脳腫瘍の治療と共に歩んだ40年(最終講義)

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Forty years ago, when I graduated the medical school, the prognosis of brain tumors was quite pessimistic. Since 1970 when CT scan was developed, the diagnosis of brain tumors has become easy and accurate, and the meticulous surgical manipulation has been realized by microscope. Since 1980, MRI has been widely introduced, and the diagnosis of neurological disorders has much been improved. Although most of benign brain tumors have completely been cured by surgery, malignant gliomas can not be cured by surgery alone. The importance of radiotherapy, chemotherapy and immunotherapy as adjuvant therapy is recognized and we have continuously investigated basic and clinical problems of those treatments. The outcome of malignant glioma treatment has year by year been improved by chemo-radiotherapy and maintenance treatment with interferon etc. Pituitary adenoma is a common brain tumor which early diagnosis has been established by MRI. The outcome has been much improved by transsphenoidal adenomectomy. Especially we have established the standard two stage operation with adjuvant radiotherapy for huge pituitary adenoma and brought good outcome for those tumors. Germinoma is also a common brain tumor in Japan, and the research on the patho-physiology of this tumor has much developed and improved its outcome. Regarding radiotherapy, gamma knife as a new radiotherapeutic instrument was introduced in 1990 in our clinic. It has become the most effective therapeutic modality for metastatic brain tumors. I have further introduced the photon radiosurgical system (PRS) for treatment of primary brain tumors and has proved the efficacy for local control of tumors. The cooperative study on heavy particle irradiation for malignant brain tumors has started and the favourable effect on skull base chordoma is anticipated. As the surgery is the most important factor influencing the outcome of brain tumor therapy, I have investigated to develop three dimensional image monitoring system for surgery. The research project includes to develop 3 dimensional (3-D) high definition television for observing a surgical field, volumegraph which demonstrate 3-D MRI image of brain and tumor visualizing transparently in the head of the patient, 3-D ultrasound sonography and endoscope. These devices can contribute for the better technology of computer aided surgery. Although there were many difficulties during forty years I have spent for treating brain tumors, it was a pleasant pass accompanied with marvelous development of diagnostic and therapeutic technologies.
東京女子医科大学の論文
1999-01-25

脳腫瘍の治療と共に歩んだ40年(最終講義)

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