HANDA, HAJIME

ISHIKAWA, JUNICHIRO

ISHIKAWA, MASATSUNE

KIM, CHOIGON

MATSUMOTO, MASATO

TAKEUCHI, JUJI

Kyoto University Research Information Repository

TitleRetrocollicular Arachnoid Cyst with the Inferior Sagittal SinusAnomaly and the Corpus Callosum DysgenesisAuthor(s)KIM, CHOIGON; MATSUMOTO, MASATO; ISHIKAWA,JUNICHIRO; TAKEUCHI, JUJI; ISHIKAWA,MASATSUNE; HANDA, HAJIMECitation日本外科宝函 (1985), 54(1): 31-35Issue Date1985-01-01URL http://hdl.handle.net/2433/208668RightType Departmental Bulletin PaperTextversionpublisherKyoto University人rchJpn Chir 54(1), 31～35, Jan .1985 症例Retrocollicular Arachnoid Cyst with the Inferior Sagittal Sinus Anomaly and the Corpus Callosum Dysgenesis CHOIGON KIM, i¥IASATO :¥IATSUMOTO, JUNICHIRO ISHIKAWA, JUJI TAKEUCHI. MASATSUNE ISHIKAWAへHAJIMERANDA* Department of Neurosurgery, Fukui Red Cross Hospital 本Departmentof Neurosurgery, K、。toUniversity Received for Publication. c;じpt.29, 1985. Summary A patient with a retrocollicular arachnoid cyst associated with anomalies of inferior sagittal sinus and posterior corpus callosum is presented. A brief discussion about the r札useof this rare association is made. Introduction The inferior川広itはl川nu、usuallybegins near the junction of the anterior and middle third of the falx and runs posteriorly along the free margin of the falx into theメtraightsinus. Anomaly of the inferior sagittal sinus is poorly knowns,10,12>. Rarely the middle third of the inferior sagittal sinus may be absent. poorly developed. or fenestrated. In this paper、問 presenta patient with retrocollicular arachnoid cyst with anomali引 ofinferior sagittal sinus and corpus callosum. Case Reoprt This 34-year-old woman first visited our outpatient clinic with a complaint of left tempora I pain in July, 1980. She hit herself on the left temporal region with a log in '.¥'ovcrnber司 1979.Sinn・thenshe had been complaining of dull headache in that region. ぐ’Iscan disclosed a retrocollicular げ叫icmass. But further examination was refused. She again visited our clinic because of dizziness and feeling of tension in her left cheak, which started in July, 1982. She entered our hospital in February, 1983. 1決aminationon admi5sion disclosed that she had disturbance of upward gaze of the right eye, paresthesia of the second and third divisions of the left trigerninal nerve司bilateralhorizontal Key words: retrocollicular arachnoid cyst, inferior sagital sinus, splenium. anomaly. 索引語：四丘体部クモ膜護胞，下矢状静脈洞奇形，脳決形成不全Present address: Correspondence to Ch. Kim, M.D., Department of :¥eurosurgery, Fukui Red Cross Hospital, 2 4-1 Tsukimi-cho, Fukui 910. 32 Fig. 1. Fig. 2. 日外宝第54巻第l号（昭和60年1月）Fi邑.1. Fig. 2. Computerized tomography scan demonstrating a moderate hydrocephalus and a supracollicular cystic n1a、:Vletrizamide ( 'Tcisternography. ¥lctrizamidc抗 日、五!ledinto the supracollicular口stern,and surrounded the rysl!c mass. nvstagmus which w出 smallerand more frequent in the left. ("I、scanshowed mild hydrocephalus with a retrocollicular arachnoid cyst which became larger than the previous （γscan had shown. A metrizamide < "]' cisternography demonstrated a retrocollicular water density mass which was 叩 rroundeclby the contrast material. On angiogram. the inferior sagittal sinus w山 foundto lack its posterior third and drained directly into the vein of Galen at the junction of internal cerebral veins. And the posterior pericallosal artery ran just parallel to the abnormal part of the inferior sagittal sinus. An operation w川 performedon :¥larch. 