頭蓋骨血管腫 : 自験2症例と文献報告62症例の検討

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Case l. A 49-year-old woman was admitted because of a lump in the forehead. She had noticed a lump 5 years previously, and it slowly increased in size. She had been medicated with thyroxin for 2 months prior to admission because of the diagnosis of hypothyroidism and high serum thyroid stimulating hormone level (130 μu/ml). Physical and neurological examinations were normal except for the lump. Laboratory findings were normal. Plain skull films showed an osteolytic area with a reticular pattern and sclerotic margin in the frontal bone. A bone scintigram revealed an accumulation of radioisotopes at the lesion. A selective external carotid angiogram demonstrated feeding arteries from the middle meningeal artery and the superficial temporal artery, and a pooling of contrast material in the arterial through venous phases. A vascular tumor was removed en block. The histology revealed thin-walled dilated vessels between the trabeculae, which was diagnosed as a cavernous hemangioma of the frontal bone. Postoperative recovery was uneventful. Case 2. A 59-year-old woman was admitted because of a mass in the right temporal region and right facial palsy. She had under gone thyroidectomy for thyroid carcinoma 6 years previously. Postoperatively, she had been medicated with thyroxin. She had noticed a lump on the right temporal region 4 years previously. She had stopped taking thyroxin one year prior to admission. The tumor slowly increased in size and she developed right facial palsy. On examination, she was noted to have a large tumor on the temporal region, right facial pasty of the peripheral type and a slight paresis of the left upper extremity. Plain skull films showed a large osteolytic lesion without reticular pattern or sclerotic margins in the temporal and the sphenoid bones. Computed tomography revealed a large, high and low density mass, which occupied the middle fossa and destroyed the temporal and sphenoid bones. A right common carotid angiogram demonstrated a pooling of contrast material in part of the tumor in the arterial through the venous phases. A vascular tumor was removed partially. The underlying dura was vascular and adherent to the tumor, but there was no invasion of the dura. Microscopically, this tumor was a cavernous hemangioma. Postoperatively, preoperative neurological signs improved. Some authors suggested that trauma was one of the promoting factors of the tumor growth. In the two cases of the authors, there was no history of trauma but both had hypothyroidism. Some changes in hormonal environments may be one of the promoting factors of tumor growth.
日本脳神経外科学会の論文
1982-02-15

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