鼻腔に進展した巨大な脳下垂体腫瘍の1治験例

　I．緒論

　脳下垂体腫瘍の手術には経鼻法と開頭法があり得失が論ぜられてきた。最近の抗菌治療法の発達は経鼻手術の成績を著しく向上せしめ，経鼻中隔法が多く採用されている。一方，開頭法は技術的な困難さにもかかわらず感染のおそれのすくない点を賞用され，大部分の症例は開頭手術で処理されるのが現状である。とくに腫瘍が上方に進展した症例については絶対的の適応と考えられている。腫瘍が主として下方に進展する症例は数は少ないが，この型に対しては開頭手術は不適当であり，外鼻切開による経鼻手術によらざるを得ない。

　著者らは再三の開頭手術にもかかわらず鼻腔，鼻咽腔につよく進展し，鼻内に腫瘤をつくつた1例にたいして経鼻手術をおこない，その全部を摘出して治癒せしめることができた。このように広範な下方進展型の脳下垂体腫瘍はきわめて稀であり手術による治験例も記載されていないので報告する。

A case of pituitary tumor with a nasal involvement of the growth is reported. The chief complaint of a woman, aged 49, was blur red vision. with rhinoscopic examination a large tumor mass protruding from the supe-rior wall of the nasal cavity was revealed. By roentgenography and biopsy examination the tumor was diagnosed as that of pituitary origin. The tumor was successfully removed through extranasal approach measuring 50cc volumetrically and was encapsulated by firm tissues that was composed of dura mater as well as cicatricial tissues apparently the ens-uing results of previous intracranial operat-ions that were performed on two different occasions. Consequently, it appeared that postoperative infection was avoided because of the presence of this firm barrier. Structures such as sella turcica, the sphenoid cavity and ethmoid sinuses were encroached upon with destructions. Problems of selecting the proper operative technique were discussed.