Neurological Surgery 脳神経外科37巻3号

2009年03月発行

症例

脳室内ビデオスコープ（軟性鏡）にて摘出した第三脳室コロイド囊胞の2例

著者： 小濱みさき¹ 藤村幹¹ 永松謙一¹ 村上謙介¹ 冨永悌二¹

所属機関： ¹東北大学大学院医学系研究科神経外科学

ページ範囲：P.261 - P.267

Ⅰ．はじめに

　コロイド囊胞は，第三脳室に発生し閉塞性水頭症の原因となる稀な疾患である^3,7,14,16)．コロイド囊胞の嵌頓や急性水頭症により突然死を来した症例も報告されており⁸⁾，早期の外科治療が必要と考えられる．1922年にDandyがコロイド囊胞の摘出術を報告して以来⁴⁾，外科治療が試みられ，ステレオ定位下でのaspiration，シャント術が行われてきた．過去10年間ではtranscortical-transventricular approachあるいはtranscallosal approach ²⁾を用いた開頭下摘出術が標準的治療であったが，近年は低侵襲治療の観点から主に硬性鏡を用いた神経内視鏡的治療の有用性が報告されている^{1,5,6,10-13,15,20-22)}．今回，われわれは高解像度の軟性神経内視鏡である脳室内ビデオスコープ⁹⁾を用いて治療したコロイド囊胞の2例を経験したので文献的考察とともに報告する．

参考文献

1）Abdou MS, Cohen AR：Endoscopic treatment of colloid cysts of the third ventricle. Technical note and and review of the literature. J Neurosurg 89：1062-1068, 1998

2）Antunes JL, Louis KM, Ganti SR：Colloid cysts of the third ventricle. Neurosurgery 7：450-455, 1980

3）Batnitzky S, Sarwar M, Leeds NE, Schechter MM, Azar-Kia B：Colloid cysts of the third ventricle. Radiology 112：327-341, 1974

4）Dandy WE：Diagnosis, localization and removal of tumors of the third ventricle. Bull Johns Hopkins Hosp 33：188-189, 1922

5）Decq P, Le Guerinel C, Brugieres P, Djindjian M, Silva D, Keravel Y, Melon E, Nguyen JP：Endoscopic management of colloid cysts. Neurosurgery 42：1288-1296, 1998

6）Deinsberger W, Boker DK, Samii M：Flexible endoscopes in treatment of colloid cysts of the third ventricle. Minim Invas Neurosurg 37：12-16, 1994

7）Desai KI, Nadkarini TD, Muzumdar DP, Goel AH：Surgical management of colloid cyst of the third ventricle-A study of 105 cases. Surg Neurol 57：295-304, 2002

8）De Witt Hamer PC, Verstegen MJ, De Haan RJ, Vandertop WP, Thomeer RT, Mooij JJ, van Furth WR：High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle. J Neurosurg 96：1041-1045, 2002

9）Endo H, Fujimura M, Kumabe T, Kanamori M, Watanabe M, Tominaga T：Application of high-definition flexible neuroendoscopic system to the treatment of primary pineal malignant B-cell lymphoma. Surg Neurol 2008 Jan 18 [Epub ahead of print]

10）Hellwig D, Bauer BL, Schulte M, Gatscher S, Riegel T, Bertalanffy H：Neuroendoscopic treatment for colloid cysts of the third ventricle：the experience of decade. Neurosurgery 52：525-533, 2003

11）Horn EM, Feiz-Erfan I, Bristol RE, Lekovic GP, Goslar PW, Smith KA, Nakaji P, Spetzler RF：Treatment options for third ventricular colloid cysts：comparison of open microsurgical versus endoscopic resection. Neurosurgery 60：613-620, 2007

12）Kehler U, Brunori A, Gliemroth J, Nowak G, Delitala A, Chiappetta F, Arnold H：Twenty colloid cysts- Comparison of endoscopic and microsurgical management. Minim Invas Neurosurg 44：121-127, 2001

13）King WA, Ullman JS, Frazee JG, Post KD, Bergsneider M：Endoscopic resection of colloid cysts：Surgical considerations using the rigid endoscope. Neurosurgery 44：1103-1111, 1999

14）Little JR, MacCarty CS：Colloid cysts of the third ventricle. J Neurosurg 40：230-235, 1974

15）Longatti P, Martinuzzi A, Moro M, Fiorindi A, Carteri A：Endoscopic treatment of colloid cysts of the third ventricle：9 consecutive cases. Minim Invasive Neurosurg 43：118-123, 2000

16）Nittta M, Symon L：Colloid cysts of the third ventricle. A review of 36 cases. Acta Neurochir (Wien) 76：99-104, 1985

17）Oi S, Samii M, Samii M：Frameless free-hand maneuvering of a small-diameter rigid-rod neuroendoscope with a working channel used during high-resolution imagimg. J Neurosurg (Pediatrics 1) 102：113-118, 2005

18）Pollock BE, Huston J 3rd：Natural history of asymptomatic colloid cysts of the third ventricle. J Neurosurg 91：364-369, 1999

19）Powell MP, Torrens MJ, Thomson JL, Horgan JG：Isodense colloid cysts of the third ventricle：a diagnostic and therapeutic problem resolved by ventriculoscopy. Neurosurgery 13：234-237, 1983

20）Rodziewicz GS, Smith MV, Hodge CJ Jr：Endoscopic colloid cyst surgery. Neurosurgery 46：655-662, 2000

21）Schroeder HWS, Gaab MR：Endoscopic resection of colloid cysts. Neurosurgery 51：1441-1445, 2002

22）Zohdi A, Kheshin SE：Endoscopic approach to colloid cysts. Minim Invas Nerosurg 49：263-268, 2006