脊髄腫瘍非手術例の経過

Clinical Course of Non-Operated Patients with Spinal Cord Tumor

　抄録：初診から1年以上手術をせずに経過観察し，MRIを撮像できた脊髄腫瘍24例の臨床経過を検討した．神経学的所見は7例にみられた．腫瘍は多発性が7例と多く，組織診断は神経鞘腫が16例と多かった．画像の経時的変化は4例にみられ，神経鞘腫の2例は増大していた．症状の経時的変化は不変17例，改善3例，一時悪化後改善2例，悪化2例であった．改善例は腫瘍が痛みの原因ではなかった．一時悪化後改善例は，神経鞘腫の増大に伴い症状が一時悪化したと思われた．悪化例は神経症状を伴う髄内腫瘍で，相対的脊柱管狭窄状態から経時的な悪化を生じた．神経症状を伴う髄内腫瘍以外は，症状の急激な悪化はみられなかった．症状の軽微な脊髄腫瘍では，組織型がある程度判断でき，中でも神経鞘腫や神経線維腫と診断できる例においては，注意深い経過観察のもと手術時期は慎重に判断してもよいと思われる．

　The clinical course of spinal cord tumors in 24 non-operated patients who were followed by MRI for more than 1 year was investigated retrospectively. Only 7 patients were positive in neurological symptoms. 7 patients had multiple tumors, and the histopathologic diagnosis in 16 patients was neurinoma. The MRI findings changed in 4 patients, and follow-up MR images showed rapid growth of 2 neurinomas. The clinical manifestations did not change in 17 patients, but they improved in 3 patients whose symptoms were not caused by tumors and improved after temporary worsening caused by tumor growth in 2 patients. They worsened in 2 patients with intramedullary tumors associated with neurological symptoms. The diameter of the spinal cord of the patients with intramedullary tumors increased, making the spinal cord susceptible to both anterior and posterior compression. Finally, the clinical course of the patients with spinal cord tumors did not deteriorate rapidly, except in the patients with intramedullary tumor associated with neurological manifestations. We concluded that when spinal cord tumors that are asymptomatic or associated with minor symptoms are diagnosed as neurinoma or neurofibroma based on the MRI findings, early surgery should not be performed and followed by meticulous follow-up.