頭蓋内播種をきたしたSpinal Glioblastomaの1例

A Case of Spinal Glioblastoma with Intracranial Dissemination

I．はじめに

　頭蓋内原発のglioblastomaが脊髄に播種することはよく知られているが，脊髄に発生したglioblastomaが脳へ播種することはまれである^1,2,6-14）．今回われわれは脊髄に原発したglioblastomaが，他の脊髄レベルや頭蓋内に播種性転移を起こした症例を経験したので，若干の文献考察を加えて報告する．

A 50-year-old male developed gait disturbance and bi-lateral sensory disturbance in territories below Th 11 level in February, 1990. On February 26,1990, an intradu-ral tumor was partially removed at Th 11-12 levels, which was histologically diagnosed as glioblastoma mul-tiforme, followed by post-operative radiotherapy (40Gy to the tumor area). CT scan of the brain was unremark-able and he was discharged home as ambulatory in July, 1990.

Gait disturbance, occasional headache and vomiting developed in June, 1991. MRI revealed multiple spinal cord tumors at Th 11-12 and L 2-3 levels, as well as mul-tiple intracranial tumors in the cerebellum, cingulate gyrus, and sylvian fissure, all of which were thought to be located in the cerebrospinal fluid (CSF) space. VP shunt was performed for hydrocephalus. MRI taken 2 months after operation demonstrated diffuse sub-arachnoid dissemination and new spinal cord tumors at C 3-4 and Th 3-10 level's Although pathology of the intracranial tumors was not confirmed, dissemination from the spinal tumor was strongly suggested by the evidence including the long in-terval after the spinal cord operation, the location of the multiple tumors in the CSF space, and the simultaneous intraspinal dissemination.

Only 31 cases with intracranial dissemination from malignant spinal astrocytoma or glioblastoma have been reported, and, of these, most were located around the brainstem, cerebellum, and other regions bordering the CSF space. In malignant spinal cord tumor, every effort should be made to prevent CSF dissemination at opera-tion or to detect it as early as possible thereafter. MRI was found to be the most effective method for evaluating CSF dissemination.