Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.
Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan.
World Neurosurg. 2020 Jun;138:541-544.e1. doi: 10.1016/j.wneu.2020.03.112. Epub 2020 Mar 27.
Superficial siderosis is an irreversible disease in the central nervous system caused by the deposition of hemosiderin in the subpial tissue due to persistent bleeding in the subarachnoid space. The main symptoms include sensorineural hearing loss, cerebellar ataxia, and pyramidal tract disorder. Superficial siderosis is mainly idiopathic, but bleeding factors such as tumors or history of surgery often play an important role in its pathogenesis.
A 66-year-old man with a history of surgery for a cerebellar tumor 37 years ago complained of hearing loss. Magnetic resonance imaging showed recurrence of the tumor on T2-weighted images and hypointense areas along the cerebellar sulci on T2∗-weighted images. During the operation, microscopic bleeding was observed on the surface of the tumor. The pathologic diagnosis was pilocytic astrocytoma. A biopsy obtained during the first surgery revealed almost the same pathologic findings as those from a biopsy obtained during the second surgery, but the first specimen showed no hemosiderin deposition or active bleeding, which the second specimen did show.
Recurrent pilocytic astrocytoma with intratumoral hemorrhage was the suspected cause for superficial siderosis. The source of chronic bleeding was identified with intraoperative and pathologic findings. We describe the first report of superficial siderosis associated with a pilocytic astrocytoma that recurred 37 years after an initial tumor was excised.
由于蛛网膜下腔持续出血，铁蛋白在软脑膜组织中的沉积导致中枢神经系统的不可逆转疾病——表浅铁沉着症。主要症状包括感觉神经性听力损失、小脑性共济失调和锥体束障碍。表浅铁沉着症主要是特发性的，但出血因素，如肿瘤或手术史，往往在其发病机制中起重要作用。
一名 66 岁男性，37 年前因小脑肿瘤接受手术治疗，主诉听力损失。磁共振成像显示 T2 加权图像上肿瘤复发，T2∗-加权图像上小脑沟沿出现低信号区。在手术过程中，观察到肿瘤表面有显微镜下出血。病理诊断为毛细胞型星形细胞瘤。第一次手术获得的活检显示与第二次手术获得的活检几乎相同的病理发现，但第一次标本没有铁蛋白沉积或活动性出血，而第二次标本有。
复发性伴瘤内出血的毛细胞型星形细胞瘤被怀疑是表浅铁沉着症的原因。术中及病理发现确定了慢性出血的来源。我们描述了首例与毛细胞型星形细胞瘤相关的表浅铁沉着症，该肿瘤在初次切除 37 年后复发。
