巨大神経鞘腫による著明な脊柱の破壊に対して矯正短縮術を行った1例

Reconstruction for Severe Spinal Destruction Caused by Giant Schwannoma : Case Report

　抄録：われわれは，再発性巨大神経鞘腫により著明な脊柱の破壊を生じた症例に対し，腫瘍摘出および脊柱矯正短縮術を施行した．症例は47歳女性．24歳時に胸腰椎移行部の神経鞘腫摘出術を受けたが，20年の経過で再発し，著しい背部痛のため短時間の坐位保持も困難となった．画像上，腫瘍はT11からL4レベルにわたり，椎体には著明なscallopingが認められた．L1椎体はほぼ消失しており，T12椎体もごく一部を残すのみで，脊柱の後弯変形および著しい不安定性を認めた．手術では腫瘍を一塊として摘出し，支持性の消失したT12，L1椎体を切除して，T11/L2間で脊柱矯正短縮術を行った．術後，背部痛が消失し，長時間の坐位保持が可能となり，ADLが著しく向上した．

　Spinal giant schwannoma is rare, and only 7 cases that required spinal reconstruction have been reported. We report the case of a 47-year-old woman whose spinal column was extensively destroyed by a recurrent giant schwannoma. At 24 years of age, she had undergone laminectomy and excision of a schwannoma extending from vertebral level T11 to L3. However, the tumor had grown back over the past 20 years, and it had become difficult for her to sit for even a short time because of intolerable back pain. Sensory and motor nerve function had been completely lost from the T11 level to the end of the spinal cord. Magnetic resonance imaging (MRI) revealed that the tumor was localized from vertebral level T11 to L4, and there was marked scalloping of the posterior surface of the vertebral bodies. Vertebral body L1 had almost vanished, and only a part of vertebral body T12 remained. The spinal column was kyphotic, and there was severe instability between vertebral body T11 and L2. We performed total resection of the tumor, removed vertebral bodies T12 and L1, which were unstable, and reconstructed the spinal column by shortening between T11 and L2. Good alignment of the spinal column has been achieved, the patient's back pain has improved to the point that she can sit for a long time, and there has been a marked improvement in her activities of daily living.