腫瘍脊椎骨全摘術後の髄液漏に小脳出血を合併した1例

Remote Cerebellar Hemorrhage Secondary to Cerebrospinal Fluid Leakage after Total en bloc Spondylectomy. Case Report

　腫瘍脊椎骨全摘術後の髄液漏に続発して小脳出血を来した1例を経験した．症例は73歳の男性で膀胱癌の第6-8胸椎転移に対し，放射線療法が奏効しなかったため手術を行った．術中に硬膜と壁側胸膜を損傷した．術後，ドレーンから漿液性の排液が持続し髄液漏が疑われた．また，胸部X線像では右胸水の貯留に伴う無気肺を認めた．術後3日目から意識障害を認め，頭部CTで小脳出血を認めた．髄液漏により低髄液圧が持続し，小脳出血に至ったと推察した．髄液漏に伴う小脳出血は重篤な合併症の1つであり注意が必要である．

　We report a case of remote cerebellar hemorrhage (RCH) secondary to cerebrospinal fluid (CSF) leakage after total en bloc spondylectomy.　The patient was a 73-year-old man with bladder cancer metastasis at T7.　Magnetic resonance imaging revealed invasion of T6 and T8.　Total en bloc spondylectomy was performed, and a dural tear and parietal pleural injury that occurred intraoperatively caused some CSF to leakout.　We concluded that CSF leakage had occurred when we observed clear serous fluid emerging from the drainage tube.　In addition, chest X-rays revealed atelectasis associated with pleural effusion.　The patient became drowsy on postoperative day 3.　Computed tomography showed small areas of RCH in both cerebellar hemispheres, and we concluded that impairment of cerebellar venous drainage by the excessive CSF drainage during the perioperative period had caused the hemorrhages.　Patients who undergo spinal surgery should be monitored for RCH, because it is a serious postoperative complication of spinal surgery.