脊柱管内に進展した胸椎海綿状血管腫の1例

Vertebral Hemangioma Extending into the Spinal Canal : Case Report

　Ⅰ．はじめに

Vertebral hemangioma（VH）は良性の血管性腫瘍であり，椎体内の様々な部位に発生する³⁾．そのほとんどは症状のない，いわゆる無症候性血管腫（asymptomatic VH）であり，特に治療を必要としない．しかし，稀に増大し，脊髄や神経根を圧迫して背部痛やradiculopathy，myelopathyを呈するもの（compressive VH）があり，積極的な治療を必要とすることがある^6,7)．今回われわれは，椎体から脊柱管内に進展し脊髄圧迫症状を呈した，いわゆるcompressive VHを経験した．海外の文献においてはcompressive VHについていくつかの報告がみられるが，本邦においてはほとんど報告されていない．そこでわれわれの経験したcompressive VHの1症例を報告し，その臨床症状，検査所見，治療について考察する．

　A 73-year-old woman was admitted to our hospital presenting slowly progressive hypoesthesia below the 5th thoracic dermatome and spastic paraparesis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a mass lesion in the T3 vertebral body extending into the spinal canal. The spinal cord was compressed to the left side and right T3 and T4 nerve roots were encased in the mass lesion. One week after admission,T2-T4 laminectomy was performed to relieve the spinal cord compression. A highly vascularized tumor was observed in the epidural space at T3 and T4 levels. The tumor in the spinal canal was removed. The histopathological diagnosis was cavernous hemangioma. The patient's symptoms improved after the surgery. Asymptomatic vertebral hemangiomas are common,but its extraosseus extension causing neurologic symptoms (compressive vertebral hemangioma) is rare. The clinical symptoms,the radiological features,and the strategies for the treatment of compressive vertebral hemangiomas were discussed.