Neurological Surgery 脳神経外科40巻9号

2012年09月発行

連載 教訓的症例に学ぶシリーズ

（3）第三脳室chordoid gliomaの1例

著者： 成澤あゆみ¹ 隈部俊宏¹ 齋藤竜太¹ 園田順彦¹ 渡辺みか² 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分野 ²東北大学病院病理部

ページ範囲：P.805 - P.811

Ⅰ．経験症例

1．症例

　40歳女性，軽度頭痛の精査目的で施行したMRIにて第三脳室内腫瘍を指摘され，当科に紹介された．MRIで，第三脳室前半部に境界明瞭で均一に造影されるほぼ球形の腫瘤 （体積2.3cm³）を認めた（Fig. 1）．視機能・下垂体機能とも正常で，高次機能障害も認めなかった．無症候であったことから，半年ごとにMRIで経過を追っていたところ，5年後に腫瘍体積は3.5倍（8.1cm³）となった（Fig. 2）．後方視的に腫瘍体積を計測すると，腫瘍の増大速度はほぼ一定だった（Fig. 3）．摘出術前の2年間で体重は16kg増加し，公務員としての勤務は継続可能であったが，短期記憶障害が顕著となってきていた．症状出現および腫瘍増大の経過から摘出術を行う方針とした．

　CTでは石灰化を伴わず，軽度高吸収域を呈し（Fig. 4A），proton MR spectroscopy（¹H-MRS）ではコリン（choline：Cho）の高いピークとN-アセチルアスパラギン酸（N-acetyl aspartate：NAA）およびクレアチン（creatine phosphate：Cre）ピークの低下を認めた（Fig. 4D）．見かけ上拡散係数最低値（minimum apparent diffusion coefficient：mADC）は0.623×10^-3mm²/secと低値であった（Fig. 4C）．2-[¹⁸F]fluoro-2-deoxyglucose positron-emission tomography（FDG-PET）では，SUVmax（maximum standardized uptake value）8.4と比較的高値を示した（Fig. 4B）．

参考文献

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