クロイツフェルト・ヤコブ病と人工硬膜—ライオデュラ®，そして脳神経外科に求められるプリオン病対策

Creutzfeldt-Jakob Disease and Lyodura:A Special Reference to Prion Disease Control in the Field of Neurosurgery

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・日本ではこれまでライオデュラ^®移植歴のある医原性プリオン病が156症例判明しており，現在でも新規発症がみられている．ライオデュラ^®移植歴とは，すなわち脳神経外科手術歴である．

・上記とは別に，孤発性プリオン病・遺伝性プリオン病は年間200例程度発症している．この患者群に脳神経外科手術を行わざるを得なくなったとき，脳神経外科手術器械によるプリオン病二次感染は避けねばならない．厚生労働省研究班を中心にプリオン病二次感染対策が講じられており，ガイドラインが策定されている．

・脳神経外科手術器械滅菌法は，厚生労働省研究班が公表する最新の『プリオン病感染予防ガイドライン』を遵守する必要がある．

　In Japan, 156 cases of dura mater-transplanted Creutzfeldt-Jakob disease（dCJD）with a history of Lyodura transplantation have been confirmed until February 2022, with only a few new cases still being identified. The history of Lyodura transplantation is one involving a neurosurgical procedure. The cumulative global number of cases of bovine spongiform encephalopathy-related variant CJD（BSE-related vCJD）, which has shaken societies around the world, is 232 as of 2019. Thus, the impact of dCJD on the society in Japan needs no explanation. Thanks to the world's concerted efforts in research and countermeasures, medically induced prion diseases are finally becoming a thing of the past. However, due to the extremely long incubation period of CJD and the difficulty of tracing the source of infection, immediate action in the event of an outbreak is not possible, and efforts must focus on preventing disease outbreaks.

　Independent of this, approximately 200 cases of solitary and hereditary prion diseases occur annually in Japan. If neurosurgery must be performed on such patients, secondary transmission of prion disease by neurosurgical instruments must be prevented. Therefore, sterilization methods for neurosurgical instruments are critical, and various measures including sterilization methods have been determined and published by a research group designated by the Japanese Ministry of Health, Labour and Welfare.

　The sterilization of neurosurgical instruments should comply with the latest guidelines that are published by this study group.