脊髄砂時計腫118例の検討

Clinical Features of Dumbbell Tumors

　砂時計腫はその特徴的な形態のために通常の硬膜内髄外，硬膜外腫瘍とは臨床像，組織診断，手術法が異なったものとなる．本研究では砂時計腫の特徴について検討した．1988年から2002年までに手術した脊髄腫瘍674例中，砂時計腫は118例（18％）であった．Eden分類ではtype 3が53％で最も多かった．神経鞘腫と神経線維腫を合わせたものが80％を占めた．神経鞘腫でC2神経根からの発生が19％にみられ，1根あたりの発生数で際立っていた．84％で片側椎弓切除が行われ，片側椎間関節切除の組み合わせにより腫瘍が摘出された．

　The feature of dumbbell tumors was reviewed. There were 118 patients (18％) of the dumbbell tumors out of 674 patients with spinal cord tumors. The average age was 43 years, and was younger than that of the all spinal cord tumors (an average of 50 years old). 63 cases (53％) were classified into Eden type 3, and were in majority. There were 11 patients under 10 years old, and all tumors were classified into Eden type 3. 68％ of the dumbbell tumors were neurinomas. The rate of the dumbbell tumor in the cervical spine was significantly higher than that of the all spinal cord tumors. 15 (19％) neurinomas were observed in C2 nerve root, showing the highest rate compared to those in the other nerve roots. In 99 cases (84％), the tumors were removed through hemilaminectomy with or without facetectomy and posterior fusion.