Neurological Surgery 脳神経外科39巻12号

2011年12月発行

総説

中枢神経系への放射線照射によって生じる高次脳機能障害の評価ならびに予防法の開発

著者： 石内勝吾¹

所属機関： ¹琉球大学大学院医学研究科脳神経外科

ページ範囲：P.1127 - P.1137

Ⅰ．はじめに

　中枢神経系に対する放射線照射は，原発性および転移性脳腫瘍ばかりでなく，頭頚部腫瘍，リンパ腫／白血病に対しても広く行われている重要な癌治療法である．しかし，小児および成人を問わず，脳への広範な放射線照射は記憶，注意，遂行，社会的行動などの高次脳機能の障害³⁸⁾を来すことが知られている．腫瘍が制御された患者においては，治療終了後数カ月から数年後に生じる晩発性放射線障害による認知機能低下は生活の質を低下させるため克服すべき重大な課題であり，近年社会問題化している．3歳以下の小児では特に重篤な発達発育障害や知能低下が必発である．悪性リンパ腫患者においても，高濃度メソトレキセート療法後の放射線療法は，放射線量を40～50Gyに軽減しても，長期生存患者では白質障害による認知機能低下が必発である．これら放射線治療によって引き起こされる高次脳機能障害は，従来，生命予後を優先し看過されてきたが，脳疾患の予防，治療，周術期管理，リハビリテーション，外来治療すべてを担うわれわれ脳神経外科医にとっては，日常診療で遭遇している極めて身近な克服すべき重要な問題である．

　最近では，放射線による高次脳機能障害の原因として，海馬歯状回の神経新生の障害との関連が示唆されている⁵⁾．転移性脳腫瘍に対する線量計画においては，視交叉・視神経同様，積極的に神経幹細胞が局在する側脳室壁を照射野から除外する試みもなされている．本邦では認知機能低下を危惧し，転移性脳腫瘍の手術後の補助療法としての放射線治療は，欧米で推奨されている全脳照射を回避する傾向にある．ガンマナイフやサイバーナイフなどを用いた高線量局所放射線，もしくは強度変調放射線療法により，腫瘍に放射線を収束させ，神経幹細胞の局在部位への照射量を軽減する試みも施行されている．

　本稿では，臨床における高次脳機能診断の実際とその評価，放射線治療経過に伴う高次脳機能障害の特徴，放射線が誘発する高次脳機能障害と海馬歯状回の神経新生との関連について論じることにする．

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