頸椎部より腰椎部に渉る脊髄動脈奇型の全摘出例

A CASE OF TOTAL REMOVAL OF SPINAL ARTERIOVENOUS MALFORMATION IN AN EXTENSIVE REGION from C6 to L2

Ｉ．はじめに

　手術用顕微鏡を使用し行なわれる手術手技の進歩とともに，今まで手術適応とならなかった広範囲脊髄動静脈奇型も，この方法を用い脳神経外科医にとって手術可能なものとなりつつある。しかし脊髄動静脈奇型患者の多くは症状発生後，正確な診断のつかぬまま不適当な治療が行なわれ，手術適応時期を逸する場合が多い。

　われわれは最近第6頸椎より第2腰椎に及ぶ脊髄動静脈奇型の手術を経験し，術前の症状の著しい改善が見られたので報告する。

With the recent advancement of microneurosur-gery, the surgical operation of the extensive spinal arteriovenous malformation is coming to be per-formed by the neurosurgeon. Our present case was a male of 54-year-old. He had felt numbness in lower half of the body since January, 1968. From around June in the same year the inclination of stambling during walking appeared. Since early June in 1972 it became difficult for him to walk mcre than 5 minutes. Yet, no motor weakness in the upper extremity and no radiate pain in the lower extremity were found in the historical course. On an admission to the hospital, motor weakness in both lower extremities, more distinct at left, sensory disturbance of touch, pain, temperature and vibratory sensation, etc. were found lower than the seventh thoracic nerve. In addition to these sensory loss there were analgesia below the 9th thoracic nerve and loss of thermal sensation below the 2nd lumbar nerve, while deep sensation was lost at the lower extremity. The tendon reflexes were hy-poactive at the upper extremity and hyperactive at the lower extremity, while the all abdominal re-flexes as well as cremaster reflexes and anal reflexes were absent, but the Babinski reflexes were observed at the both lower extremities. The urination and fecal excretion took long time and were imperfect.

The myelography showed an extensive spinal arteriovenous malformation in the region from the 6th cervical vertebra to the 2nd lumbar vertebra. On the 14 the of July, 1972, after the luminectomy from C 6 to L 2, total removal of spinal arteriove-nous malformation was performed. Sensory loss disappeared and walking became smooth after the surgical operation. The difficulty of urination and fecal excretion was improved. The finger base disturbance was 25 cm and dorsiflexion of vertebral column was good.