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それまでまったく無症状であり, 突然発症した脳室内髄膜腫の2症例について報告した.症例1 : 61歳の高血圧の既往をもつ男性が突然の意識障害により来院した.CTで右側脳室内に腫瘍を認め, 周囲に脳内出血を認めた.神経症状の急速な悪化を認め, 死亡退院となった.剖検で腫瘍はangiomatous meningiomaと診断された.症例2 : 20歳, 女性.交通事故にて頭部打撲後, 頭痛ならびに嘔吐が始まり, CTで巨大な左側脳室内腫瘍が認められた.手術にて全摘しなんら症状なく退院となった.組織所見ではfibrous meningiomaであった.側脳室内腫瘍は無症状に経過して, 頭蓋内圧緩衝系は限界にまで小さくなっていることが多く, このような場合には容易に頭蓋内圧亢進症状をきたしてくることを強調した.
Intraventricular meningiomas are of rare occurrence. However, they are very interesting in the clinical and radiological points of view. Even though meningiomas usually appear gradually with a slow and progressive course, we experienced 2 cases with acute onsets. Case 1 : A 58-year-old male was transported to the hospital with an acute consiousness level deterioration. The CT scan exposed an intracerebral hematoma adjacent to a tumor which was located within the antrum of the lateral ventricle. The patient's neurological condition being life-threatening, an operation could not be performed. As expected, the autopsy revealed a round mass in the antrum with a massive hematoma in the adjacent cerebral hemisphere. Case 2 : A 20-year-old female complained of severe headaches accompanied by vomiting persisting for 3 days subsequent to a head trauma related to a traffic accident. CT and MRI revealed a huge mass occupying almost half of the left suprasentorial space. The tumor was successfully removed via a left parietal transcortical approach and the patient went back home without any neurological deficits. Both patients never had any symptoms suggesting the presence of an intraventricular tumor prior to the incident, intracerebral hemorrhage in the first case and blunt head injury in the second case. Clinical symptoms and signs related to intraventricular meningioma which includes headache, disturbed mentation, motor and sensory deficits, seizure, visual field defects, dysphagia, alexia and ataxia are sometimes vague because the tumor expands in a gradual manner, slowly increasing the capacity of the ventricle. We would like to stress that some intraventricular meningiomas can present acute symptoms when the tumor grows to be of considerable size and also as the result of buffering effect as the intracranial pressure becomes too small.
