胸椎部Spinal Meningeal Cyst（type Ia）の1治験例

Posterolateral Extradural Approach for Total Excision of Spinal Meningeal Cyst (Type Ia):Case report

I．はじめに

　脊髄の嚢胞性の病変に対しては，病名の統一がされておらず，胸椎部の髄膜瘤は本邦でも各種の病名で報告がある^4,5,9,10）．さらに胸椎部の髄膜瘤の手術法に関しても，開胸による報告などもあり一致しない^9,10）．今回われわれは第10胸椎部に存在する髄膜瘤（spinal menin—geal cyst type Ia）に対し，侵襲度が低いと思われる1椎体の椎弓のみの除去による，根治術を施行し，良好の結果を得たので，病態とともに手術法に関しても検討を加えたので報告する．

Lateral thoracic meningocele is an uncommon dis-order known to occur with high frequency in patients with neurofibromatosis. We report a case not accompa-nied by neurofibromatosis and describe the operative technique utilizing a posterolateral extradural approach. A 41-year-old man was referred to our cardiologic clinic for severe anterior chest pain. Plain chest X-ray demon-strated an oval mass lesion in the right 9th to 10th thor-acic paravertebral region. Magnetic resonance imaging revealed a cystic mass at the 10th thoracic intervetebral foramen without distortion of the spinal cord. Signal in-tensity of the cystic mass was the same as the cerebros-pinal fluid around the spinal cord. In the prone posi-tion, laminotomy of the 10th vertebral only was carried out. A pulsatile round mass in continuity with the dura mater was exposed. The wall of the sac, which was thickened with CSF, was identified. The neck of the menigocele was ligated with the help of an aneurysm needle. The patient's severe chest pain disappeared postoperatively.