Contralateral subchoroidal approachを用いたhypothalamic cryptic angiomaの1例

DOI
  • 堤 一生
    埼玉医科大学総合医療センター脳神経外科
  • 浅野 孝雄
    埼玉医科大学総合医療センター脳神経外科
  • 茂野 卓
    埼玉医科大学総合医療センター脳神経外科
  • 松居 徹
    埼玉医科大学総合医療センター脳神経外科
  • 石井 敏郎
    埼玉医科大学総合医療センター脳神経外科

書誌事項

タイトル別名
  • A Case of Hypothalamic Cryptic Angioma Operated Through the Contralateral Subchoroidal Approach

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A case of the right hypothalamic angioma operated by the contralateral subchoroidal approach is presented. A 31-year-old man presenting with mild hemiparesis and diplopia was admitted for examination in May 1991. He had suffered from a similar attack a few month before and at that time, a small hypothalamic hematoma revealed by MRI was left untreated. The CT and MRI revealed a hematoma in the right thalamus just above the mamillary body, extending from the posterior hypothalamus to the upper cerebral peduncle. Despite this apparent lesion in the right mamillary body, his recent memory function was found to be normal. Four-vessel angiography revealed no vascular abnomalities. T2-weighted MRI demonstrated a typical picture of cavernous angioma with a mixed intensity core surrounded by a low-intensity hemosiderin ring. Since this was the second hemorrhage, it was decided to undertake a radical operation.<BR>Via the interhemispheric approach, the corpus callosum was divided and the left lateral ventricle was entered. The thalamostriate vein was sacrificed and the third ventricle was opened from above by dividing the tenia choroidea posteriorly. Following section of the massa intermedia, the contralateral wall of the third ventricle could be seen clearly by the above approach. The hematoma was easily found by the discolaration of the wall. On evacuation of the hematoma, angioma-like abnormal vessels were found and resected. The pathological diagnosis was AVM. The postoperative course was uneventful except for recent memory disturbance, which was severe in the first three months and then gradually improved. The patient returned to his previous job 18 months after the operation.<BR>The above case shows that lesions in the vicinity of the third ventricular wall can be safely operated on by the contralateral subchoroidal approach. However, since some damage to the contralateral thalamus due to retraction or venous stasis is unavoidable, this approach is considered to carry a high risk of recent memory disturbance, although if may be transient.

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