著者

津田 恭治 高野 晋吾 今井 資 松原 鉄平 阿久津 博義 松村 明

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.40, no.3, pp.149-153, 2012 (Released:2013-03-09)

参考文献数

26

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We reviewed three cases of mid-brain cavernous angioma treated in our hospital. Here we describe the case summary and discuss therapeutic strategy for this lesion. Case 1 was a 56-year-old man who had dorsal mid-brain cavernous angioma and presented with Parinaud syndrome and right abducent nerve palsy. He had been observed conservatively, because removal of the lesion might be difficult or nearly impossible without producing a postoperative neurological deficit. The lesion increased gradually, and the patient suffered from walk disturbance due to Parkinsonism, and from memory disturbance. After six years of follow-up, he was admitted to a nursing home because of dependence (mRS 4). Case 2 was a 52-year-old woman who had ventral mid-brain cavernous angioma and presented with right hemiparesis. She underwent stereo-tactic radiation therapy (SRT). However, the lesion gradually progressed. Two years after SRT, she became disabled due to right-side hemiplegia and disuse of legs and was admitted to a nursing home (mRS 5). Case 3 was a 37-year-old woman who had dorsal mid-brain cavernous angioma and presented with right-mild hemiparesis, right extremities involuntary movement, right oculomotor nerve palsy, and Parinaud syndrome. The lesion was completely removed surgically via the occipital inter-hemispheric trans-callosal approach with intraoperative neurophysiological monitoring. One year after operation, right hemiparesis and voluntary movement improved gradually and she became able to walk independently, although Parinaud syndrome remained (mRS 3). Only Case 3 showed neurological recovery and an uneventful course. Cavernous angioma with re-hemorrhagic episode and located in a superficial region should be removed aggressively via the proper approach and with intra-operative neurophysiological monitoring.