脊髄円錐部脂肪腫の手術

Surgery for Spinal Lipoma of the Conus Medullaris

Point

・手術は解剖学的な構造を把握することが重要であり，脂肪腫の発生学的な背景を推察することで疾患の理解が深まる．

・手術は，① 脊髄係留解除，② 脂肪腫の可及的摘出と癒着剝離，③ 神経／脊髄損傷の予防，④ 再癒着の予防（軟膜縫合，硬膜形成）が基本である．

・手術後は脊髄再係留により神経症状が出現することは稀ではないため，長期にわたるチーム医療による経過観察が重要である．

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　Lipoma of the conus medullaris（LCM）can cause neurological symptoms known as tethered cord syndrome（TCS）. The symptoms can be seen at diagnosis and during long-term follow-up. Even after surgical treatment, some patients can present with neurological deterioration indicating a TCS, defined as retethered cord syndrome（ReTCS）.

　In this report the surgical technique for conus lipoma comprising wide osteoplastic laminotomy with confirmed whole spinal lipoma and adjacent normal spinal tissue is described, with dissection performed from the proximal side to the distal side with confirmed normal spinal cord and roots under operative microscope, expansive dural plasty aiming to get low cord/sac ratio was reported. Considering that some patients with LCM show postoperative neurological symptoms due to TCS in a long-term follow-up period, careful postoperative follow-up is necessary.