Neurological Surgery 脳神経外科36巻1号

2008年01月発行

総説

胎児期水頭症―疫学調査20年の軌跡

著者： 森竹浩三¹ 山崎麻美² 森惟明³ 菊池晴彦⁴

所属機関： ¹島根大学医学部脳神経外科 ²国立病院大阪医療センター脳神経外科 ³高知大学医学部脳神経外科 ⁴京都大学医学部大学院研究科脳神経外科

ページ範囲：P.7 - P.24

Ⅰ．はじめに

　「“一人の人間の生命は地球より重い”とする絶対的生命権を倫理的観点から振りかざすものではないし，またこのような立場が現実の解決に役立つとも思わない．解決の糸口は，過酷な現実に迎合することなく，これまでの臨床的蓄積をふまえ合理的に，予後に希望のあるものまで葬られないよう，周産期医学の英知を駆使して果敢に新しい世界へ挑戦する以外ないと考える」（石川　薫・黒柳充男²⁶⁾より）．これは，1980年代初め超音波を用いた胎児中枢神経奇形の診断を手探りで始めたころ目にした一文である．

　厚生省特定疾患調査研究班として難治性水頭症班が新たに組織された1987年当時，超音波診断法の進歩・普及により中枢神経を含む各種臓器の先天奇形が出生前に診断されるようになり，臨床現場では医療側のみならず患者側にもさまざまな問題が生じつつあった^26,79)．出生前に診断される各種中枢神経奇形のなかで，水頭症は発生頻度が高く治療の可能性も高いことから，われわれ脳神経外科医にとり最も関わりの深い疾患である．このことから，胎児期水頭症の成因・病態解明と診断・治療の指針作りが研究班の重要課題の1つとなった．その第一歩として，わが国の胎児期水頭症の診療実態を把握する目的で疫学調査が企画され開始された^46,47)．途中，組織基盤，構成などは変わったがこの疫学研究は継続され，その成果は各年度の研究報告書のなかで，また一部は学会，論文等で報告してきた．2005年に刊行された「胎児期水頭症　診断と治療ガイドライン」⁸⁰⁾の基盤資料にもなった．

　本稿では，まず疫学研究と出生前診断の基本的事項と趨勢について解説したのち，われわれの疫学調査の経緯と概要，そして解析結果のうち脳神経外科診療に関係が深いものを示し文献的考察を加える．そして最後に，水頭症発生予防にも繋がる葉酸投与の話題について触れてみた．

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