1983. The splenium w山 notfound. A small vein was found running from the inferior sagittal sinus around posterior margin of the corpus callosurn into the proximal part of the vein of Galen. Further, there was a rudimentary small venous channel in the falx, corresponding to the posterior third of the inferior メagitt日lsinus. Arachnoid cyc,t was found under the tentrium, which was divided along the叫rnight sinus. The outer mern-brane of the cpt was opened、andposterior third ventriculostomy was added. Ommaya’5 自ystemwas placed in the cystic cavity. If cystic fluid again collects in future, it will be easily <I叶Jir:itedthrough the < lmmava＇ぉ valve.I'.¥ FlニRl<>R何人c;JTTALSl'.¥l'S . ＼＇.＼り＼ IλI.y Fig. 3. Cerebral venography. The posterior third of the inferior sagital sinus """ absent and it drained dir引・tkinto the vein of Galen at the junction of internal cerebral 刊 ins33 Postoperatively, her complaints have much improved. In fact‘her nvstctgmus. p辻resthesiaand restriction of the right eye movement have stil continued. Th句、 however司 haveclcnc山 eltheir severities. Microscopic Examination Histological examination disclosed that the biopsy specimen was compatible with the arach-noid 句、twith mild inflammatory signs such as increased rnllagen 五beτs,hyalin degeneration and minimal infiltration of lymphocyteもvein vein of Galen Fig. 4. Diagram of the venography. 34 ｜｜外宝第54巻第l号（昭和60年1月）Discussion A（了cordingto Padget13J‘the sigmoid sinus is first formed at the 20 mm crown-rump stはge.Formation of the tentorial plexus哩 whichwill become the Torcular in future, begins at the 22 24 mm stage噌thecavernous ≫inus and inferior petrosal sinusはt40 mm stage, the superior petrosal ,,inus and the straight sinus at 60 80 mm stage. The tentorium and the straight sinuses first develop in a relatively vertical position, while it migrates backward and downward with the growth of the cerebral hemisphere. This migration stops when the crown-rump length becomes 90 111 (3 month fetus) In relation to this tentorial angle, WoLPERT tried to classify the congenital anomalies1si. The inferior sagittal sinus is formed by an anterior extension of the straight sinus after 3 111onth fetal stage. The fibers forming the corpus callosum first bee、omedefinite in the early half of the 3 month embryonal stage. The fibers gradually extend caudally. It is the 5 month fetus which has a completed corpus callosum. Bruce reported that developmental anomaly of the corpus callosum causes its agenesis before 4 month and dysgenesis after 4 month embryonal stage3・7l. This case had an inferior sagittal sinus anomaly, corpus callosum dysgenesis, and a retrocollicular cyst which is known且sa rare anomaly1•11l. The anomaly of the inferior sagittal sinus appears to have some relationship at least with corpus callosum dysgenesis. According to討TREETER、venoussinus development requires two mechanism10,1;i. One is the passive migration due to some flexion or traction on the vein wall itself, and the other is the spontanious migration, in which there is a change in position by the blood stream. Following this theory, corpus callocum dysgenesis of this case would have had influence on the pa州ivemigration of the inferior sagittal sinus after 4 month fetus stage. The primary cause of the anomalies of this patient‘however, by which the corpus callosum dysgenesis had occurred, is stil unclear. It is unlikely that the retrocollicular arachnoid r、・stwould have interfered the formation of the posterior part of the corpus callosum. It is di伍cultto decide whether the cyst existed before birth or not2,.i,e,1i. It is well known that corpus callosum agenesis sometimes has other anomalies or tumors such as lipomas or dermoids5•9•16l But there has been no report like this case. This case had three types of anomalies and it seem討veryinteresting to us to consider the came of the anomalies, though we can not decide definitely the relationship between the arachnoid cyst and other anomalies. References 1) Alexander EJr: Benign subtentorial supracollicular cvst as " cau町 ofobstructi、じ hydrocephalus. Report of a case. J r¥eurosurg 1953; 10: 317-323. 