Neurological Surgery 脳神経外科38巻2号

2010年02月発行

連載 脳神経外科疾患治療のスタンダード

15．頭蓋咽頭腫などのparasellar tumor

著者： 川俣貴一¹² 堀智勝² 天野耕作² 藍原康雄² 久保長生² 岡田芳和²

所属機関： ¹東京女子医科大学附属八千代医療センター脳神経外科 ²東京女子医科大学脳神経外科

ページ範囲：P.185 - P.193

Ⅰ．はじめに

　本稿では下垂体腺腫以外の頭蓋咽頭腫などの傍鞍部腫瘍に関して，治療上の問題点を中心に記載する．

　中枢神経系腫瘍の病理分類は発生部位の性格上，多岐にわたり複雑である．国際分類であるWHO分類の中枢神経系腫瘍2007の分類をもとに傍鞍部に発生する可能性がある腫瘍を挙げると，tumors of neuroepithelial tissue，tumors of the meninges，germ cell tumors，tumors of the sellar region（craniopharyngiomaなど），metastatic tumorsなどとなる．また，WHO分類だけではすべてを網羅することはできないので，臨床・病理脳腫瘍取扱い規約³⁶⁾から，cysts and tumor-like lesionsとして，craniopharyngioma，Rathke's cleft cyst，epidermoid，dermoid，arachnoid cystなどが挙げられ，さらに下垂体腺腫などは内分泌臓器の腫瘍WHO 2004で詳細に分類されている³³⁾．

　誌面の都合もあるため，本稿ではこの中で日常診療で遭遇する機会の多い頭蓋咽頭腫ならびにラトケ囊胞の治療を中心に記載する．

参考文献

1）Adamson TE, Wiestler OD, Kleihues P, Yaşargil M：Correlation of clinical and pathological features in surgically treated craniopharyngiomas. J Neurosurg 73：12-17, 1990

2）Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH：Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102：189-193, 2005

3）天野耕作，川俣貴一，久保長生，堀　智勝：ラトケ囊胞手術症例における長期治療成績の検討．東女医大誌78：519-524, 2008

4）Baskin DS, Wilson CB：Surgical management of craniopharyngiomas. A review of 74 cases. J Neurosurg 65：22-27, 1986

5）Belen D, Er U, Yiqitkanli K, Bolay H：Delayed neurotoxic complication of intracavitary bleomycin therapy for craniopharyngioma in a child who had previously undergone radiosurgery. Case report. J Neurosurg 106：391-393, 2007

6）Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD：Surgery for Rathke cleft cysts：technical considerations and outcomes. J Neurosurg 101：577-584, 2004

7）Bunin GR, Surawicz TS, Witman PA, Preston-Martin S, Davis F, Bruner JM：The descriptive epidemiology of craniopharyngioma. J Neurosurg 89：547-551, 1998

8）Carmel PW, Antunes JL, Chang CH：Craniopharyngiomas in children. Neurosurgery 11：382-389, 1982

9）Chakrabarti I, Amar AP, Couldwell W, Weiss MH：Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102：650-657, 2005

10）Ciric IS, Cozzens JW：Craniopharyngiomas：transsphenoidal method of approach--for the virtuoso only? Clin Neurosurg 27：169-187, 1980

11）The Committee of Brain Tumor Registry of Japan：Report of brain tumor registry of Japan (1969-1996), ed 11. Neurol Med Chir (Tokyo) 43：1-111, 2003

12）de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A：Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61：219-228, 2007

13）De Vile CJ, Grant DB, Kendall BE, Neville BG, Stanhope R, Watkins K, Hayward, RD：Management of childhood craniopharyngioma：can morbidity of radical surgery be predicted? J Neurosurg 85：73-81, 1996

14）Dekkers OM, Biermasz NR, Smit JWA, Groot LE, Roelfsema F, Romijn JA, Pereira, AM：Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 154：483-489, 2006

