脊髄癒着性くも膜炎に対するGore-Tex(R)sheetを使用したくも膜下腔再形成術および硬膜形成術

Expansive Duralplasty and Subarachnoid Reconstruction for Spinal Adhesive Arachnoiditis Using Gore-Tex Surgical Membrane

　Ⅰ．はじめに

脊髄癒着性くも膜炎は炎症や外傷などによって脊髄や神経根やくも膜に慢性炎症性変化が起き，さらに髄液の灌流障害や脊髄の循環障害を来し，脊髄の萎縮やくも膜嚢胞あるいは脊髄空洞症を呈する病態である^4,5,11,14)．発症した時点で既に神経症状が進行している症例が多いこと，脊髄炎を合併していること，手術療法を行っても再癒着が多いことなどから脊髄疾患の中でも極めて治療困難な疾患の1つと考えられる．今回われわれは，脊髄癒着性くも膜炎症例に対してGore-Tex^(R)sheetによる硬膜形成術およびくも膜下腔再形成術を行い良好な成績を得ているので報告する．

　Effective surgical treatment of adhesive spinal arachnoiditis has not been established because of its complex clinical manifestation. The authors present a new surgical technique to minimize the postoperative recurrence of adhesion after microlysis of adhesion to treat spinal adhesive arachnoiditis. After complete release and reconstruction of the spinal cord,a 0.1 mm Gore-Tex surgical membrane was placed over the cord and fixed to the lateral dural surface with stay sutures. Furthermore,maximal expansion of a subarachnoid space was performed by expansive dural plasty with a 0.3 mm Gore-Tex surgical membrane. We performed this surgical method in tree cases of spinal adhesive arachnoiditis. During a postoperative follow-up period ranging from 2 to 3 years,postoperative neurological deterioration did not occur in all cases,and postoperative MR imaging studied showed no adhesion spinal cord and reconstructed subarachnoid space. The authors believe that this procedure is an effective surgical treatment for spinal adhesive arachnoiditis.