中脳水道閉塞をきたしたsarcoidosisの1例

REPORT OF A CASE OF AQUEDUCTAL OCCLUSION IN A PATIENT OF SARCOIDOSIS

I．まえがき

　Sarcoidosisの患者で，経過中に神経症候を呈するものは少なく，そのなかでも，開頭術の対象となつたものは報告上きわめて稀である。もちろん，神経系sarcoidosisの治療に手術的療法が第一義とは考えられないが，神経系のなかでも，中枢神経系sarcoidosisは症例により，より積極的に手術的療法が行なわれてよいものもあると考えられる。

　われわれは，sarcoidosisの患者で中脳水道閉塞をきたし，頭蓋内圧亢進症候のみられた例に，開頭術によるTorkildsen手術（側脳室大槽短絡術）を行ない，症候を軽快せしめ得ることができたので，ここに報告し，中枢神経系sarcoidosisの手術的療法について触れたい。

Sarcoidosis rarely affects the central nervous system. The authors reported a case of pulmonary sarcoidosis suffering from the signs of the increased intracranial pressure in the course of the disease. Myodil ventri-culography showed the aqueductal occlusion in this case. At suboccipital craniectomy, the basal adhesive leptomeningitis and the ependymitis in the fourth ventricle were found to be present and the aqueductal occlusion was also assertained. The cause of the oc-clusion was considered to be the result of sarcoidosis from the operative findings. Torkildsen's procedure proved to be effective in this case.

The authors reviewed the same cases of the aque-ductal occlusion by sarcoidosis in the literatures.

There may be some cases of sarcoidosis of the central nervous system which need operative treat-ment and if the indication may be present, the opera-tion should not be hesitated.