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Neurological Surgery No Shinkei Geka Volume 29, Issue 8 （August 2001）

Neurological Surgery 脳神経外科 29巻8号（2001年8月発行）

Japanese English

症例

短期間に再発育を繰り返した頭蓋咽頭腫—MIB-1 labeling indexの有用性 Craniopharyngioma with Rapid Regrowth : Role of MIB-1 Labeling Index 姉川繁敬 ¹ , 林隆士 ¹ , 中川摂子 ¹ , 古川義彦 ¹ , 友清誠 ¹ Shigetaka ANEGAWA ¹ , Takashi HAYASHI ¹ , Setsuko NAKAGAWA ¹ , Yoshihiko FURUKAWA ¹ , Makoto TOMOKIYO ¹ ¹聖マリア病院脳神経センター脳神経外科 ¹Department of Neurosurgery, Institute of Neurosciences, St. Mary's Hospital キーワード： craniopharyngioma , recurrence , proliferative activity , MIB-1 labeling index Keyword: craniopharyngioma , recurrence , proliferative activity , MIB-1 labeling index pp.727-733

発行日 2001年8月10日 Published Date 2001/8/10

DOI https://doi.org/10.11477/mf.1436902080

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Abstract 文献概要
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I．はじめに

　頭蓋咽頭腫は一般に良性とされているが，発生場所によっては摘出には困難を伴い，治療には長い忍耐と努力が必要となってくる^6）。水頭症により来院した4歳の男児において鞍上部より第3脳室を占拠する頭蓋咽頭腫を認め，最初の手術後のMRIで一部腫瘍の残存が疑われるものの，独歩退院となった．術後3ヵ月目に，視力障害にて再来院し，急速な再増大を認めたために再手術を行い画像上全摘出できたものと確信した．しかし，その後の経過観察で再々発がみられ，ガンマナイフ（γ-K）による治療を必要とした．本症例では第1回目のMIB-1labeling index（LI）で9.2％，2回目で21.2％と共に高値を呈した．本症例における臨床経過を記すると共に本腫瘍の治療のうえでのpitfallについて検討を加える．

The treatment of craniopharyngioma becomes quite difficult when it extends into the third ventricle. In a4-year-old boy, we encountered a large cystic craniopharyngioma which grew into the third ventricle. Ini-tially, the tumor was successfully removed via a right transcallosal transchoroidal approach. A residualpart seemed to have remained in the right perioptic region. Even though the patient had an episode ofSIADH, his postoperative course was uneventful. He developed visual disturbance 4 months after the ini-tial operation. CT and MRI revealed a large suprasellar mass. The tumor was totally resected via a rightpterional approach. Careful follow-up disclosed again a small recurrent lesion in the anterior commisure.Gamma knife therapy was used to successfully reduce the volume of the tumor. The MIB-1 labeling index(LI) of the specimen taken at the time of the first operation was at 9.2% and that of the second operationat 21.2%.

Recently, the importance of MIB-1 LI for assessing proliferative activity of this tumor was reported. Inpatients whose MIB-1 LI is higher, they have more significant rate of recurrence. Our results also indicatethat in cases where MIB-1 LI indicates a high value, careful follow-up is necessary. Through fact of thenecessity of two operations and additional gamma knife therapy, we would like to stress the importance ofMIB-1 LI in indicating the proliferative activity of this tumor. These surgical procedures are presentedhere, and the role of MIB-1 LI in determining the proliferative activity of craniopharyngioma is also dis-cussed.