seitetu Memorial Hospital ⁶Department of Neurology, Morioka Yuai Hospital キーワード： Pontine glioma , Ventrally exophytic extension , Low-intensity band , Paradoxical sign of pontine glioma , Orbitofrontomalar approach Keyword: Pontine glioma , Ventrally exophytic extension , Low-intensity band , Paradoxical sign of pontine glioma , Orbitofrontomalar approach pp.1037-1042

発行日 1995年11月10日 Published Date 1995/11/10

DOI https://doi.org/10.11477/mf.1436901119

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Abstract 文献概要
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I．はじめに

　本来髄内性浸潤を主とする脳幹部gliomaにおいて，側頭葉内側，大脳基底核，視床下部，小脳橋角部，小脳半球第四脳室などへの髄外性進展が知られているものの，そのほとんどは終末像である^1,6,9,13）．これに対し，病初期より髄内性浸潤よりも髄外性発育を主とする脳幹部gliomaの報告は，非常に少ない^3,7,8,13）．

　今回われわれは，上位脳幹腹側部にて，MRI上脳幹との間にextra-axial signであるlow-intensity bandを有し，ほとんど髄外性に発育した脳幹部astrocytoma grade Ⅲの1例を経験した．このような脳幹腹側髄外発育の例は，文献的にも見出せず，極めて稀と思われたので，報告する．

A surgically treated case of ventrally exophytic pon-tine glioma is reported.

A 49-year-old woman, complaining of dysarthria, dysphagia and gait disturbance, was admitted to our department. Her past history included bronchial asthma. Plain skull x-p and tomography revealed des-truction of the dorsum sellae and upper clivus. CT de-monstrated an enhanced oval mass at the ventral side of the upper brainstem. The mass was severely com-pressing the brainstem dorsally. MRI revealed a low-intensity band between the tumor and the brainstem. Dynamic MRI demonstrated a pattern of rapid increas-ing and slow reduction. Cerebral angiogram demon-strated a paradoxical sign that pontine branches were lo-cated anterior to the basilar artery. The finding demon-strated that the tumor was an intraaxial mass. The first operation was performed by the orbitofrontomalar approach. On the trans-sylvian route, the tumor was re-moved partially with CUSA and neuronavigation sys-tem. Its histology was astrocytoma grade Ⅲ. Radiation therapy was added. The patient's symptoms aggravated again. On the second operation, the transtemporal routewith tentorial resection was chosen. Under a wide visual field, intracapsular subtotal resection of the tumor was performed. Interferon therapy was added. She was discharged to her home with no neurological deficits.

Ventrally exophytic pontine glioma is very rare. Low-intensity band of MRI, a sign of extraaxial mass, was visualised in our case. On the other hand, cerebral angiogram demonstrated a paradoxical sign. This sign suggested that the tumor originated from the brain-stem. With update skull base surgery and neuronaviga-tion system, surgical therapy of ventrally exophytic pontine glioma is safe and effective.