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Neurological Surgery No Shinkei Geka Volume 24, Issue 4 （April 1996）

Neurological Surgery 脳神経外科 24巻4号（1996年4月発行）

Japanese English

研究

Frontobasal interhemispheric approachで全摘出した頭蓋咽頭腫の機能予後 Prognosis after total removal of craniopharyngiomas via the frontobasal interhemispheric approach 丹羽潤 ^1,2 , 上出廷治 ¹ , 大滝雅文 ¹ , 伊林至洋 ¹ , 田辺純嘉 ¹ , 端和夫 ¹ Jun NIWA ^1,2 , Teiji UEDE ¹ , Masafumi OHTAKI ¹ , Yukihiro IBAYASHI ¹ , Sumiyoshi TANABE ¹ , Kazuo HASHI ¹ ¹札幌医科大学脳神経外科 ²市立函館病院脳神経外科 ¹Department of Neurosurgery, Sapporo Medical University キーワード： craniopharyngioma , total removal , frontobasal interhemispheric approach , lamina terminalis , QOL Keyword: craniopharyngioma , total removal , frontobasal interhemispheric approach , lamina terminalis , QOL pp.321-328

発行日 1996年4月10日 Published Date 1996/4/10

DOI https://doi.org/10.11477/mf.1436901188

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Abstract 文献概要
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I．はじめに

　頭蓋咽頭腫は良性の奇形性腫瘍であるが，腫瘍が視交叉部から視床下部，第3脳室にかけて局在するために，外科的に全摘出を試みると永続的な神経脱落症状を残すことも少なからず認められている．そこで多くの施設では腫瘍を亜全摘出するにとどめて補助療法として放射線療法を選択しているが，この方法では腫瘍を完治させることが出来ないばかりか，放射線照射に起因する知能障害などの副作用を併発する危険性が高い^6,7）．最近腫瘍を全摘出した報告が見られるが，手術成績や患者のQOLを考える場合にきわめて重要である大脳高次機能を含めた詳細な検討はなされていない^1,4,12）．

　われわれはこれまで頭蓋咽頭腫の全摘出を目標として最も術野の確保がすぐれているfrontobasal interhemi—spheric approachを行い，全例で肉眼的に腫瘍の全摘出を行い得た^3,8）．本稿では術前後の視床下部—下垂体機能，視機能，大脳高次機能を検討し，本アプローチの機能予後に対する有用性を検討した．

Prognosis after total removal of craniopharyngiomas via the frontobasal interhemispheric approach is re-viewed. Seventeen patients with craniopharyngiomas were operated on in Sapporo Medical University Hos-pital between January, 1985 and December, 1993. In eleven patients, lamina terminalis was incised and in the last six patients, it was left intact. Tumors were completely resected in all patients. After removal of the tumor, hypothalmic-pituitary functions, visual func-tions and psychometric functions were examined. Two of the 17 cases showed hypernaturemia and fourteen (82%) had permanent DI. Fourteen patients are receiv-ing DDAVP and all are receiving endocrine replace-ment. Of fourteen patients who had disturbance of their visual acuity, nine (64%) improved. Five of six patients (83%) who presented visual field defect showed im-provement in their deficits. Thirteen patients had a psychometric assessment at the time of follow-up ex-amination. Full-scale intelligence quotient scores were distributed as follows: three above 120, five between 90 and 109, three between 70 and 79 and two below 69. Four (32%) had some impairment of memory. Concern-ing the QOL after total removal of craniopharyngiomas via the frontobasal interhemispheric approach, thirteen patients (76%) are leading normal lives, and three (18%) are leading nearly normal lives but require some help to overcome mild deficits. One (6%) has suffered a significant handicap.