妊娠36週に閉塞性水頭症を発症した小脳血管芽腫の1例
妊娠後期に水頭症で発症した小脳血管芽腫症例を経験した. 症例は29歳女性. 妊娠36週に頭痛と嘔気を訴え徐々に傾眠となった. MRIでは左小脳半球に主座をおき強く造影される境界鮮明な腫瘤性病変を認め広範な浮腫により脳幹および第四脳室は圧排され水頭症を呈していた. 緊急帝王切開術にて児娩出後に腫瘍を摘出した. 術後4週間のリハビリテーションを経て自宅退院した. 小脳血管芽腫においては妊娠中の循環血漿量増大およびエストロゲン上昇, 胎盤由来の血管新生因子により腫瘍容積増大や脳浮腫増悪を生じ頭蓋内圧亢進や水頭症をきたすと報告されている. 母体優先の大原則のもと, 治療に際しては妊娠週数や母体の状態に...
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| Published in | 脳神経外科ジャーナル Vol. 26; no. 8; pp. 610 - 616 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
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日本脳神経外科コングレス
2017
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.26.610 |
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| Abstract | 妊娠後期に水頭症で発症した小脳血管芽腫症例を経験した. 症例は29歳女性. 妊娠36週に頭痛と嘔気を訴え徐々に傾眠となった. MRIでは左小脳半球に主座をおき強く造影される境界鮮明な腫瘤性病変を認め広範な浮腫により脳幹および第四脳室は圧排され水頭症を呈していた. 緊急帝王切開術にて児娩出後に腫瘍を摘出した. 術後4週間のリハビリテーションを経て自宅退院した. 小脳血管芽腫においては妊娠中の循環血漿量増大およびエストロゲン上昇, 胎盤由来の血管新生因子により腫瘍容積増大や脳浮腫増悪を生じ頭蓋内圧亢進や水頭症をきたすと報告されている. 母体優先の大原則のもと, 治療に際しては妊娠週数や母体の状態に応じて個々の症例ごとに治療戦略を構築する必要がある. |
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| AbstractList | 妊娠後期に水頭症で発症した小脳血管芽腫症例を経験した. 症例は29歳女性. 妊娠36週に頭痛と嘔気を訴え徐々に傾眠となった. MRIでは左小脳半球に主座をおき強く造影される境界鮮明な腫瘤性病変を認め広範な浮腫により脳幹および第四脳室は圧排され水頭症を呈していた. 緊急帝王切開術にて児娩出後に腫瘍を摘出した. 術後4週間のリハビリテーションを経て自宅退院した. 小脳血管芽腫においては妊娠中の循環血漿量増大およびエストロゲン上昇, 胎盤由来の血管新生因子により腫瘍容積増大や脳浮腫増悪を生じ頭蓋内圧亢進や水頭症をきたすと報告されている. 母体優先の大原則のもと, 治療に際しては妊娠週数や母体の状態に応じて個々の症例ごとに治療戦略を構築する必要がある. |
| Author | 長南, 雅志 吉田, 昌弘 田代, 亮介 三野, 正樹 加藤, 侑哉 岩渕, 直也 我妻, 理重 冨永, 悌二 |
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| References | 24) Surico D, Amadori R, Garofalo G, Nuzzi NP, Cariero A, Surico N : “One-shot” endovascular management of cerebral aneurysm and fourth ventricle hemangioblastoma in a pregnant woman. Int J Gynecol Obstet 129 : 79-80, 2015. 15) Ng J, Kitchen N : Neurosurgery and pregnancy. J Neurol Neurosurg Psychiatry 79 : 745-752, 2008. 19) Rehman T, Ali R, Yonas H : Cerebellar haemangioblastoma : temporising treatment in a high risk pregnancy. BMJ Case Rep doi : 10.1136/bcr.01.2009.1413, 2009. 6) Haas JF, Jänisch W, Staneczck W : Newly diagnosed primary intracranial neoplasms in pregnant women : a population-based assessment. J Neurol Neurosurg Psychiatry 49 : 874-880, 1986. 18) Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, Derksen R, Branch W, Motta M, Gordon C, Ruiz-Irastorza G, Spinillo A, Friedman D, Cimaz R, Czeizel A, Piette JC, Cervera R, Levy RA, Clementi M, De Carolis S, Petri M, Shoenfeld Y, Faden D, Valesini G, Tincani A : Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther 8 : 209, 2006. 3) Erdogan B, Sen O, Aydin MV, Bagis T, Bavbek M : Cerebellar hemangioblastoma in pregnancy. A case report. J Reprod Med 47 : 864-866, 2002. 14) Nevo O, Soustiel JF, Thaler I : Maternal cerebral blood flow during normal pregnancy : a cross-sectional study. Am J Obstet Gynecol 203 : 475, e1-e6, 2010. 4) Frantzen C, Kruizinga RC, van Asselt SJ, Zonnenberg BA, Lenders JW, de Herder WW, Walenkamp AM, Giles RH, Hes FJ, Sluiter WJ, van Pampus MG, Links TP : Pregnancy-related hemangioblastoma progression and complications in von Hippel-Lindau disease. Neurology 79 : 793-796, 2012. 21) Romansky K, Arnaudova V, Nachev S : Hemagioblastoma during pregnancy. Case report. Zentralbl Neurochir 53 : 37-39, 1992. 8) Hayden MG, Gephart R, Kalanithi P, Chou D : Von Hippel-Lindau disease in pregnancy : a brief review. J Clin Neurosci 16 : 611-613, 2009. 17) Pereda Rios A, Pintado Recarte P, De León-Luis J, Fernández-García P, Iza B, Salinero Paniagua E, Aguarón de la Cruz A, Ortiz Quintana L : Cerebellar hemangioblastoma as the cause of maternal obstructive hydrocephalus during the third trimester. Eur J Obstet Gynecol Reprod Biol 165 : 370-372, 2012. 