2) Anderson FN‘Landig BH Cerebral arachnoid cysts in infants. J Pediatr 1966; 69：・ 88-96.3) Bruce A: On the absence oi the corpus callosum in human brain with description of new case. Brain 1890; 12: 171 4) Craig¥¥':¥! Chronic cystic arachnoiditis. Am J Surg 1932; 17: 384・ 388 5) Danziger], Bloch S, ¥'an Rensburg :¥IJ: Agcnesis of the corpus callosum with an azygos anterior cerebral artery, a lipoma and porencephalic cyst. S Afr Med J 1972; 46: 739-741. 6) Ghatak :'¥R. :¥lushrush GJ: Supratentorial infraarachnoid cyst; case report. T Neurosurg 1971; 35: 477 482. I¥'FERIOR SACITT.¥L SI¥'l'S A'¥()¥IAL九 35 71 Handa H, Handa J, Koyama T: λgenesis of the corpus callosum ＇＂川口 ated川thmultiple developmental anomalies of the cerebral arteries、reportof a r川，.and r円 icwof literatur" :¥ o To汚hinkei1968; 20(4）・ 317326. (Eng. Abstr.) 8) Heinz ER: Pathology involving the supratentorial veins and dural sinuses. In: l¥＂、t川 iTJI, Potts I>C eds目 Radiologyof the skull and brain. I’ol 2, book 3. St Louis: ("¥" :¥Iosby. 1974: 1894 1895 9) Holman CB, ¥lac℃arty CS Cerebral angiography in agenesis of the corpus callosum. Radiology 1959; 72: 317-322. 10) Kaplan iIA町 BrowderAA. Browder J Atresia of the rostral superior sagittal ,inu" associated cerebral venous patterns. Radiology 1972; 4: 208-211. 11) Kuratsu J, Matsukado ¥". Kodama T: Large infratentorial multilocular <1rachnoid ＂＇.日（＂ hild’sBrain 1983; 10: 67 72. 12) ＼［辻パ、ordGM. Goree JA, Jimenez JP: ¥"enou、drainageto the inferior sagittal sinus. Radiology 1972; 105: 583-589. 13) Padget DH: The development of the venous system in man. from the 、ic、pointof comparatl¥T anatomv Contrib Embryo! 1957; 36・79140. 14) Streeter GL: The development of the 、cnoussinuses of the dura matter in the human em¥,r山人merJ Anat 1915; 18: 145 178 15) Wolpert Sl¥I Dural sinus con五guration measure of congenital disease. Radiology 1969; 92: 1511-1516. 16) Zingesser L, Schechter M, Gonatas N Agenesis of the corpus callosum associated with乱ninterhemispheric arachnoid cvst. Br J Radiol 1964: 37: 905 909. 和文抄録下矢状静脈洞奇形に四丘体部クモ膜嚢胞，脳梁形成不全を合併した一例福井赤卜字病院脳神経外科金星坤，松本真人，石川純一郎，武内重二京都大学医学部脳神経外科学教本石川疋恒，半田 肇下矢状静脈洞の異常に関する報告は少なく，九I町lo・m目ningoaleでの中間部1/3の奇形や，腫場等によるshiftが知られているにすぎない． 我々は，下矢状静脈洞後部1/3の奇形l乙，脳梁不完全欠損， retrololliculararachnoid cy引を合併した稀な症例を終日食したので，その成因につき，考察を加え報告する．症例： 34才女性．昭和57年7月より左頬部のつっぱ')Iふ dizzinessが出現しに神経学的には， BrunsNystagmusと左三叉神経第2～第3枝領域の pare-sthesia，右眼の上方注視制限を認めた. CT scan にては， Hydrocephalus,retrocollicular cystを認め，九七、trizamide CTでは cyst内delayedfillingが確認できた．血管写上，下欠状静脈j同は直接ガレン大静脈｛C注ぎ，通常認められる後部1/3は欠損していた．以上より脳梁形成不全に，下矢状静脈洞奇形， retrocolliculararachnoid cystが合併していると判明し，水頭症及び脳幹部圧迫症状の原因となっている cvstIと対し，外膜の開放と， Ventriculostomyを行ない，痕状の改善をみた．胎生期 dural sinusの形状［ま， passivemigrationとspontaneous migration によるとされる． また，下矢状締脈洞は日台宅3ヶ月以 eを， straight sinusが前方へ伸展することで形成され，一方脳梁形成は胎生3～5ヶ月に行なわれる．従ってこの下矢状静脈洞奇形は，脳梁形成不全により，主に passive1日igr川 ionlこ変化をきたし生じたものと考えられる．また，両者と re-trocollicular arachnoid cystの合併は非常に稀で，興味ぷいものと恩われた．

下矢状静脈洞奇形に四丘体部クモ膜囊胞, 脳梁形成不全を合併した一例

http://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/208668/1/ngh054001_031.pdf

下矢状静脈洞奇形に四丘体部クモ膜囊胞, 脳梁形成不全を合併した一例

Abstract

Similar works

Full text

Available Versions

Kyoto University Research Information Repository