頚椎部に発生したdumb-bell型神経鞘腫の治療成績

The Results of Surgical Treatment for Dumbbell-Type Neurinoma in Cervical Region

　抄録：頚椎部の砂時計腫は腫瘍の大きさにより全摘出が難しい例がある．今回，頚椎部に発生した砂時計腫の手術例について検討を行った．1989～2001年に手術を行った14例．年齢は平均47歳．術後経過観察期間は平均23カ月．術前・術後症状，手術術式，腫瘍全摘の有無，再発または増大の有無，について検討した．術前JOAスコアは4～17点，平均11.6点，術後のJOAスコアは13～17点，平均16点で，1例を除き症状は改善した．手術は，前方後方より腫瘍を全摘出した例が1例，後方アプローチのみが13例で，うち全摘出が6例，部分摘出が7例であった．全摘出例では再発はなく，部分摘出の7例のうち，残存腫瘍の増大のため再手術に至った例は1例のみであった．前方アプローチの併用は侵襲が大きい．後方アプローチのみで可及的に腫瘍切除を行うことで十分満足のいく結果が得られた．

　Total removal of dumbbell-type neurinomas in the cervical region is sometimes difficult because of their anatomical relation-ships and their large size. This study assessed the clinical results of surgical treatment of such lesions. Fourteen cases of dumbbell-type neurinoma in the cervical region treated surgically between 1989 and 2002 were reviewed. Average age at the time of the operation was 47 years, and the average follow-up period was 23months. Pre-and post-operative clinical symptoms, surgical approach, extent of tumor removal (total or subtotal), and recurrence or enlargement of the residual tumor were assessed. Symptoms and neurological signs improved in every case except one. The tumor was totally removed, by a combination of the anterior approach and posterior approach in one case, only the posterior approach was used in the other 13 cases, with total removal achieved in 6 and subtotal removal in the other 7. Intraspinal canal mass were totally removed in all cases. Reoperation because of enlargement of the tumor was required in only one of the 7 cases with residual tumor. When total removal of the tumor could not be achieved by the posterior approach alone, the clinical results were satisfactory. Combining the anterior approach and posterior approach is more invasive. Neurinoma is the benign tumor, it is enough to remove subtotally for extraspinal canal mass.