15）Duff JM, Meyer FB, Ilstrup DM, Laws ER Jr, Schleck CD, Scheithauer BW：Long-term outcomes for surgically resected craniopharyngiomas. Neurosurgery 46：291-305, 2000

16）Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M：Surgical treatment of craniopharyngiomas：experience with 168 patients. J Neurosurg 90：237-250, 1999

17）Fisher PG, Jenab J, Gopldthwaite PT, Tihan T, Wharam MD, Foer DR, Burger, PC：Outcomes and failure patterns in childhood craniopharyngiomas. Childs Nerv Syst 14：558-563, 1998

18）Habrand JL, Ganry O, Couanet D, Rouxel V, Levy-Piedbois C, Pierre-Kahn A, Kalifa, C：The role of radiation therapy in the management of craniopharyngioma：a 25-year experience and review of the literature. Int J Radiat Oncol Biol Phys 44：255-263, 1999

19）Honegger J, Buchfelder M, Fahlbusch R：Surgical treatment of craniopharyngiomas：endocrinological results. J Neurosurg 90：251-257, 1999

20）堀　智勝，川俣貴一，藍原康雄，天野耕作，久保長生：解剖に基づいた頭蓋咽頭腫の手術─術前後のホルモン障害の頻度と神経心理学的データ─．No Shinkei Geka 35：1067-1077, 2007

21）Hukin J, Steinbok P, Lafay-Cousin L, Hendson G, Strother D, Mercier C, Samson Y, Howes W, Bouffet E：Intracystic bleomycin therapy for craniopharyngioma in children：the Canadian experience. Cancer 109：2124-2131, 2007

22）Julow J, Backlund EO, Lányi F, Hajda M, Bálint K, Nyáry I, Szeifert GT：Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas. Neurosurgery 61：288-296, 2007

23）Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O, Shine B, Turner HE, Wass JA：Craniopharyngiomas in children and adults：systematic analysis of 121 cases with long-term follow-up. Clin Endocrinol 62：397-409, 2005

24）Kawamata T, Iseki H, Ishizaki R, Hori T：Minimally invasive endoscope-assisted endonasal transsphenoidal microsurgery for pituitary tumors：Experience with 215 cases comparing with sublabial transsphenoidal approach. Neurol Res 24：259-265, 2002

25）Kawamata T, Iseki H, Shibasaki T, Hori T：Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors：Technical note. Neurosurgery 50：1393-1397, 2002

26）Kawamata T, Kamikawa S, Iseki H, Hori T：Flexible endoscope-assisted endonasal transsphenoidal surgery for pituitary tumors. Minim Invasive Neurosurg 45：208-210, 2002

27）Kawamata T, Kubo O, Hori T：Histological findings at the boundary of craniopharyngiomas. Brain Tumor Pathol 22：75-78, 2005

28）Kawamata T, Amano K, Hori T：Novel flexible forceps for endoscopic transsphenoidal resection of pituitary tumors：Technical report. Neurosurg Rev 31：65-68, 2008

29）Kawamata T, Hori T：Endoscopic trans-sphenoidal surgery for pituitary tumors. Expert Rev Endocrinol Metab 3：567-575, 2008

30）Kawamata T, Amano K, Aihara Y, Kubo O, Hori T：Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities. Neurosurg Rev 33：71-81, 2010

31）Khafaga Y, Jenkin D, Kanaan I, Hassounah M, Al Shabanah M, Gray A：Craniopharyngioma in children. Int J Radiat Oncol Biol Phys 42：601-606, 1998

32）Kim JE, Kim JH, Kim OL, Paek SH, Kim DG, Chi JG, Jung HW：Surgical treatment of symptomatic Rathke　cleft cysts：Clinical features and results with special attention to recurrence. J Neurosurg 100：33-40, 2004

33）久保長生，川俣貴一，天野耕作，堀　智勝：間脳・下垂体腫瘍の病理．脳神経外科エキスパート間脳下垂体．佐伯直勝 編，中外医学社，東京，pp48-68, 2008

