後頭蓋窩髄膜腫摘出術後，広範な脳血管攣縮を呈した1例

Diffuse cerebral artery vasospasm following total resection of posterior fossa meningioma:a case report

I．はじめに

　脳腫瘍摘出術後に脳血管攣縮を合併した報告は，下垂体およびその近傍腫瘍例に散見される^1,3,6,7,9））が，同部以外の腫瘍例で術後に血管攣縮を併発することは極めて稀である．後者の血管攣縮の原因は術中のくも膜下出血が多いとされている^1,3,7）が，厳密なetiologyに関しては，不明な点が多い．今回われわれは，後頭蓋窩髄膜腫摘出術後，くも膜下出血がきわめて少なかったにもかかわらず，術翌日に広範な脳血管攣縮を併発した一例を経験したので，若干の文献的考察を加え報告する．

Diffuse cerebral artery vasospasm following brain tumor resection is a rare complication. The authors re-ported a case of symptomatic diffuse cerebral artery vasospasm of early phase following resection of a left posterior fossa meningioma.

A 50-year-old female patient was admitted to our hospital complaining of headache. No neurological de-ficits were detected at the time of admission. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large mass in the left posterior fossa. Cerebral angiography demonstrated mildly diffuse ste-nosis of the bilateral internal carotid artery. The tumor was resected totally. CT after operation showed a small amount of subarachnoid hematoma in the superior aspect of the cerebellum. Pathological specimen of the tumor showed fibrous meningioma.

One day after this radical operation, the patient was found to have weakness in her left leg. Then she de-veloped left hemiparesis, weakness in the right leg and left homonymous hemianopsia. MRI showed ischemic lesions in the bilateral parietal and the occipital lobe. Angiography demonstrated diffuse severe vasospasm throughout the whole cerebral artery. Ten days after the operation, angiographical findings were improved. This case indicates that vasospasm may occur even after resection of brain tumors which are localized out-side the suprasellar area.