孤在性悪性グリオーマによる瀰漫性硬膜静脈洞閉塞 : グリオーマの発育形式に関する一考察

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This paper reports a diffuse dural sinus obstruction due to invasion of a solitary malignant glioma. A 32-year-old female suffered from an anaplastic astrocytoma in the left frontal lobe. Her symptoms were mental disturbance and right hemiparesis. A computed tomography scan with contrast medium revealed a round enhanced mass in the left frontal region, attached to the superior sagittal sinus, with a perifocal low density zone. The tumor was well demarcated from the brain and was removed totally at operation. Tumor recurrence was found 7 months after the initial operation, and subsequently, the patient underwent 5 craniotomies within 13 months. Whenever the tumor recurred, it was macroscopically removed totally, and her symptoms subsided. Because recurrent massive regrowth of the tumor was rapid, intraoperative irradiation was performed with Linac electron beam on two occasions, 20 Gy 6 MeV and 25 Gy 9 MeV, respectively. Soon after the fifth craniotomy, she developed mental disturbance and motor weakness again, and obstruction of the superior sagittal sinus was confirmed by digital subtraction angiography. A large subcortical hematoma in the bilateral fronto-parietal region led to her death 15 months from onset of illness. Postmortem examination showed that the superior sagittal sinus, transverse sinus, and straight sinus were obliterated by tumor mass. However, there was no evidence indicating subarachnoid dissemination or remote metastases of the tumor. Pathological examination of the tumor attached to the sinus wall disclosed abundant reticulin filber in the anaplastic astrocytoma. Tumor cell adhesive factor, fibronectin, glial fibrillary acidic protein and other staining were performed. The results indicated a biological peculiarity of this tumor in regard to solitary regrowth and dural sinus invasion. It is quite possible that the rare pathological findings were caused by decrease of natural resistance of the dura mater due to irradiation with electron beam and the biological nature of the tumor.
日本脳神経外科学会の論文
1986-11-15

孤在性悪性グリオーマによる瀰漫性硬膜静脈洞閉塞 : グリオーマの発育形式に関する一考察

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