演題抄録

口演

開催概要
開催回
第58回・2020年・京都
 

先天性頭蓋内巨大奇形腫における低侵襲性治療戦略

演題番号 : O46-4

[筆頭演者]
江﨑 雄仁:1,2 
[共同演者]
三輪 点:2、河野 まや:2、西本 真章:2、青森 達:1,3、村松 博:1、吉田 一成:2

1:慶應義塾大学病院・薬剤部、2:慶應義塾大学・脳神経外科、3:慶應義塾大学・薬学部・病院薬学講座

 

Background:
Intracranial immature teratoma can be seen well-circumscribed on MRI but invades the surrounding nerve and brain tissue in many cases. Moreover, it is a high possibility of recurrence and relapse even if it could be totally or partially removed and this is why adjuvant therapy after surgery is indispensable. Surgery and total management for neonates or early infants are at high risk and minimally invasive treatments are required.

Method:
At first, two patients of intracranial giant congenital teratoma with hydrocephalus were performed long-term placement of ventricular drainage and endoscopic biopsy with same burr hole. And then neoadjuvant chemotherapy (carboplatin + etoposide: CARE) was done before surgical resection. After neoadjuvant chemotherapy, total removal was performed with weight gains.

Result:
All treatment process was done safely and minimally invasive. Although they showed tumor growing after neoadjuvant chemotherapy, the degree of bleeding during tumor removal was less than that of the endoscopic biopsy. Nothing has any problems with the post-treatment course, and no recurrence has been observed for 3 years and 5 years.

Conclusion:
Regarding congenital giant intracranial teratoma, neoadjuvant chemotherapy was not obvious reduction of tumor size, but it has two expected merits. 1) They showed decrease in blood loss at the time of tumor removal due to a decrease in the vascular bed. 2) They could set weight gain period up to the time of surgery. It suggests that endoscopic biopsy for pathological diagnosis and simultaneous hydrocephalus control using a single burr hole be minimally invasive for neonates or early infants. Moreover, our strategy using neoadjuvant chemotherapy for total removal of giant intracranial teratoma in early infant is considered to be safe and effective.

キーワード

臓器別:脳神経

手法別:化学療法

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