脊髄神経鞘腫・脊髄髄膜腫に対する手術方針

Surgical Strategies and Procedures for Spinal Schwannoma and Meningioma

Point

・安全な神経鞘腫の摘出には，硬膜内・外における脊髄末梢神経の解剖を理解することが重要である．

・脊髄髄膜腫摘出術では根治性と手術安全性の両方を考慮して，腫瘍摘出度（Simpson grade）を決定する．

・ダンベル型神経鞘腫や脊髄腹側髄膜腫では，周囲組織（脊髄，椎骨動脈など）を損傷しないような手術アプローチの工夫を要する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Spinal extramedullary tumors are the most common types of schwannomas and meningiomas. Therefore, most spinal cord surgeons should safely perform surgeries for these tumors. The posterior approach with conventional laminectomy is sufficient for the safe resection of almost all spinal extramedullary tumors. However, for specific tumors, it is necessary to consider mechanical stress on the spinal cord during surgery, invasion of the surrounding tissues, and postoperative spinal instability. In addition, if part of the tumor is left behind, the risk of recurrence should be considered in the treatment strategy.

　This study aimed to understand the key anatomical features and surgical techniques to choose the optimal approach for spinal extramedullary tumors, including dumbbell-shaped schwannomas and ventral meningiomas, which require a safer and more secure surgical approach.