頸静脈孔神経鞘腫に対する手術アプローチの工夫—術中頭部回転を利用したCombined suboccipital and infralabyrinthine approach

Surgical Approach for Jugular Foramen Neurinoma: Combined suboccipital and infralabyrinthine approach using a rotatable head holder

I．はじめに

　頸静脈孔神経鞘腫は比較的稀な腫瘍であるが，頭蓋内に発育する場合には，聴神経鞘腫と同様にsuboccipitalapproachで摘出可能である．しかし，ときに頸静脈孔を拡大し，腫瘍の大部分が孔内に存在している場合がある．今回われわれは，嗄声を主訴とした左頸静脈孔神経鞘腫で，腫瘍の大部分が孔内を占拠し，その一部分が頭蓋内外に進展していた1症例を経験した．これに対して，手術手技を工夫し，全摘することができた．そこで，この症例を呈示し，頸静脈孔腫瘍に対する手術アプローチにつき検討を加え報告する．

A 36-year-old male with jugular foramen neurinoma was operated upon using a rotatable head holder, which enables the surgeon to rotate the patient's head at any time during the procedure and to gain access in multiple directions to the tumor. The tumor was situated primarily in the jugular foramen and showed partial extension into intracranial as well as into extracranial space.

The patient was placed in the lateral position with a rotatable head holder, which allows rotation of the patient's head with the range of 10° face up to 80° face down from the horizontal plane.