症候性囊胞形成を来しBCNU wafer除去を施行した膠芽腫の1例

A Case of Symptomatic Cyst Formation after BCNU Wafer Implantation for Glioblastoma

Ⅰ．はじめに

　新規局所抗腫瘍薬であるBCNU wafer（商品名ギリアデル^®）が，2013年1月より本邦でも悪性神経膠腫に対して使用可能となった．ニトロソウレア系アルキル化剤であるカルムスチンは，細胞内DNAをアルキル化し核酸合成を阻害することで細胞周期の停止とアポトーシスを誘導し抗腫瘍効果を発揮する²⁾．悪性神経膠腫の腫瘍摘出腔にBCNU waferを留置することにより，生存期間の延長が報告されている¹⁴⁾．ただ副作用として痙攣，脳浮腫，水頭症，創傷治癒不良，感染症などが報告されているが¹⁾，症候性囊胞形成に至った症例は少ない^4,5,9)．今回われわれは膠芽腫に対しBCNU wafer留置後，症候性囊胞形成を認め摘出術を要した1例を経験したので報告する．

　We report a case of a 56-year-old woman admitted to our hospital for status epilepticus. Three months before hospitalization, the patient underwent gross total removal of a glioblastoma with BCNU wafer implantation in the left parietal lobe. The cavity was subsequently lined with five BCNU wafers. After admission, magnetic resonance imaging（MRI）showed cyst formation accompanied by strong edema, with no recurrence of glioblastoma. She was initially administered antiepileptic drugs and glycerol with betamethasone, after which her seizures stopped but recurred one month later due to a decrease in betamethasone. The BCNU wafers were removed four months after the initial surgery, after which the seizures completely stopped. Histopathological examination of the cavity indicated the presence of inflamed tissue and no recurrence of glioblastoma. Neurosurgeons should be aware of the possibility of cyst formation after BCNU wafer implantation for malignant gliomas. In this manuscript, we provide a case presentation and a review of the literature.