自然経過に基づいた症状の軽微な脊髄腫瘍に対する治療法の選択

Natural Course and Selection of Treatment for Slightly Symptomatic Patients with Spinal Cord Tumors

　症状が軽微な脊髄腫瘍25例について手術をせずに1～10年，平均5年7カ月自然経過を観察し，かつ1年以上の間隔でMRIを撮像した．結果，頚髄髄内腫瘍の4例中，血管芽細胞腫と上衣腫の2例が5年以後に症状が悪化して手術となった．これらの術後成績は不良であったので，頚髄髄内腫瘍は症状が軽微な早期に手術を勧めるべきである．硬膜内髄外腫瘍の神経鞘腫，神経線維腫では比較的短期間に腫瘍が増大して症状を発現していた．馬尾の神経鞘腫は症状の一時的な増悪を来しても自然に軽快することが多いので，経過観察でもよい．

　The natural course of 25 spinal cord tumor patients who were asymptomatic or whose symptoms were minimal, was observed for 1 to 10 years, including the clinical features and MRI findings. Two of 4 patients with an intramedullary cervical tumor underwent surgery after 5 years. Their surgical outcomes were poor. Therefore intramedullary cervical tumor patients should be considered for operative intervention, if their symptoms are not serious. Extramedullary neurinomas or neurofibromas have the possibility of rapid growth and clinical deterioration. Neurinomas sited in cauda can not be considered for operative intervention until their symptoms become serious because they will recover naturally from short period clinical deterioration.