顔面痙攣のみで発症した後頭蓋窩静脈洞交会部テント髄膜腫の1手術例

橋田 篤知; 武田 康; 清野 純平; 太田 浩嗣; 山本 淳考

doi:10.7888/juoeh.45.237

Abstract

顔面痙攣の多くは顔面神経と血管あるいは腫瘍性病変が直接接することで生じるが，離れた腫瘍性病変が小脳や脳幹を圧排して間接的にその周囲の構造物が接することで生じることもある．我々は，顔面痙攣のみで発症した後頭蓋窩静脈洞交会部テント髄膜腫を経験したので報告する．症例は68歳女性．2週間前から右顔面痙攣が出現したため受診した．右顔面痙攣以外，頭蓋内亢進症状や小脳失調を含め脱落症状はなかった．MRIで後頭蓋窩静脈洞交会部に周囲浮腫を伴う45mm径の髄外腫瘍を認めテント髄膜腫と診断し，腫瘍栄養血管塞栓術後に右後頭下開頭腫瘍摘出術を行った．術直後より顔面痙攣は軽快した．術後MRIでは腫瘍は全摘され，右小脳橋角部脳槽の狭小化は改善して顔面神経とその周囲の構造物との接触は指摘できなかった．現在，顔面痙攣の再燃はなく外来通院している．本症例は，テント髄膜腫により小脳や脳幹が偏位して間接的に顔面痙攣を生じさせたものと考えた．また，45mmの腫瘍が他の症状を随伴することなく経過していたことは稀と思われ報告した．

Translated Abstract

Hemifacial spasm is commonly caused by compression of the facial nerve due to overlying vessels, and also due to various types of tumor or aneurysm, and other factors. It occurs, although rarely, as a secondary effect of cerebellar or brainstem shift resulting from a tumor. In such a case, the presence of a large tumor often leads to additional neurological deficits. We present a case of hemifacial spasm caused by a peritorcular type of large tentorial meningioma in the posterior fossa. A 68-year-old woman presented with right facial numbness 4 months ago and right hemifacial spasm 2 weeks ago. Upon visiting our hospital, she displayed no neurological deficits other than the right hemifacial spasm. MRI revealed a peritorcular type of large tentorial meningioma in the posterior fossa with perifocal edema. The right cerebellopontine cistern was narrowed, and the cerebellar tonsil was herniated. The right facial nerve ran adjacent to the anterior inferior cerebellar artery (AICA). Angiography showed that only the left posterior meningeal artery (PMA) flowed to the tumor. The loop of the right AICA extended into the right cerebellopontine cistern. After embolization of the PMA, the tumor was surgically removed, leading to an improvement in the patient’s hemifacial spasm. Postoperative MRI confirmed complete removal of the tentorial meningioma without any contact with the right facial nerve. The hemifacial spasm was caused secondarily by the cerebellar or brainstem shift due to the large tentorial meningioma in the posterior fossa. This large tumor had not produced any other neurological deficits before the hemifacial spasm appeared. We report this case because it is extremely rare.

Notes

15/注釈 Notes）

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