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Neurological Surgery No Shinkei Geka Volume 48, Issue 6 （June 2020）

Neurological Surgery 脳神経外科 48巻6号（2020年6月発行）

Japanese English

症例

優位側椎骨動脈浸潤を伴った頭蓋頚椎移行部硬膜内髄外腫瘍に対し，椎骨動脈塞栓術を行い全摘出し得た1例 Successful Total Resection with Preceding Arterial Coil Embolization of Intradural Extramedullary Tumor at Craniovertebral Junction Encasing Dominant-side Vertebral Artery 舘澤諒大 ^1,3 , 岩﨑素之 ¹ , 飛騨一利 ² , 長内俊也 ³ , 川堀真人 ³ , 守田玲菜 ⁴ , 山内朋裕 ¹ , 新谷好正 ¹ , 古川浩司 ¹ , 鐙谷武雄 ¹ , 馬渕正二 ¹ Ryota TATEZAWA ^1,3 , Motoyuki IWASAKI ¹ , Kazutoshi HIDA ² , Toshiya OSANAI ³ , Masahito KAWABORI ³ , Rena MORITA ⁴ , Tomohiro YAMAUCHI ¹ , Yoshimasa NIIYA ¹ , Koji FURUKAWA ¹ , Takeo ABUMIYA ¹ , Shoji MABUCHI ¹ ¹小樽市立病院脳神経外科 ²札幌麻生脳神経外科病院脳神経外科 ³北海道大学大学院医学研究科脳神経外科 ⁴小樽市立病院病理診断科 ¹Department of Neurosurgery, Otaru General Hospital ²Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital ³Department of Neurosurgery, Hokkaido University Graduate School of Medicine ⁴Department of Pathology, Otaru General Hospital キーワード： craniovertebral junction meningioma , foramen magnum meningioma , VA occlusion , VA sacrifice , balloon test occlusion Keyword: craniovertebral junction meningioma , foramen magnum meningioma , VA occlusion , VA sacrifice , balloon test occlusion pp.509-514

発行日 2020年6月10日 Published Date 2020/6/10

DOI https://doi.org/10.11477/mf.1436204220

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Abstract 文献概要
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Ⅰ．はじめに

　頭蓋頚椎移行部（craniovertebral junction：CVJ）の腫瘍は，脳神経や延髄，椎骨動脈（vertebral artery：VA）など周囲に重要な構造物が多く，一般的に摘出は困難である．また，VA浸潤を伴った場合，摘出時のVA損傷リスクが高く，安全を期して部分摘出にとどめる例や，長時間に及ぶ手術となることもある．今回，VA浸潤を伴うCVJの硬膜内髄外腫瘍の症例に対し，血管内治療でVA塞栓を先行した上で摘出術を行い，安全に腫瘍の全摘出をし得た症例を経験したため報告する．

　OBJECTIVE:The surgical resection of craniovertebral junction（CVJ）meningioma is challenging because of the neighboring brainstem, lower cranial nerves, and vertebral artery（VA). Moreover, encasement of the VA by the tumor can raise the risk of complications and require cautious manipulation during surgery.

　CASE:A 46-year-old woman presented with a one-year history of neck pain. She had temporal hemiplegia and numbness on her left side. Magnetic resonance imaging（MRI）showed a CVJ meningioma pushing the brainstem from the right vertebral side and encasing the right VA. Digital subtraction angiography（DSA）showed two feeding arteries arising from the right VA and a sunburst sign. The right VA was the dominant side but did not have the right posterior inferior cerebellar artery（PICA). The anterior spinal artery（ASA）was dominant in the left VA. We performed a balloon test occlusion（BTO）for 20 min and it did not cause any complications;therefore, we occluded the VA using endovascular coils. After 4 days, we removed the meningioma in the prone position, using a far-lateral approach and C1-laminectomy. The laterally located meningioma pushed the brainstem. After detaching the tumor from the dura, we cut the encased VA and the tumor was resected safely（Simpson grade Ⅱ). Postoperatively, she developed temporal thermal hypoalgesia on the left side of her body. Magnetic resonance imaging showed a microinfarction in the medulla.

　CONCLUSION:If the VA test occlusion provides a clear result, pre-operative endovascular sacrifice of the VA encased by CVJ meningioma is a feasible treatment strategy.