20) Robinson RG : Aspects of the natural history of cerebellar haemangioblastomas. Acta Neurol Scand 41 : 372-380, 1966. 26) Ye DY, Bakhtian KD, Asthagiri AR, Lonser RR : Effect of pregnancy on hemangioblastoma development and progression in von Hipple-Lindau disease. J Neurosurg 117 : 818-824, 2012. 12) Kasarskis EJ, Tibbs PA, Lee C : Cerebellar hemangioblastoma symptomatic during pregnancy. Neurosurgery 22 : 770-772, 1988. 5) Gros BA, Du R : Hemorrhage from arteriovenous malformations during pregnancy. Neurosurgery 71 : 349-356, 2012. 16) Palmer JJ : Haemangioblastomas. A review of 81 cases. Acta Neurochir (Wien) 27 : 125-148, 1972. 23) Stevenson CB, Thompson RC : The clinical management of intracranial neoplasms in pregnancy. Clin Obstet Gynecol 48 : 24-37, 2005. 22) Scarcella G, Allen MB Jr, Andy OJ : Vascular lesions of the posterior fossa during pregnancy. Am J Obstet Gynecol 82 : 836-840, 1961. 13) Nathan L, Satin AJ, Twickler DM : Cerebellar hemangioblastoma complicating pregnancy. A case report. J Reprod Med 40 : 662-664, 1995. 11) Jeffreys R : Clinical and surgical aspects of posterior fossa haemangioblastomata. J Neurol Neurosurg Psychiatry 38 : 105-111, 1975. 1) Broager B : Multiple cerebellar angioreticulomas ; discussion of high protein contents of the cysts and of enclosed parts of the subarachnoid space. Acta Psychiatr Neurol 24 : 317-332, 1949. 25) Whittaker PG, Macphail S, Lind T : Serial hematologic changes and pregnancy outcome. Obstet Gynecol 88 : 33-39, 1996. 9) Iizuka J : Rückfälle bei Lindautumoren. Beobachtungen an 57 Fällen von Hämangio-blastom des Kleinhirns. Acta Neurochir (Wien) 20 : 281-298, 1969. [Article in German] 7) Hayashi S, Takeda N, Komura E : Symptomatic cerebellar hemorrhage from recurrent hemangioblastoma during delivery. Case report. Neurol Med Chir (Tokyo) 50 : 1105-1107, 2010. 10) 井上明宏, 高野昌平, 久門良明, 渡邉英昭, 大西丘倫, 橋本 尚, 松原圭一 : 手術施行時期に苦慮した妊娠合併小脳血管芽腫の1例. No Shinkei Geka 43 : 57-62, 2015. 2) Delisle MF, Valimohamed F, Money D, Douglas MJ : Central nervous system complications of von Hippel-Lindau disease and pregnancy ; perinatal considerations : case report and literature review. J Matern Fatal Med 9 : 242-247, 2000. |
| References_xml | – reference: 24) Surico D, Amadori R, Garofalo G, Nuzzi NP, Cariero A, Surico N : “One-shot” endovascular management of cerebral aneurysm and fourth ventricle hemangioblastoma in a pregnant woman. Int J Gynecol Obstet 129 : 79-80, 2015. – reference: 18) Østensen M, Khamashta M, Lockshin M, Parke A, Brucato A, Carp H, Doria A, Rai R, Meroni P, Cetin I, Derksen R, Branch W, Motta M, Gordon C, Ruiz-Irastorza G, Spinillo A, Friedman D, Cimaz R, Czeizel A, Piette JC, Cervera R, Levy RA, Clementi M, De Carolis S, Petri M, Shoenfeld Y, Faden D, Valesini G, Tincani A : Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther 8 : 209, 2006. – reference: 26) Ye DY, Bakhtian KD, Asthagiri AR, Lonser RR : Effect of pregnancy on hemangioblastoma development and progression in von Hipple-Lindau disease. J Neurosurg 117 : 818-824, 2012. – reference: 7) Hayashi S, Takeda N, Komura E : Symptomatic cerebellar hemorrhage from recurrent hemangioblastoma during delivery. Case report. Neurol Med Chir (Tokyo) 50 : 1105-1107, 2010. – reference: 6) Haas JF, Jänisch W, Staneczck W : Newly diagnosed primary intracranial neoplasms in pregnant women : a population-based assessment. J Neurol Neurosurg Psychiatry 49 : 874-880, 1986. – reference: 20) Robinson RG : Aspects of the natural history of cerebellar haemangioblastomas. Acta Neurol Scand 41 : 372-380, 1966. – reference: 21) Romansky