Neurological Surgery 脳神経外科43巻10号

2015年10月発行

症例

再発大型下垂体腺腫に対する経蝶形骨洞的および経頭蓋到達法による一期的複合手術：2症例報告

著者： 池田直廉¹ 戸田弘紀¹ 箸方宏州¹ 西田南海子¹ 岩崎孝一¹

所属機関： ¹公益財団法人田附興風会医学研究所北野病院脳神経外科

ページ範囲：P.933 - P.939

Ⅰ．はじめに
　大型/巨大下垂体腺腫に対しては，経蝶形骨洞的到達法あるいは経頭蓋到達法による単独手術では十分な摘出が困難で，残存腫瘍からの出血などに起因する重篤な術後合併症を来す危険性がある^7,8)．また下垂体腺腫の再発例の手術においては，いずれの手術法を用いても周囲正常組織と腫瘍の癒着，腫瘍内隔壁形成，指標となる正常構造の偏位・欠損などのため，初回手術に比して摘出が格段に困難であることは論をまたない²⁾．今回われわれは，再発大型非機能性下垂体腺腫の2例に対して，内視鏡下経蝶形骨洞的到達法と経頭蓋到達法同時手術（combined supra- and infra-sellar approach：CSISA）による一期的摘出術を行い良好な結果を得たので，文献的考察を加え報告する．

参考文献

1) Alleyne CH Jr, Barrow DL, Oyesiku NM：Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol 57：380-390；discussion 390, 2002

2) Cavallo LM, Solari D, Tasiou A, Esposito F, de Angelis M, D'Enza AI, Cappabianca P：Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas：experience on a 59-patient series. World Neurosurg 80：342-350, 2013

3) Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T：Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches：surgical experience in 105 cases. Neurosurgery 55：539-547；discussion 547-550, 2004

4) D'Ambrosio AL, Syed ON, Grobelny BT, Freda PU, Wardlaw S, Bruce JN：Simultaneous above and below approach to giant pituitary adenomas：surgical strategies and long-term follow-up. Pituitary 12：217-225, 2009

5) Dehdashti AR, Ganna A, Witterick I, Gentili F：Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions：indications and limitations. Neurosurgery 64：677-687；discussion 687-689, 2009

6) Di Maio S, Cavallo LM, Esposito F, Stagno V, Corriero OV, Cappabianca P：Extended endoscopic endonasal approach for selected pituitary adenomas：early experience. J Neurosurg 114：345-353, 2011

7) Garibi J, Pomposo I, Villar G, Gaztambide S：Giant pituitary adenomas：clinical characteristics and surgical results. Br J Neurosurg 16：133-139, 2002

8) Goel A, Nadkarni T, Muzumdar D, Desai K, Phalke U, Sharma P：Giant pituitary tumors：a study based on surgical treatment of 118 cases. Surg Neurol 61：436-445；discussion 445-446, 2004

9) Greenfield JP, Leng LZ, Chaudhry U, Brown S, Anand VK, Souweidane MM, Schwartz TH：Combined simultaneous endoscopic transsphenoidal and endoscopic transventricular resection of a giant pituitary macroadenoma. Minim Invasive Neurosurg 51：306-309, 2008

10) Hardy J：Transsphenoidal hypophysectomy. J Neurosurg 34：582-594, 1971

11) Ishii Y, Tahara S, Oyama K, Kitamura T, Teramoto A：Easy slip-knot：a new simple tying technique for deep sutures. Acta Neurochir（Wien）153：1543-1545；discussion 1545, 2011

12) Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P：Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63：ONS44-ONS52；discussion ONS52-ONS53, 2008

13) Loyo M, Kleriga E, Mateos H, de Leo R, Delgado A：Combined supra-infrasellar approach for large pituitary tumors. Neurosurgery 14：485-488, 1984

14) Nishioka H, Hara T, Usui M, Fukuhara N, Yamada S：Simultaneous combined supra-infrasellar approach for giant/large multilobulated pituitary adenomas. World Neurosurg 77：533-539, 2012

15) Ojha BK, Husain M, Rastogi M, Chandra A, Chugh A, Husain N：Combined trans-sphenoidal and simultaneous trans-ventricular-endoscopic decompression of a giant pituitary adenoma：case report. Acta Neurochir（Wien）151：843-847；discussion 847, 2009

16) Umemura A, Suzuka T, Isomura K, Ito M, Mukodaka H：Simultaneous transcranial and endoscopic transnasal approach for recurrent huge pituitary adenoma. Acta Neurochir（Wien）141：1359-1360, 1999

17) 山田正三，福原紀章，大山健一：非機能性巨大下垂体腺腫の複合治療（〈特集〉間脳下垂体腫瘍の治療）．脳外誌19：658-665, 2010