頭蓋咽頭腫の治療と長期予後の検討―56症例の分析結果

Clinical Analysis of Treatment and Long-term Outcome in 56 Craniopharyngiomas

Ⅰ．はじめに

　頭蓋咽頭腫では，内分泌機能や視機能，また認知能などがさまざまな程度に障害される．それらは治療前より既に障害されていることもあり，治療の過程や再発でも新たに障害されうる．一方，発生部位が第3脳室や下垂体柄，またトルコ鞍内と一定でないため，手術到達路も経蝶形骨洞，経シルビウス裂，経終板や経脳梁と多様である．摘出が完全であれば治癒するが，不完全であると再発し再度の摘出や放射線治療が少なからず必要となる^2,6,8,10,12)．このように頭蓋咽頭腫は個々の症例により症候や治療法が一定せず，再発による修飾も加わり，治療効果の評価は必ずしも容易ではない．また長期治療成績に関して欧米からの文献報告は多数あるが，本邦からの報告は稀少である．本研究では，治療後の生存率とQOL改善を目的にわれわれの施設で行われた治療法を総括し，各種治療法の是非と機能予後を左右する因子を分析した．

　In order to improve QOL in patients with craniopharyngioma, retrospective analysis was performed to discover factors for influencing functional outcome and the best treatment strategy.

　56 patients were treated between 1978 and 2005. They were initially treated with surgery and surgical cure was obtained in 29 patients (Group A). Subtotal tumor resection with prophylactic radiation was performed in 8 patients (Group D). Tumor recurrence was noted in 19 patients and stereotactic radiation or 2nd operation was performed in 11 patients (Group B). 2nd operation and fractionated radiation were undertaken in 8 patients (Group C). Endocrine, vision and recognition were scored from 2 to 0, respectively; 2 indicates normal, 1 partially disturbed, 0 fully disturbed.

　The mean score before treatment was 4.7 and the final score was 3.9. Factors leading to poor outcome included extrasellar origin, solid tumor, bad score before treatment, 2nd surgery for recurrence. The change of scores after the treatment was－0.1 in group A,－0.7 in Group B, －0.9 in Group C and 0.3 in Group D.

　Maximum tumor removal should be attempted with functional preservation. Subtotal removal with prophylactic radiation is recommended if the patient has normal hypothalamic function.