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 46, Issue 1 （January 2018）

Neurological Surgery 脳神経外科 46巻1号（2018年1月発行）

Japanese English

研究

腰椎椎間孔外神経鞘腫の手術方法 Surgical Technique for Lumbar Spinal Extraforaminal Schwannoma 櫻井公典 ^1,2 , 朝本俊司 ^1,2 , 中村聡 ² , 石原慎一 ² , 石川雅之 ² , 西山誠 ² , 左村和宏 ¹ , 吉岡史隆 ¹ , 河島雅到 ¹ , 福井康之 ² Kiminori SAKURAI ^1,2 , Shunji ASAMOTO ^1,2 , Satoshi NAKAMURA ² , Shinichi ISHIHARA ² , Masayuki ISHIKAWA ² , Makoto NISHIYAMA ² , Kazuhiro SAMURA ¹ , Fumitaka YOSHIOKA ¹ , Masatou KAWASHIMA ¹ , Yasuyuki FUKUI ² ¹国際医療福祉大学医学部三田病院脳神経外科 ²国際医療福祉大学医学部三田病院脊椎脊髄センター ¹Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Mita Hospital ²Spine and Spinal Cord Center, International University of Health and Welfare, School of Medicine, Mita Hospital キーワード： extraforaminal schwannoma , Wiltse paraspinal approach Keyword: extraforaminal schwannoma , Wiltse paraspinal approach pp.5-9

発行日 2018年1月10日 Published Date 2018/1/10

DOI https://doi.org/10.11477/mf.1436203666

PDF(1671KB)

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

　脊髄神経鞘腫は硬膜内，特に馬尾レベルに多いが，比較的大きいものであっても，顕微鏡下で手術を行えば安全に合併症なく全摘出可能である．しかし，硬膜外で，かつdumbbell typeではない神経鞘腫（extraforaminal schwannoma：EFS）は比較的珍しく，手術方法も大きく異なる．今回われわれは，腰椎EFSの摘出術を安全に行うための手術方法について，自験例をもとに検討した．

　INTRODUCTION:Spinal neurinomas are frequently observed in the cauda equina, particularly within the dura mater. However, extraforaminal schwannomas（EFS), which are neither intradural nor dumbbell type, are relatively rare；hence, different surgical procedures have been employed. Here, we report 12 cases of lumbar EFS with total resection that were safely performed.

　METHODS and SUBJECTS:This study was comprised of 12 patients with lumbar EFS（excluding those with neurofibromas）who were previously treated at our hospital. Using the Wiltse paraspinal approach, we inserted the microscope until it reached the tumor surface. After confirming the tumor surface, we inserted a scalpel to make an incision in a portion of the outer capsule. Then, we confirmed that the surfaces of the outer capsule and the tumor within the capsule could be dissected. Next, a thread was attached to the outer capsule and pulled upwards so that there was enough space to perform the required procedures within the capsule. Using a CUSA^®, we removed the intracapsular tumor. After its removal, the outer capsule was treated carefully to ensure that the origin nerve was not damaged.

　RESULTS:In all cases, we successfully performed a total removal of the intracapsular tumor;in the mean postoperative observation period of 8 years, no recurrence was observed. Although temporary paralysis was observed in three patients, this improved over time.

　CONCLUSION:We report our experience with a surgical technique that ensured the safe removal of lumbar EFS. Satisfactory results were achieved, with no recurrences observed during the mean 8-year postoperative observation period.