Neurological Surgery 脳神経外科48巻10号

2020年10月発行

症例

Holmes振戦を来した第三脳室内成熟奇形腫の1例

著者： 三海正隆¹ 松崎遼¹ 中田知恵¹ 寺園明¹ 安藤俊平¹ 原田雅史¹ 桝田博之¹ 近藤康介¹ 原田直幸¹ 周郷延雄¹

所属機関： ¹東邦大学医学部医学科脳神経外科学講座（大森）

ページ範囲：P.927 - P.933

Ⅰ．はじめに
　頭蓋内奇形腫は小児期に好発する胚細胞腫瘍であり，原発性脳腫瘍のうち約0.1%と稀である．また，好発部位として松果体部や第三脳室内が知られている²⁾．その初発症状は，頭痛，痙攣，運動・感覚障害などであり，振戦を来すことは少ない．Holmes振戦は安静時や企図時に上肢でみられる低振幅の振戦で，中脳や小脳における変性疾患，血管障害，外傷などで起こることが多く，脳腫瘍での報告は極めて稀である¹³⁾．
　今回われわれは，Holmes振戦を主訴とした5歳男児の第三脳室内巨大成熟奇形腫の1例を経験したので，若干の文献的考察を加えて報告する．

参考文献

1) Algahtani H, Shirah B, Abdullah A, Bazaid A：Teratoma of the nervous system：a case series. Neurocirugia（Astur）29：143-149, 2018

2) Committee of Brain Tumor Registry of Japan：Report of the Brain Tumor Registry of Japan（2001-2004). Neurol Med Chir（Tokyo）54（Suppl）：1-102, 2014

3) Espinoza Martinez JA, Arango GJ, Fonoff ET, Reithmeier T, Escobar OA, Furlanetti L, Alvarez Berastegui GR, Fernandes da Silva FE, Contreras Lopez WO：Deep brain stimulation of the globus pallidus internus or ventralis intermedius nucleus of thalamus for Holmes tremor. Neurosurg Rev 38：753-763, 2015

4) Ferlazzo E, Morgante F, Rizzo V, Sciarrone G, Meduri M, Magaudda A, Girlanda P, Quartarone A：Successful treatment of Holmes tremor by levetiracetam. Mov Disord 23：2101-2103, 2008

5) Grover PJ：Thalamic tumour presenting with Holmes' tremor：diagnostic difficulties. BMJ Case Rep 2010：2432, 2010

6) Ha BJ, Kim YS, Cheong JH：Large mature cystic teratoma of the third ventricle in infancy：a case report and review of literatures. Brain Tumor Res Treat 4：44-47, 2016

7) Holmes G：On certain tremors in organic cerebral lesions. Brain 27：327-375, 1904

8) Huang X, Zhang R, Zhou LF：Diagnosis and treatment of intracranial immature teratoma. Pediatr Neurosurg 45：354-360, 2009

9) Kim MC, Son BC, Miyagi Y, Kang JK：Vim thalamotomy for Holmes' tremor secondary to midbrain tumour. J Neurol Neurosurg Psychiatry 73：453-455, 2002

10) 厚生労働省：平成22年乳幼児身体発育調査の概況について：図7乳幼児（男子）身体発育曲線（頭囲）．https://www.mhlw.go.jp/file/04-Houdouhappyou-11901000-Koyoukintoujidoukateikyoku-Soumuka/zu7.pdf（2020年1月17日アクセス）

11) Koyalmantham V, Garg K, Sardana H, Singh M, Chandra PS：Holmes' tremor secondary to a posterior third ventricular germinoma：a rare case report. Childs Nerv Syst 33：885-887, 2017

12) O'Grady J, Kobayter L, Kaliaperumal C, O'Sullivan M：‘Teeth in the brain’-a case of giant intracranial mature cystic teratoma. BMJ Case Rep 2012：bcr0320126130, 2012

13) Raina GB, Cersosimo MG, Folgar SS, Giugni JC, Calandra C, Paviolo JP, Tkachuk VA, Zuñiga Ramirez C, Tschopp AL, Calvo DS, Pellene LA, Uribe Roca MC, Velez M, Giannaula RJ, Fernandez Pardal MM, Micheli FE：Holmes tremor：clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 86：931-938, 2016

14) Rosenblum JS, Nazari M, Al-Khalili Y, Potigailo V, Veznedaroglu E：Unilateral symptomatic hypertrophic olivary degeneration secondary to midline brainstem cavernous angioma：a case report and review of the literature. World Neurosurg 110：294-300, 2018

15) Sanyal P, Barui S, Mathur S, Basak U：A case of mature cystic teratoma arising from the fourth ventricle. Case Rep Pathol 2013：702424, 2013

16) Sekimoto S, Oyama G, Izawa N, Ueno S, Jo T, Shimo Y, Nakajima A, Nakajima M, Umemura A, Arai H, Hattori N：Effect of zonisamide on post-traumatic Holmes' tremor. Neurol Clin Neurosci 4：184-185, 2016

17) Strowd RE, Burger P, Holdhoff M, Kleinberg L, Okun MS, Olivi A, Pardo-Villamizar C, Schiess N：Steroid-responsive intracranial germinoma presenting as Holmes' tremor：importance of a tissue diagnosis. J Clin Neurosci 22：911-913, 2015

18) 若井　晋：頭蓋内奇形腫の発生起源．Brain Nerve 41：947-953, 1989

19) Wang J, Kazmi SA：Teratoma with malignant transformation：a case report with pathological, cytogenetic, and immunohistochemistry analysis. Sarcoma 2011：450743, 2011

20) Yang SH, Kulkarni AV：Successful treatment of tremor by endoscopic third ventriculostomy in an adolescent with obstructive hydrocephalus due to tectal glioma：case report. Childs Nerv Syst 27：1007-1010, 2011

21) Yoon JH, Yong SW, Lee JS：Spontaneous disappearance of Holmes' tremor in a patient with a midbrain cavernous hemangioma. Neurol Sci 36：2137-2138, 2015

22) Zhong J, Li ST, Xu SQ, Wan L：Holmes' tremor caused by midbrain cavernoma. Chin Med J（Engl）120：2059-2061, 2007