Neurological Surgery 脳神経外科39巻11号

2011年11月発行

連載 先天奇形シリーズ

（12）くも膜囊胞

著者： 稲垣隆介¹

所属機関： ¹関西医科大学脳神経外科

ページ範囲：P.1105 - P.1111

Ⅰ．はじめに

　くも膜囊胞は頭蓋内囊胞性疾患の約1％を占めるとされる．米国での剖検結果からは1,000例に1例程度が認められると報告されている²⁴⁾．

　くも膜囊胞がどのような機序で形成されるかはまだわかっていないが，女児より男児に多く，また，人種に関係なく左側に多いことが知られている．くも膜囊胞は髄液腔であればどこに存在してもよいが，30～50％は中頭蓋窩にできるとされる．その他には，脳表，トルコ鞍上部，四丘体部，小脳橋角部，後頭蓋窩正中部などに認められる⁷⁾．

　本稿では一般的なことを最初に記載し，発生部位によるそれぞれの特徴，診断のポイントなどについて述べる．

参考文献

1）Alexiou GA, Varela M, Sfakianos G, Prodromou N：Shunting for the treatment of arachnoid cysts in children. Neurosurgery 67：1632-1636, 2010

2）Al-Holou WN, Yew AY, Boomsaad ZE, Garton HJ, Muraszko KM, Maher CO：Prevalence and natural history of arachnoid cysts in children. Clinical article. J Neurosurg Pediatr 5：578-585, 2010

3）Arai H, Sato K, Wachi A, Okuda O, Takeda N：Arachnoid cysts of the middle cranial fossa：experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery 39：1108-1112, discussion 1112-1113, 1996

4）Bannister CM, Russell SA, Rimmer S, Mowle DH：Feta arachnoid cysts：their site, progress, prognosis and differential diagnosis. Eur J Pediatr Surg 9 (suppl 1)：27-28, 1999

5）Beltramello A, Mazza C：Spontaneous disappearance of a large middle fossa arachnoid cyst. Surg Neurol 24：181-183, 1985

6）Benton JW, Nelhaus G, Huttenlocher PR, Ojemann RG, Dodge PR：The bobble-head doll syndrome：report of unique truncal tremor associated with third ventricular cyst and hydrocepha-lus in children. Neurology 16：725-729, 1966

7）Boop FA, Young RL, Scott RM：Arachnoid cysts of the middle cranial fossa and convexity. (In Kaufmann HH (9ed)：Cerebrospinal fluid collections, Park Ridge, IL, American Association of Neurological Surgeons Publications, 1998, pp67-76)

8）Bright R：Reports of medical cases. Selected with a view of illustrating the symptoms and cure of diseases by a reference to morbid anatomy. VolⅡ：Diseases of the brain and nervous system. London, Longman, Rees, Orme, Brown, Green, and Highley, pp 437-439, 1831

9）Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P：Prolonged ICP monitoring in Sylvian arachnoid cysts. Surg Neurol 60：211-218, 2003

10）Ersahin Y, Kesikci H：Endoscopic management of quadrigeminal arachnoid cysts. Childs Nerv Syst 25：569-576, 2009

11）Faris AA, Bale GF, Cannon B：Arachnoidal cyst of the third ventricle with precocious puberty. South Med J 64：1139-1142, 1971

12）Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G：CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa：classification and pathophysiological aspects. Surg Neurol 17：363-369, 1982

13）Gangemi M, Colella G, Magro F, Maiuri F：Suprasellar arachnoid cysts：endoscopy versus microsurgical cyst excision and shunting. Br J Neurosurg 21：276-280, 2007

14）Go KG, Houthoff HJ, Blaauw EH, Havinga P, Hartsuiker J：Arachnoid cysts of the sylvian fissur：Evidence of fluid secretion. J Neurosurg 60：803-813, 1984

15）Hanieh A, Simpson DA, North JB：Arachnoid cysts：a critical review of 41 cases. Child's Nerv Syst 4：92-96, 1988

16）Hoffman HJ, Hendrick EB, Humphreys RP, Armstrong EA：Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57：597-602, 1982

17）Iacono RP, Labadie EI, Johnstone SJ, Bendt TK：Symptomatic arachnoid cyst at the clivus drained stereotactically through the vertex. Neurosurgery 27：130-133, 1990

18）Laviv Y, Michowitz S：Acute intracranial hypertension and shunt dependency following treatment of intracranial arachnoid cyst in a child：a case report and review of the literature. Acta Neurochir (Wien) 152：1419-1423, 2010

19）Lena G, van Calenberg F, Genitori L, Choux M：Supratentorial interhemispheric cysts associated with callosal agenesis：surgical treatment and outcome in 1 children. Childs Nerv Syst 11：568-573, 1995

20）Maher CO, Goumnerova L：The effectiveness of ventriculocystocisternostomy for suprasellar arachnoid cysts. J Neurosurg Pediatrics 7：64-72, 2011

21）Marin-Sanabria EA, Yamamoto H, Nagashima T, Kohmura E：Evaluation of the management of arachnoid cyst of the posterior fossa in pediatric population：experience over 27 years. Childs Nerv Syst 23：535-542, 2007

22）Oertel JMK, Wagner W, Mondorf Y, Baldauf J, Schroeder HWS, Gaab MR：Endoscopic treatment of arachnoid cysts：a detailed account of surgical techniques and results. Neurosurgery 67：824-836, 2010

23）Parsch CS, Krauß J, Hofmann E, Meixensberger J, Roosen K：Arachnoid cysts associated with subdural hematomas and hygromas：analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40, 483-490, 1997

24）Robinson RG：Congenital cysts of the brain：arachnoid malformations. Prog Neurol Surg 4：133-174, 1971

25）Russo RH, Kindt GW：A neuroanatomical basis for the bobble-head doll syndrome. J Neurosurg 41：720-721, 1974

26）Santamarta D, Aguas J, Rerrer E：The natural history of arachnoid cysts：endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 38：133-137, 1995

27）Sato K, Shimoji T, Yaguchi K, Sumie H, Kuru Y, Ishii S：Middle fossa arachnoid cyst：Clinical, neuroradiological, and surgical features. Childs Brain 10：301-316, 1983

28）Sgouros S, Chapman S：Congenital middle fossa arachnoid cysts may cause global brain ischaemia：a study with 99Tc-hexamethylpropyleneamineoxime single photon emission computerized tomography scans. Pediatr Neurosurg 35：188-194, 2001

29）Starkman SP, Brown TC, Linnell EA：Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17：484-500, 1958