11．Gliomaの治療--手術的治療を中心にして

（11）Treatment of Glioma. State-of-the-Art: A Series of 1,036 Surgeries on 944 Cases

Ⅰ．はじめに

　筆者は，1993年にZürich大学脳神経外科主任教授に着任した後，2007年5月の退官の期日をはさんで2011年末までにgliomaの手術を1,036回行った（Fig.1）．これは同じ期間の脳動脈瘤の手術1,039回に匹敵する回数である．その間に前者は，治療的には放射線療法（radiotherapy：RT），化学療法（chemotherapy）の発展，手術的には術中MRI，navigationなどの発達があり，後者は，endovascular surgeryの発展で治療の様相が変わり，その治療成績はともに改善してきたといえる．

　本稿では，筆者が経験してきた自執刀glioma症例についての成績，そのfollow-up，印象をcase report的に提示し，種々の技術的，治療的問題点，それらの歴史的な変遷にも言及するが，読者の日常診療のご参考になれば幸いである．

　The author's own experience of 1,036 surgeries on 944 glioma cases in the period between 1993 to 2011（mostly at the University Hospital Zürich）are presented. Glioblastoma cases were the most frequent, amounting to ca. 30% of cases as is shown in Fig.4A. They were operated on 1.3 times on the average but the most frequent repetition-surgery was in cases with fibrillary astrocytomas（Fig.1), as these tended to transform into secondary glioblastomas which needed surgery again. The latter amounting to 10% of glioblastoma cases that had transformed from astrocytoma in the course of 3.8 years on the average（Fig.4B). With modern “state-of-the-art” treatment of glioma（Table), survival term for glioblastoma patients has clearly improved. This can be seen by comparison of figures between generations（Fig.4C, D）:Prof. Krayenbühl's era（macrosurgery±RT), Prof. Yasşargil's era（microsurgery＋RT）and the most recent part of my treatment（microsurgery＋ “state-of-the-art” treatment).

　Representative cases of various glioma are presented in which “cured” cases of glioblastoma are also included.