脊髄髄内腫瘍の手術成績―最近10年間の自験例の検討

Surgical Results of Intramedullary Spinal Cord Tumors Over the Past 10 Years

　過去10年間の髄内腫瘍のうち頻度が高かった上衣腫33例，星細胞腫23例，血管芽細胞腫12例の手術成績を後ろ向きに検討した．上衣腫は約90％で全摘可能で生命予後は良好であったが，機能的予後は術前麻痺が高度な症例や胸髄発生例は不良であった．低悪性度星細胞腫で全摘可能であった6例は全例生存していたが，高悪性度では術式にかかわらず12例中9例が2年以内に死亡していた．血管芽細胞腫は92％で全摘が可能で機能的予後も良好であったが，腹側に流入動脈が存在する場合やvon Hipple-Lindau病を有する場合は注意を要する．

　Surgical results of spinal intramedullary tumors over the past 10 years were retrospectively evaluated to clarify problems in the treatment of these tumors. The tumors were ependymomas in 33, astrocytomas in 23, and hemangioblastomas in 12 patients. Total excision was possible in approximately 90％ of the ependymomas and adequate improvement in functional outcome was obtained when preoperative palsy was mild. Approximately 50％ of low-malignancy astrocytomas could be totally excised with favorable survival outcomes, suggesting that total excision of low-malignancy astrocytomas should be attempted. However, total excision of high-malignancy tumors was difficult and the functional outcome was poor. Cordotomy should be considered in patients with thoracic high-grade astrocytoma. Although surgical results for spinal intramedullary tumors are improving, early diagnosis and surgery before development of severe neurological deficits are important, because the functional outcome is poor in patients with severe palsy even when the tumor can be totally excised.