上部頸椎脊索腫の外科的治療

Surgical Treatment of Upper Cervical Churdoma

Ⅰ．はじめに

　脊索腫chordomaは，胎生期の遺残物であるembryonic chorda dorsalisより発生する腫瘍と考えられ，頭部においては，斜台部，蝶形骨洞部に好発する．仙椎，尾椎部の発生は，頭部とほぼ同頻度であるが，その他の脊椎での発生は少なく，令脊索腫の10-20％と推定される^2,5,6,7,9）（Table 1）．

　1970年以降，当脳神経外科で治療した脊索腫は，男性6例，女性2例の計8例であり，7例は頭蓋底に発生し，他の1例が上部頸椎に発生した．

Treatment of upper cervical chordoma is generally considered to he difficult one, because of serious troubles in supporting cranio-spinal junction after the surgery and at the recurrence. Clinical course of a 22-year-old man with chordoma originated from C2 vertebral body was reported, and the operation for such a condition were discussed with emphasis on the mode of craniovertebral fixation.

Simple subtotal removal of the vertebral chordoma was carried out by posterior approach at the first operation. The second one was necessary fourteen months later for recurrence of the tumor.