巨大頭蓋底神経線維腫の1例

Huge skull base neurofibroma:case report

I．はじめに

　近年，頭蓋底外科の進歩により，広範な頭蓋底腫瘍の摘出術が可能になった．今回，われわれは，非常に稀な巨大頭蓋底神経線維腫に対して手術治療を行い，良好な結果を得たので，文献的考察を加えて報告する．

A case of a huge skull base neurofibroma completely resected by a combined subtemporal-infratemporal and basal subfrontal approach is reported. A 32-year-old female complained of left facial paresthesia and de-formity since several months before. Neurological ex-amination revealed hypesthesia in the distribution of the left trigeminal nerve second branch. CT and MRI images showed a huge tumor in the infratemporal fos-sa, parapharyngeal space and middle fossa extending into the cavernous sinus, compressing the left temporal lobe and distorting the left hypothalamus and the brain stem. The patient tolerated trial balloon occlusion of the left internal carotid artery for 45 minutes. Trans-maxillary biopsy revealed the tumor to be a neuro-fibroma. Through a combined basal subfrontal and a subtemporal-infratemporal approach in two staged op-erations, total tumor resection was performed. This tumor originated at the second branch of the trigeminal nerve. We recommend these combined approaches and two staged operations for such a huge skull base tumor as presented in this case.