上矢状洞を閉塞した腎細胞癌頭蓋骨転移の2例

Superior Sagittal Sinus Occlusion due to Calvarial Metastasis of Renal Cell Carcinoma : 2 cases report

I．はじめに

　転移性腫瘍は，quality of life（QOL）の改善のため，治療対象は拡大されつつあり，特にradio-surgeryの登場以後，多種多様な治療に対するoptionが考えられるようになってきた．腎細胞癌は初診時すでに30％の例において遠隔転移を伴っており，骨転移は肺，リンパ節，肝に次いで4番目に多いといわれているが，その大半は赤色髄が多く分布する脊椎，骨盤，大腿骨への転移で，頭蓋骨転移は1.5％と比較的まれである^2,3,5,8）．われわれは腎細胞癌が頭蓋骨正中部に転移し，硬膜外・皮下に広がり，superior sagittal sinus（SSS）を閉塞した2例を経験したのでここに報告する．

We report two cases of superior sagittal sinus (SSS) occlusion due to calvarial metastasis of renal cellcarcinoma. Both cases were presented with bulging of the skull. No stigmata of increased intracranialprssure was detected, Cerebral angiogram showed the occlusion of the SSS. Tumor cells did not penetrateinto the dura mater nor the galea and the tumors were able to be removed easily in both cases. One casewithout collateral circulation showed recanalization of the SSS on the postoperative angiography. Anothercase with development of collateral circulation did not show recanalization of SSS on the postoperativemagnetic resonance angiography. In the latter case, cortical veins flowed into the occiuded Portion. Weconsider that SSS should be preserved to prevent venous congestion in the cases where collateral circula-tion has not developed.