Subcutaneous sacrococcygeal ependymomaの脊椎転移に対し多数回の手術を行った1例

Spinal Metastasis of a Subcutaneous Sacrococcygeal Ependymoma and Long-Term Follow-Up. Case Report

　Subcutaneous sacrococcygeal ependymomaの脊椎転移を来した非常に稀な1症例を経験した．43歳時に仙骨部のmyxopapillary ependymomaを切除し，50歳時にT9への転移に対し手術したものの再発した．しかしながら15年にわたり，重度の麻痺を来す前に手術を繰り返したことで，日常生活の自立を維持できている．緩徐発育性である本症例のような腫瘍では，脊椎転移の再発例であっても，脊髄機能の温存と脊柱安定性の獲得をあきらめず治療していくことが必要である．

　Subcutaneous sacrococcygeal ependymomas are rare, and pulmonary metastasis and lymph node metastasis have been reported, but spinal metastasis is extremely rare.　We report a case of recurrent spinal metastasis by a subcutaneous sacrococcygeal ependymoma that was followed up long-term.　Management consisted of surgical resection of a thoracic spinal metastasis eight times over a 15 year period.　The patient has maintained his activities of daily living paralysis-free.　It is generally agreed that complete excision of subcutaneous sacrococcygeal ependymomas is the best treatment option.　However, extraspinal ependymomas tend to metastasize more frequently than their intrameningeal counterparts, which originate in the cauda.　Once the metastasis in our patient recurreds the disease was slowly but relentlessly progressive.　Resection of metastatic spinal tumors before paralysis occurs is important to maintaining patients' activity levels.