K, Arnaudova V, Nachev S : Hemagioblastoma during pregnancy. Case report. Zentralbl Neurochir 53 : 37-39, 1992. – reference: 11) Jeffreys R : Clinical and surgical aspects of posterior fossa haemangioblastomata. J Neurol Neurosurg Psychiatry 38 : 105-111, 1975. – reference: 8) Hayden MG, Gephart R, Kalanithi P, Chou D : Von Hippel-Lindau disease in pregnancy : a brief review. J Clin Neurosci 16 : 611-613, 2009. – reference: 1) Broager B : Multiple cerebellar angioreticulomas ; discussion of high protein contents of the cysts and of enclosed parts of the subarachnoid space. Acta Psychiatr Neurol 24 : 317-332, 1949. – reference: 14) Nevo O, Soustiel JF, Thaler I : Maternal cerebral blood flow during normal pregnancy : a cross-sectional study. Am J Obstet Gynecol 203 : 475, e1-e6, 2010. – reference: 19) Rehman T, Ali R, Yonas H : Cerebellar haemangioblastoma : temporising treatment in a high risk pregnancy. BMJ Case Rep doi : 10.1136/bcr.01.2009.1413, 2009. – reference: 25) Whittaker PG, Macphail S, Lind T : Serial hematologic changes and pregnancy outcome. Obstet Gynecol 88 : 33-39, 1996. – reference: 9) Iizuka J : Rückfälle bei Lindautumoren. Beobachtungen an 57 Fällen von Hämangio-blastom des Kleinhirns. Acta Neurochir (Wien) 20 : 281-298, 1969. [Article in German] – reference: 4) Frantzen C, Kruizinga RC, van Asselt SJ, Zonnenberg BA, Lenders JW, de Herder WW, Walenkamp AM, Giles RH, Hes FJ, Sluiter WJ, van Pampus MG, Links TP : Pregnancy-related hemangioblastoma progression and complications in von Hippel-Lindau disease. Neurology 79 : 793-796, 2012. – reference: 17) Pereda Rios A, Pintado Recarte P, De León-Luis J, Fernández-García P, Iza B, Salinero Paniagua E, Aguarón de la Cruz A, Ortiz Quintana L : Cerebellar hemangioblastoma as the cause of maternal obstructive hydrocephalus during the third trimester. Eur J Obstet Gynecol Reprod Biol 165 : 370-372, 2012. – reference: 2) Delisle MF, Valimohamed F, Money D, Douglas MJ : Central nervous system complications of von Hippel-Lindau disease and pregnancy ; perinatal considerations : case report and literature review. J Matern Fatal Med 9 : 242-247, 2000. – reference: 3) Erdogan B, Sen O, Aydin MV, Bagis T, Bavbek M : Cerebellar hemangioblastoma in pregnancy. A case report. J Reprod Med 47 : 864-866, 2002. – reference: 12) Kasarskis EJ, Tibbs PA, Lee C : Cerebellar hemangioblastoma symptomatic during pregnancy. Neurosurgery 22 : 770-772, 1988. – reference: 13) Nathan L, Satin AJ, Twickler DM : Cerebellar hemangioblastoma complicating pregnancy. A case report. J Reprod Med 40 : 662-664, 1995. – reference: 15) Ng J, Kitchen N : Neurosurgery and pregnancy. J Neurol Neurosurg Psychiatry 79 : 745-752, 2008. – reference: 16) Palmer JJ : Haemangioblastomas. A review of 81 cases. Acta Neurochir (Wien) 27 : 125-148, 1972. – reference: 23) Stevenson CB, Thompson RC : The clinical management of intracranial neoplasms in pregnancy. Clin Obstet Gynecol 48 : 24-37, 2005. – reference: 10) 井上明宏, 高野昌平, 久門良明, 渡邉英昭, 大西丘倫, 橋本 尚, 松原圭一 : 手術施行時期に苦慮した妊娠合併小脳血管芽腫の1例. No Shinkei Geka 43 : 57-62, 2015. – reference: 5) Gros BA, Du R : Hemorrhage from arteriovenous malformations during pregnancy. Neurosurgery 71 : 349-356, 2012. – reference: 22) Scarcella G, Allen MB Jr, Andy OJ : Vascular lesions of the posterior fossa during pregnancy. Am J Obstet Gynecol 82 : 836-840, 1961. |
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| Snippet | 妊娠後期に水頭症で発症した小脳血管芽腫症例を経験した. 症例は29歳女性. 妊娠36週に頭痛と嘔気を訴え徐々に傾眠となった. MRIでは左小脳半球に主座をおき強く造影される... |
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| Title | 妊娠36週に閉塞性水頭症を発症した小脳血管芽腫の1例 |
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