手術・化学療法にて治療した乳児anaplastic strocytomaの1例

A case of infantile anaplastic astrocytoma treated with surgery and chemotherapy

I．はじめに

　小児gliomaの治療成績は成人例に比し良好であることは良く知られている^11）一方，乳児gliomaの治療成績は未だ充分なものとは言えず^19），今後解決しなければならない問題が多々残っている．そのひとつとして，放射線療法後の精神・知能障害，内分泌機能障害がある^4,6,25,28）．今回われわれは術後放射線療法を施行せず，手術及び化学療法のみで治療し良好な経過を示した乳児anaptastic astrocytomaの1例を経験したので，若干の文献的考察を加えて報告する．

A 5-month-old girl presented with enlargement of the head circumference. Neurological examination revealed right hemiparesis and bulging of the anterior fontanel. T1-weighted magnetic resonance imaging with gadoli-nium DTPA showed a well-enhanced, huge tumor ex-tending from the left frontal lobe to the parietal lobe. Cerebral angiography showed the main feeding arteries were the central sulcus artery and the posterior parietal artery. The tumor was totally removed using a sulco-tomy and temporary clipping of these feeding arteries to control bleeding. The histological diagnosis was ana-plastic astrocytoma. Postoperative radiation therapy was avoided so as to prevent the side effect of radiation therapy such as mental retardation and growth impaire-ment. Chemotherapy using VP-16 and CDDP was given every six months as adjunct therapy. No tumor recurrence has been recognized for over a period of 2 years and 5 months after surgery and growth and men-tal development have been satisfactory. Total removal using great care not to damage neurological function followed by postoperative chemotherapy is the treat-ment of preference to obtain good prognosis and quali-ty of survival in infant with such tumors.