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Neurological Surgery No Shinkei Geka Volume 25, Issue 10 （October 1997）

Neurological Surgery 脳神経外科 25巻10号（1997年10月発行）

Japanese English

研究

斜台脊索腫に対するstereotactic brachytherapy Stereotactic brachytherapy for clival chordoma 松本健五 ¹ , 為佐信雄 ¹ , 富田享 ¹ , 田宮隆 ¹ , 古田知久 ¹ , 大本堯史 ¹ Kengo MATSUMOTO ¹ , Nobuo TAMESA ¹ , Susumu TOMITA ¹ , Takashi TAMIYA ¹ , Tomohisa FURUTA ¹ , Takashi OHMOTO ¹ ¹岡山大学脳神経外科 ¹Department of Neurological Surgery, Okayama University Medical School キーワード： clival chordoma , stereotactic brachytherapy , iridium−192 Keyword: clival chordoma , stereotactic brachytherapy , iridium−192 pp.919-925

発行日 1997年10月10日 Published Date 1997/10/10

DOI https://doi.org/10.11477/mf.1436901467

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Abstract 文献概要
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I．はじめに

　斜台脊索腫はその発育部位，性質から，多くの場合全摘出は困難で，可及的摘出ののち残存腫瘍に対して放射線治療が行われている^5,6）．しかしながら，解剖学的に脳幹，脊髄，視神経や主要動脈などが近傍にあるため腫瘍増加の制御に要する十分の放射線量がかけられないことから従来の放射線治療にも限界があり，治療困難な腫瘍とされている^7,12,16）．

　この斜台脊索腫に対する新しいアプローチとして，正常組織を温存しながら腫瘍局所に大量照射が可能な集光照射の一つであるbrachytherapy（低線量率持続放射線組織内照射）の有効性が最近報告されている^8,11）．本法の最大の問題点は複雑な形をした腫瘍内へ正確にカテーテルを刺入することの困難性にある^10）．

　われわれはカテーテル刺入法の改良を試み，良好な成績が得られたので若干の文献的考察を加え報告する．

There has recently been interest in the use of high-dose radiation with methods such as radiosurgery and brachytherapy for skull base tumors. Brachytherapy is believed to be effective for clival chordomas, but tech-nical difficulties exist in stereotactic insertion of cathe-ters into the clivus. We assessed the usefulness follow-ing improvement of implantation techniques in three patients with clival chordomas. All tumors were larger than 50mm in diameter. Removable iridium-192 sources were held in catheters which were implanted through a transnasal approach under general anesthesia using a CT-guided stereotactic system in one patient and a CRW stereotactic system adapted to a magnetic reso-nance imaging (MRI) scanner in 2 patients. The im-plantation array was designed based on results of stereotactic 3-D MRI scanning, and coordinates were calculated for stereotactic implantation through twist drill holes. These catheters were introduced through the nares and directed into the clival chordoma under endoscopic visualization and X-ray fluoroscopy. No com-plications such as CSF liquorrhea, hemorrhage or infec-tion were observed. Brachytherapy with a total dose of 43.2-58.0Gy at the tumor periphery was administered for 7 to 10 days, and serial follow-up imaging studies demonstrated reduction in tumor size in two patients and no tumor growth in the other. Our results sug-gested that stereotactic brachytherapy is potentially useful for the control of clival chordomas and that com-puter-guided transnasal stereotactic insertion enables implantation of catheters less invasively and more accurately than does X-ray fluoroscopic guidance alone.