転倒による胸髄損傷を来したneurenteric cyst（神経腸管囊腫）の1例

An Adult Case of Cervicothoracic Neurenteric Cyst Causing Acute Deterioration of Myelopathy

　成人には稀なneurenteric cystに胸髄損傷を合併した症例を経験した．症例は57歳の男性で，誘因なく肩甲背部痛，両下肢の痛み，しびれが出現し歩行困難となり，転倒により両下肢完全麻痺となった．手術は後方から右片側椎弓切除後，椎弓根を完全に切除することで硬膜管の側方を十分に展開し，良好な視野を得ることができた．囊腫は脊髄腹側と強固に癒着しており亜全摘となった．術後麻痺の改善はみられないものの，肩甲背部痛は消失した．

　Spinal neurenteric cysts are very rare, especially after the second decade of life.　We report a case of neurenteric cyst in a 57-year-old man.　The patient complained of pain on the right side of his back and bilateral numbness of the lower extremities.　Two weeks after onset, he was unable to walk without assistance.　After sustaining a fall, he lost the ability to move his lower extremities.　He was referred to our department with complete paraplegia.　MRI of the spine revealed an ventrally located intradural extramedullary cystic lesion at the Th1-2 level.　The lesion was radically excised using pediculectomy via a posterior approach as it provided excellent visualization of the cyst.　However, the cyst was firmly adhered to the spinal cord and was subtotally removed.　Postoperatively, his back pain disappeared, but his motor strength and sensory deficit were not recovered.　Many authors have reported excellent surgical outcomes in case of cervicothoracic neurenteric cysts；thus, early diagnosis and surgical resection may have prevented neurological deterioration before the patient sustained the fall.