Neurological Surgery 脳神経外科39巻2号

2011年02月発行

症例

眼窩先端部症候群で発症し内頚動脈浸潤した副鼻腔真菌症の3症例

著者： 杉山拓¹ 黒田敏¹ 中山若樹¹ 寳金清博¹

所属機関： ¹北海道大学大学院医科学研究科脳神経外科学分野

ページ範囲：P.155 - P.161

Ⅰ．はじめに

　近年，ステロイドや抗悪性腫瘍薬での免疫抑制状態患者の増加を背景に，深在性真菌症の発生頻度は増加してきている¹⁴⁾．なかでも浸潤型アスペルギルス症やムコール症などは，比較的稀に副鼻腔炎から，粘膜や骨を破壊し，直接眼窩内や頭蓋底に浸潤^8,12,16)することがあり，海綿静脈洞部内頚動脈浸潤から，脳梗塞や脳出血などの脳血管障害を合併することがあり，注意すべき病態である．

　今回われわれは，眼窩先端部症候群（orbital apex syndrome）にて発症し，その後比較的急速な経過で海綿静脈洞部内頚動脈浸潤を生じ，結果的に脳梗塞や出血を合併することで不幸な転帰を辿った頭蓋内真菌症の3症例を経験した．本稿では，これらの症例を呈示し，文献的考察を加え報告する．

参考文献

1）Arndt S, Aschendorff A, Echternach M, Daemmrich TD, Maier W：Rhino-orbital-cerebral mucormycosis and aspergillosis：differential diagnosis and treatment. Eur Arch Otorhinolaryngol 266：71-76, 2009

2）Chandra S, Goyal M, Mishra NK, Gaikwad SB：Invasive aspergillosis presenting as a cavernous sinus mass in immuno competent individuals；report of 3 cases. Neuroradiology 42：108-111, 2000

3）Coleman JM, Hogg GG, Rosenfeld JV, Waters KD：Invasive central nervous system aspergillosis：cure with liposomal amphotericin B, itraconazole, and radical surgery--case report and review of the literature. Neurosurgery 36：858-863, 1995

4）Corr P, Wright M, Handler LC：Endocarditis-related cerebral aneurysms：radiologic changes with treatment. AJNR Am J Neuroradiol 16：745-748, 1995

5）遠藤英彦，別府高明，荒井啓史，小笠原邦昭，鈴木　豪，鈴木倫保，小川　彰，斉藤立華，澤井高志：海綿静脈洞部アスペルギルス肉芽腫の1例．No Shinkei Geka 29：325-329, 2001

6）Fernandes YB, Ramina R, Borges G, Queiroz LS, Maldaun MV, Maciel JA Jr：Orbital apex syndrome due to aspergillosis：case report. Arq Neuropsiquiatr 59：806-808, 2001

7）Galassi E, Pozzati E, Poppi M, Vinci A：Cerebral aspergillosis following intracranial surgery. Case report. J Neurosurg 49：308-311, 1978

8）Hedges TR, Leung LS：Parasellar and orbital apex syndrome caused by aspergillosis. Neurology 26：117-120, 1976

9）Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de Pauw B；Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group：Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347：408-415, 2002

10）Hurst RW, Judkins A, Bolger W, Chu A, Loevner LA： Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis：imaging and pathologic correlation. AJNR Am J Neuroradiol 22：858-863, 2001

11）鴨嶋雄大，澤村　豊，岩﨑喜信，浜田晋輔，泉　直人，奥川　周：眼窩尖端部症候群にて発症した浸潤型副鼻腔～眼窩アスペルギルス症の1例．No Shinkei Geka 35：1013-1018, 2007

12）Maiorano E, Favia G, Capodiferro S, Montagna MT, Lo Muzio L：Combined mucormycosis and aspergillosis of the oro-sinonasal region in a patient affected by Castleman disease. Virchows Arch 446：28-33, 2005

13）Marcet MM, Yang W, Albert DM, Salamat MS, Appen RE：Aspergillus infection of the orbital apex masquerading as Tolosa-Hunt syndrome. Arch Ophthalmol 125：563-566, 2007

14）Marr KA, Carter RA, Crippa F, Wald A, Corey L：Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 34：909-917, 2002

15）Matsuo T, Notohara K, Yamadori I：Aspergillosis causing bilateral optic neuritis and later orbital apex syndrome. Jpn J Ophthalmol 49：430-431, 2005

16）Sivak-Callcott JA, Livesley N, Nugent RA, Rasmussen SL, Saeed P, Rootman J：Localised invasive sino-orbital aspergillosis：characteristic features. Br J Ophthalmol 88：681-687, 2004

17）Takahashi Y, Sugita Y, Maruiwa H, Hirohata M, Tokutomi T, Shigemori M：Fatal hemorrhage from rupture of the intracranial internal carotid artery caused by aspergillus arteritis. Neurosurg Rev 21：198-201, 1998

18）Takeshita M, Izawa M, Kubo O, Tanikawa T, Onda H, Wanifuchi H, Tamura Y, Kagawa M：Aspergillotic aneurysm formation of cerebral artery following neurosurgical operation. Surg Neurol 38：146-151, 1992

19）Urculo E, Aranzadi MJ, Ruiz I, Villanua J：Aspergillus granuloma of the cavernous sinus：magnetic resonance imaging with pathologic correlation. Acta Neurochir (Wien) 147：341-342；discussion 342, 2005

20）Walsh TJ, Hier DB, Caplan LR：Aspergillosis of the central nervous system：clinicopathological analysis of 17 patients. Ann Neurol 18：574-582, 1985

21）Wilson WR, Hawrych A, Olan W：Rapid development of bilateral internal carotid artery aneurysm from sphenoid sinus aspergillosis. Skull Base Surg 8：211-214, 1998

22）Yamanoi T, Shibano K, Soeda T, Hoshi A, Matsuura Y, Sugiura Y, Endo K, Yamamoto T：Intracranial invasive aspergillosis originating in the sphenoid sinus：a successful treatment with high-dose itraconazole in three cases. Tohoku J Exp Med 203：133-139, 2004