胸部異常陰影として偶然発見された胸椎砂時計型神経鞘腫の1例—手術アプローチについて

A Case of Large Thoracic Epidural Hourglass Neurinoma, incidentally detected on Routine Chest Roentgenogram: With respect to surgical approach

　I．はじめに

　神経原性腫瘍は縦隔腫瘍の18^11）−23％^2）を占め，そのほとんどが肋間神経や傍脊柱交感神経節より発生する神経線維腫や神経節細胞腫である^10）．これらはときに脊椎管の内外へ伸展し砂時計型の形態をとるが，脊椎管外の腫瘍部分が胸腔内へ著明に伸展し，かつ脊髄への圧迫が高度の場合には，その手術的アプローチが問題となる．最近，われわれは，健康診断で実施された胸部X線撮影で，偶然，左縦隔内に異常陰影を発見され，精査にて胸椎部の砂時計型腫瘍と判明した1例を経験した．この症例の神経放射線学的所見および手術アプローチについて考察する．

In case of the advanced extension into the thoracic cavity, it has been difficult to remove a large thoracic spinal hourglass tumor by conventional laminectomy, even adding costotransversectomy, due to high risk of injuring diverse important vessels and other organs by blind manipulation.

A case of a large thoracic spinal hourglass neu-rinoma with advanced extension into the mediastinum is presented. A 49-year-old female was admitted for the further examination of the left mediastinal tumor, incidentally detected on routine chest roent-genogram, which was suspected as the part of spinal hourglass tumor.