海綿静脈洞進展をきたした蝶形骨洞原発真菌性肉芽腫の1例

Skull base aspergillosis granuloma originating from the sphenoid sinus:a case report

I．はじめに

　副鼻腔真菌症は，ときに頭蓋内に直接浸潤をきたし重篤な結果をもたらす．治療法としては，脳内浸潤のないものでは，中枢神経症状を出しても経鼻的蝶形骨洞開放術が侵襲が少なく最も良いとされている^2-6）．しかし，いったん脳内浸潤をきたすと，手術法に関わらずその予後はきわめて不良なことも知られている^1,7,9）．今回われわれは，蝶形骨洞原発のアスペルギルス症が頭蓋底部に直接浸潤し，手術を施行した1例を経験した．治療法の問題点を中心に若干の文献的考察を加え報告する．

A case of skull base Aspergillus granuloma originat-ing from the sphenoid sinus was reported.

This 64-year-old man complained of unilateral visual loss and serious facial pain, and was admitted to our department. He had been treated by transnasal sphe-noidectomy because of sphenoid sinus aspergillosis. MRI showed a mass lesion located in the sphenoid sinus, cavernous sinus, ethmoid sinus and intraorbit. Angiography showed severe stenosis of the left internal carotid artery at the cavernous portion.

As the symptoms gradually aggravated, we felt com-pelled to perform intracranial surgical treatment using the extradural approach to the skull base lesions. As the fibrous lesion was very hard and strongly adherent to the surrounding tissues, only partial removal of the lesion and resection of the trigeninal nerve were carried out. After surgery, the patient was released from severe facial pain and had an uneventful course. But, two months later, he died due to Aspergillus meningoence-phalitis.

Aspergillosis originating from the sphenoid sinus is rare, but it is known that some lesions show abrupt in-vasive extension to the skull base and the prognosis is bad.

Early diagnosis and suitable treatment for the skull base or intracranial lesions is required.