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Neurological Surgery No Shinkei Geka Volume 23, Issue 4 （April 1995）

Neurological Surgery 脳神経外科 23巻4号（1995年4月発行）

Japanese English

症例

蛇行した椎骨動脈による延髄圧迫の1例 Tortuous Vertebral Artery Compression of the Medulla Oblongata:Case report 村田浩人 ¹ , 和賀志郎 ¹ , 小島精 ¹ , 清水健夫 ¹ , 清水重利 ¹ Hiroto MURATA ¹ , Shiro WAGA ¹ , Tadashi KOJIMA ¹ , Takeo SHIMIZU ¹ , Shigetoshi SHIMIZU ¹ ¹三重大学脳神経外科 ¹Department of Neurosurgery, Mie University School of Medicine キーワード： Medulla oblongata , Vertebral artery , Microvascular decompression , Tetraparesis Keyword: Medulla oblongata , Vertebral artery , Microvascular decompression , Tetraparesis pp.349-353

発行日 1995年4月10日 Published Date 1995/4/10

DOI https://doi.org/10.11477/mf.1436901010

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Abstract 文献概要
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I．はじめに

　Dandy^1），Gardner^2），Jannetta^4）らの報告以来，hyper—active cranial nerve dysfunction syndromeのetiologyとしてneurovascular compressionという概念が定着した．現在ではtrigeminal neuratgia（TN），hemifacial spasm（HFS）のみならず，時にはtinnitus，vertigoなどに対してもmicrovascular decompression（MVD）が応用されている^4）．また，椎骨動脈による延髄圧迫によって高血圧が生ずるとの報告もある^9,13）．しかし，正常径の椎骨動脈によって延髄が圧迫され，痙性四肢麻痺等の延髄圧迫症状を呈した症例の報告は少ない．今回，われわれは蛇行した椎骨動脈による延髄圧迫を解除することにより，著明な臨床像の改善をみた1例を経験したので報告する．

We reported a case of a 58-year-old woman who suf-fered from progressive tetraparesis and sensory disturb-ance caused by compression of the medulla oblongata brought about by bilateral tortuous vertebral arteries. The neurological examination on admission revealed tetraparesis, sensory disturbance in all modalities below the level of C2, onion-skin pattern sensory disturbance of the face, and motor weakness of the sternocleido-mastoid muscles. X-ray films of the cervical spine showed OPLL at the level of C2-3, but on MRI the du-ral theca was not seen to be compressed at that level.MRI and vertebral angiography demonstrated ventro-lateral compression of the medulla oblongta by bilateral tortuous vertebral arteries. After suboccipital craniec-tomy and C1-4 laminectomy, decompression of the medulla oblongata was performed. Both vertebral artries were compressing the medulla oblongata at the ventrolateral side. Transposition of the vertebral arte-ries seemed impossible due to perforating branches to the medulla. After section of the dentate ligaments at Cl level, the medulla oblongata was decompressed and moved backward. Some small pieces of Dacron were inserted between the arteries and the medulla, in order to decrease the pulsatile effect of the vertebral arteries. Postoperatively, the patient's tetraparesis and sensory disturbance gradually improved. There are 6 reported cases concerning compression of the medulla oblongata by the vertebral artery. As MRI becomes more fre-quently used in neurological situations, it is important to keep the presence of such an entity in mind.