臨床脳外科的見地より観た悪性腫瘍の頭蓋内転移に就いて

Clinicopathologicai considerations on the intracranial metastasis of the malignant neoolasms: From the neurosurgical point of viwe

緒論

　頭蓋内転移性悪性腫瘍の診断は，所謂頭蓋内のSpace occupying lesionsの鑑別診断上極めて重要な事柄であるが，比較的若年者の悪性腫瘍に於いて，比較的早期に頭蓋内転移が起つた場合には臨床的には殆んど頭蓋内原発性の脳腫瘍との鑑別が困難であつて，脳外科に於いて手術の対象とされ，組織学的検索に依つて始めて腫瘍が転移性なる事が判明する場合がある。〔Cushing（1935），Dandy（1938），Olivecrona（1941）〕而してこれら頭蓋内転移性悪陸腫瘍の中にも，手術に依つて患者の訴えを軽減除去せしめ，更に術後可成り長期間に亘つて患者の社会的，経済的活動を可能ならしめる場合がある。

　最近吾々も又，かかる数例を経験したので，臨床医としての立場から，悪性腫瘍頭蓋内転移に就いて臨床病理学的考察を加え，これらの患者に対する治療方針に就いて，検討を加えてみたい。

17cases of intracranial metastasis were demo-nstrated (14 carcinoma and 3 sarcoma). 18 percent of cases were diagnosed preoperatively asintracranial metastasis of malignant tumour andin the remainders preoperative diagnosis of pri-mary intracranial tumour was made, as nosymptom of primary lesion was detected andintracranial lesion was considered solitary andlocalized in one region with results of neurolog-ical and neuroradiological examinations. In 14csses. then, neurosurgical procedures were perf-ormed successfully with one exception of opera-tion motality. In 4 cases, postoperativel life waswithin 6 months, though, in 64 per cent of ope-rated cases, th ese surgical procedures were con-sidered effective for the prolongation of patient'slife, and at least 3 of them were able to comeback to social works postoperatively.

Authors emphasized that the incidence of soli-tary intracranial metastatic lesions is rather highand these can be indicated to neurosurgicalprocedures, tumour resection, lobectomy for innerdecompression and skull decompression with thecombination of postoerative radiation therapy,.as in the cases of malignant glioblastoma multi-forme.