雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 45, Issue 9 （September 2017）

Neurological Surgery 脳神経外科 45巻9号（2017年9月発行）

Japanese English

研究

シベリア地区における脊髄硬膜内髄外腫瘍摘出術の手術成績：97例の検討 Neurosurgical Outcomes of Intradural Extramedullary Spinal Tumors in 97 cases:Siberian Experience Byvaltsev Vadim Anatolyevich ^1,2,3 , Damdinov Bair Batiyevich ² , Belykh Evgenii Georgiyevich ¹ , Ivanova Kristina Olegovna ^1,2,3 , Sorokovikov Vladimir Alekseevich ^1,2,3 , 常俊顕三 ⁴ , 北井隆平 ⁴ , 菊田健一郎 ⁴ Vadim Anatolyevich BYVALTSEV ^1,2,3 , Bair Batiyevich DAMDINOV ² , Evgenii Georgiyevich BELYKH ¹ , Kristina Olegovna IVANOVA ^1,2,3 , Vladimir Alekseevich SOROKOVIKOV ^1,2,3 , Kenzo TSUNETOSHI ⁴ , Ryuhei KITAI ⁴ , Kenichiro KIKUTA ⁴ ¹Irkutsk Scientific Center of Surgery and Traumatology, Siberian Division of the Russian Academy of Medical Sciences, Irkutsk, Russia ²Department of Neurosurgery, Irkutsk Railway Hospital, Russia ³Department of Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Russia ⁴福井大学医学部脳脊髄神経外科 ¹Irkutsk Scientific Center of Surgery and Traumatology, Siberian Division of the Russian Academy of Medical Sciences, Irkutsk, Russia ²Department of Neurosurgery, Irkutsk Railway Hospital, Russia ³Department of Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Russia ⁴Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui キーワード： intradural extramedullary spinal tumor , spine surgery , modified McCormick scale Keyword: intradural extramedullary spinal tumor , spine surgery , modified McCormick scale pp.781-787

発行日 2017年9月10日 Published Date 2017/9/10

DOI https://doi.org/10.11477/mf.1436203592

PDF(1206KB)

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

　脊髄硬膜内髄外腫瘍は，神経根への圧迫による根性痛や腰痛，脊髄症状による歩行障害などを来す^1,17,18)．画像診断が普及していないロシアのシベリア地区では，患者は保存的治療を受け，症状が改善しない場合に限りMRIなどの画像診断がなされる．すなわち相当の期間，経過観察されることになる．筆者らの所属している施設には，シベリア地区の患者が集積する．症状を有する脊髄硬膜内髄外腫瘍の治療の目的は，神経組織の減圧と腫瘍の根治であることは言うまでもない^1,14,17,18)．本研究では，シベリア地区における脊髄硬膜内髄外腫瘍摘出術の手術成績について，腫瘍の局在，病理所見，術前後の神経症状，手術のタイミング，手術方法について後方視的に検討した．

　We retrospectively investigated the clinical presentation and outcome of patients with spinal intradural extramedullary tumors, which had been surgically treated. A total of 97 consecutive patients（32 males and 65 females;mean age, 48 years;range, 17-79 years）underwent surgery between 2004 and 2014 at Irkutsk State Medical Academy and affiliated hospitals. To determine presentation and outcomes associated with these tumors, we evaluated the waiting period before surgery, neurological symptoms including motor, sensory, urinary, and rectal dysfunction, modified McCormick scale, Macnab's outcome assessment of patient satisfaction, surgical procedure, tumor location, and histological diagnosis. The most frequent preoperative symptom was myelopathy（52.6%）at presentation, followed by radiculopathy（20.6%), and a combination of both（26.8%). Surgical intervention produced highly successful results, in which 77 of 97 cases showed neurological improvement. However, the symptoms were not completely reversed, and there was improvement only the equivalent to one grade in the modified McCormick scale for most patients. Surgical outcomes were not influenced by tumor location, extent of lamina resection, or histological diagnosis, but there was a correlation between greater patient improvement and a shorter waiting period before surgery. As such, we recommend early total resection for symptomatic spinal intradural extramedullary tumors.