腰椎・仙椎部巨大神経鞘腫の治療成績

Surgical Outcome of Giant Neurinomas in the Lumbar and Sacral Region

　腰椎・仙椎部巨大神経鞘腫12例の治療成績を検討した．JOAスコアは有意に改善したものの，膀胱直腸障害のスコアに有意な改善はみられなかった．Cellular type schwannomaと診断された1例を除き細胞増殖能は低く，再発をみていない．骨切除の範囲に関わらず脊柱再建は全例で行わなかったが腰椎のアライメントに大きな変化はみられていない．少ないながら再発例があるため，本腫瘍は多少骨切除量が大きくなっても全摘出すべきであり，その結果不安定性を来して，脊柱再建を余儀なくされる例は少ないと思われた．

　We report the surgical outcome of 12 cases of giant neurinoma in the lumbar and sacral region. The average preoperative JOA score was 7.5 points, and it improved to 10.0 points after surgery. However, recovery from urinary dysfunction was poor. Histological examination revealed low proliferation rates even in the giant tumors, and there have been no recurrences except in one case of cellular-type schwannoma. Postoperative lumbar alignment remained unchanged, eventhough spinal reconstruction with instrumentation was not performed in every case. Spinal reconstruction with instrumentation may not be necessary in most cases, even after extensive bony resection to totally remove giant schwannomas in the lumbar and sacral region.