成長ホルモン産生下垂体腺腫を合併したempty sella症候群の1例:経蝶形骨洞腺腫摘出術及びempty sella修復術

Transsphenoidal surgery for a case of empty sella syndrome associated with GH secreting pituitary adenoma

I．はじめに

　Empty sellaは，1951年Buschら^3）によってその概念が提唱されて以来，近年のMRI等の画像の発達もあって，遭遇する機会は増加している．病態生理の面から，primary empty sellaと，secondary empty sellaに分類され^15），下垂体腺腫に合併する場合は，すでに存在していたprimary empty sellaに腺腫が生じた可能性と，腺腫の梗塞，出血，変性などの結果としてempty sellaが生じたとするいわゆるsecondary empty sellaである可能性が考えられる．外科的治療に関しては，腺腫を合併しないprimary empty sellaにおいては，臨床症状と画像所見を考慮しつつ，慎重な手術適応の検討が必要であるとされるが^17），腺腫を合併する例においては腫瘍摘出術とトルコ鞍内充填術が必要となる．今回私共は成長ホルモン（GH）産生腫瘍に合併したempty sellaに対し，経蝶形骨洞下垂体腺腫摘出術及びempty sella修復術を行い，良好な結果を得たので，特にその手術法について若干の文献的考察を加えて報告する．

A 33-year-old woman was admitted to our hospital with acromegalic face as her chief complaint. Her neurological examination was normal, and endocrinolo-gical examination revealed a high level of growth hor-mon (GH) (12.8ng/ml). CT cisternography and MRI showed an enlarged empty sella and a pituitary tumor. We performed a transsphenoidal approach operation to remove the tumor and to repair the empty sella. The tumor, which was compressed to the lateral and pos-terior wall of the sella turcica by the empty sella, was totally removed by meticulous curetting. It was histolo-gically diagnosed to be a pituitary adenoma. The empty sella was elevated by coagulation of intrasellar dura and herniated arachnoid membrane, and then we filled the residual intrasellar cavity with bone fragments and fat. Postoperative hormonal examination showed nor-mal findings, and MRI revealed obliteration of the emp-ty sella.

Surgical indication for primary empty sella is not established, but in cases associated with pituitary ade-noma, transsphenoidal surgery is necessary. We re-ported a case of empty sella syndrome associated with GH secreting pituitary adenoma, and in this report, we introduced a new surgical technique for repairing an empty sella.