減圧手術後に高度視機能障害が改善したうっ血乳頭を伴う小脳腫瘍症例

Improved severe visual disturbance following hypotensive surgery in a case of cerebellar tumor with papilledema

（G−8PM−5）　うっ血乳頭を伴う小脳腫瘍の術後に残存した高度の視機能障害が次第に改善した症例を経験した。症例は24歳男性，初診時視力は右0.1（n．c），左0.5（n．c．），両眼とも著明なうっ血乳頭を呈し，右眼で下半盲，左眼でマリオット盲点の拡大および鼻側下方の視野狭窄を認めた。直ちに小脳腫瘍摘出術および減圧術を施行したが、術後約2週で両眼とも視野狭窄はさらに進行し，約1か月後には乳頭は蒼白化した。しかし，以後約1年の経過で右眼視力は不変であったが，視野は初診時より改善し，左眼では視力は1.5に回復，拡大マリオット盲点は正常化，求心性狭窄も改善した。本例の経過から，うっ血乳頭による高度視機能障害も改善する場合があることがわかった。

A 24-year-old male presented with blurring of vision in his right eye since 3 weeks before. His corrected visual acuity was 0.1 right and 0.5 left. Funduscopy showed marked papilledema in both eyes. Perimetry showed inferior hemianopia in the right eye and inferotemporal defect with enlarged blind spot in the left eye. Computed tomography showed two space-occupying lesions in the right cerebellar hemisphere with enlarged ventricles. Removal of tumors with external drainage was performed and led to the diagnosis of cerebellar hemangioblastoma. During one year after surgery, papilledema in both eyes gradually disappeared resulting in optic atrophy. The visual field defect in both eyes improved also with the visual acuity of 0.08 right and 1.5 left. This case illustrates that severe visual disturbances withpapilledema may improve after surgery for cerebellar tumor.