2才以下乳幼児脳腫瘍の検討

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This report reviews our experience with 52 cases of intracranial tumors in children under 2 years of age observed and treated in the Neurosurgical Department, Children's Memorial Hospital, Chicago and in the Department of Neurosurgery, Kobe University Hospital, in Kobe, Japan from 1962 to 1975. All tumors were diagnosed histologically under 2 years of age except for one case of so-called unverified glioma. The youngest was 4 days of age and the oldest was 24 months of age. 9 patients were newborn, 24 infants and 19 toddlers. There were 32 boys and 20 girls.The location of tumors of children under 1 year of age were predominantly in the supratentorial area. More astrocytoma (29%) were found than medulloblastoma (19%), optic glioma (15%), ependymoma (8%) or choroid plexus papilloma (8%). Pathohistological characteristics were the extensive tumor invasions. Especially in neonatal brain tumors, inmature cells, rapid tumor growth and high malignancy were the most frequent findings.Since most brain tumors in early life were located along the cerebral axis, obstruction of cerebrospinal fluid circulation that resulted in hydrocephalus was the most common clinical finding. Enlarged head, vomiting and irritability were the cardinal symptoms. The younger the infant, the greater the incidences of increased head sizes,and the older infants and toddlers showed higher incidences of vomiting and irritability. Bobbing of the head was observed in 2 cases, one with a large craniopharyngioma and the other with a choroid plexus papilloma of the third ventricle. Forty-five patients underwent primary surgery for tumor removal. Out of 45 cases of hydrocephalic infants, 29 cases were treated with shunting procedures either after or before primary surgery. Our present approach for hydrocephalus due to the intracranial tumors is to stage our procedures so that the initial shunting operation is followed in one or two weeks by definitive surgical attack. Radiation therapies were conducted in 27 cases (51%)including one case of highly vascular tumor of a deep cerebrum which was treated by radiation therapy alone.Seven cases had chemotherapy. Twenty-three patients had steroid therapy pre- and post-operatively. Five of these,all with posterior fossa tumors, suffered gastrointestinal hemorrhage. None of the patients who did not receivesteriod therapy developed gastrointestinal bleeding. In 45 cases, which were available for follow-up study, 19 cases(42.2%) expired in 3 months postoperatively. The longest survival, 11 years, was in a child with a choroid plexus papilloma of the lateral ventricle. Absolute 2-year survival of sarcoma was 75%, optic glioma 60%, astrocytoma 61.5%, ependymoma 33% and medulloblastoma O%. Out of 7 cases of medulloblastoma available for follow-up,6 patients expired in 3 months after primary surgery. The prognosis of the medulloblastoma under 2 years of age was extremely poor.
日本脳神経外科学会の論文

2才以下乳幼児脳腫瘍の検討

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