前頭葉傷害による排尿排便障害

DISTURBANCES OF MICTURITION AND DEFECATION DUE TO FRONTAL LOBE LESIONS

I．緒言

　排尿排便機構に対する中枢性支配に関しては，古くから多くの実験的および臨床的な観察があり，その存在には疑いがないが，中枢の局在についてはなお異論がある。われわれは開頭術後に前頭葉の傷害よよると考えられる頑固な排尿排便障害をきたした症例を経験した。

The possible relationship between the frotal lobe lesions and the disturbances of micturition and de-fecation was discussed on the basis of clinical ob-servations of brain surgery. Occurences of persist-ent dysuria and abdominal distension in case of the frontal lobe lesion were formerly reported by Nathan and his associates.

The following two cases, in which the lesions of medial-posterior part of orbital surface of right frontal lobes were made, showed abdominal disten-sion because of disturbances of defecation and urinary retention.

Case 1. N. H., a 50-year-old female was cranio-tomied and a huge meningioma of the olfactory groove was totally extirpated under partial lobec-torny of right frontal lobe. Her postoperative course was uneventfull except the transient but marked degree of abdominal distension and retention of urine which lasted from 5th to 15th postoperative day.

Case 2. H. Y., a 52-year-old female was operated because her clinical pictures, carotid angiograms and pneumoencephalograms unanimously indicated the presence of meningioma of the tuberculum sellae. Unexpectedly, however, neither extracerehral nor intracerebral mass was found at exploration. Pos-terior part of gyrus rectus was biopsied. She began to complain retardation of micturition about a week after operation, and she could never urinate again after 9th postoperative day. The reasonable excuses of the misdiagnosis of the Case 2 was briefly dis-cussed.