34）Lafay-Cousin L, Bartels U, Raybaud C, Kulkarni AV, Guger S, Huang A, Bouffet E：Neuroradiological findings of bleomycin leakage in cystic craniopharyngioma. Report of three cases. J Neurosurg 107：318-323, 2007

35）Miller DC：Pathology of craniopharyngiomas：clinical import of pathological findings. Pediatr Neurosurg 21：11-17, 1994

36）脳腫瘍全国統計委員会／日本病理学会．臨床・病理脳腫瘍取扱い規約．臨床と病理カラーアトラス．第2版．東京．金原出版，2002

37）Pereira AH, Schmid EM, Schutte PJ, Voormolen JHC, Biermasz NR, van Thiel SW, Corssmit EPM, Smit JWA, Roelfsema F, Romijn JA：High prevalence of long-term cardiovascular, neurological and psychosocial morbidity after treatment for craniopharyngioma. Clin Endocrinol 62：197-204, 2005

38）Rajan B, Ashley S, Gorman C, Jose CC, Horwich A, Bloom HJ, Marsh H, Brada M：Craniopharyngioma-a long-term results following limited surgery and radiotherapy. Radiother Oncol 26：1-10, 1993

39）Regine WF, Mohiuddin M, Kramer S：Long-term results of pediatric and adult craniopharyngiomas treated with combined surgery and radiation. Radiother Oncol 27：13-21, 1993

40）Ross DA, Norman D, Wilson CB：Radiological characteristics and results of surgical management of Rathke's cysts in 43 patients. Neurosurgery 30：173-179, 1992

41）Russell DS, Rubinstein LJ：Pathology of Tumours of the Nervous System, ed 5. London：Edward Arnold, 1989

42）Sorva R, Heiskanen O：Craniopharyngioma in Finland. A study of 123 cases. Acta Neurochir (Wien) 81：85-89, 1986

43）Srinivasan S, Ogle GD, Garnett SP, Briody JN, Lee JW, Cowell CT：Features of the metabolic syndrome after childhood craniopharyngioma. J Clin Endocrinol Metab 89：81-86, 2004

44）Steno J：Microsurgical topography of craniopharyngiomas. Acta Neurochir Suppl (Wien) 35：94-100, 1985

45）Sumida M, Uozumi T, Mukada K, Arita K, Kurisu K, Eguchi K：Rathke cleft cysts：correlation of enhanced MR and surgical findings. AJNR Am J Neuroradiol 15：525-532, 1994

46）Symon L：Microsurgery of the hypothalamus with special reference to craniopharyngioma. Neurosurg Rev 6：43-49, 1983

47）Teramoto A, Hirakawa K, Sanno N, Osamura Y：Incidental pituitary lesions in 1000 unselected autopsy specimens. Radiology 193：161-164, 1994

48）Van Effenterre R, Boch AL：Craniopharyngioma in adults and children：a study of 122 surgical cases. J Neurosurg 97：3-11, 2002

49）Voges J, Sturm V, Lehrke R, Treuer H, Gauss C, Berthold F：Cystic craniopharyngioma：long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery 40：263-270, 1997

50）Weiner HL, Wisoff JH, Rosenberg ME, Kupersmith MJ, Cohen H, Zagzag D, Shiminski-Maher T, Flamm ES, Epsten FJ, Miller D：Craniopharyngiomas：a clinicopathological analysis of factors predictive of recurrence and functional outcome. Neurosurgery 35：1001-1011, 1994

51）Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P：Total removal of craniopharyngiomas. Approaches and longterm results in 144 patients. J Neurosurg 73：3-11, 1990

52）Zuccaro G, Jaimovich R, Mantese B, Monges J：Complications in paediatric craniopharyngioma treatment. Childs Nerv Syst 12：385-391, 1996