Japanese
English
- 有料閲覧
- Abstract 文献概要
- 1ページ目 Look Inside
- 参考文献 Reference
Ⅰ.はじめに
めまい,耳鳴を主訴とする第Ⅷ神経血管圧迫症(cochleovestibular neurovascular compression syndrome:CNVC)は,日常診療において稀な疾患ではない.めまいを主訴とする例については,Jannettaら6)によりdisabling positional vertigo(無力性頭位性めまい)という疾患単位として報告されている.その後,複数の手術療法の断片的報告1,3,4,7,10,12-18,23)があるが,その診断基準は確立していない.神経血管圧迫に由来するという意味では,三叉神経痛や片側顔面痙攣は,このCNVCの近縁疾患とも言える.それらの根治的治療法として,神経血管減圧術が普及しているが,CNVCに対する神経血管減圧術は普及していない.松島ら11)は,CNVCに対する神経血管減圧術が普及していない理由として,手術の適応基準が不明瞭で,診断基準が確立していないことを挙げている.今回われわれは,50例(53側)のCNVC,めまいや耳鳴を呈したCNVCの近縁疾患の11例(12側)の後ろ向き検討により,CNVCの診断基準をまとめたので報告し,その妥当性を含めて考察する.
The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% Ⅱ wave amplitude on the contralateral side and delayed interpeak latency in the Ⅰ-Ⅲ or Ⅰ-Ⅴ waves(usually low Ⅱ wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items.
Results:The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.
Copyright © 2017, Igaku-Shoin Ltd. All rights reserved.