外科的治療を行った小児脊椎管内腫瘍例の臨床的検討

Clinical study of intraspinal neoplasms in children

I．はじめに

　小児脊椎管内腫瘍は比較的まれな疾患であり^4,7,8,16），臨床症状も成人と異なることも多く，特に，乳幼児では言葉による症状の訴えが少ないために診断に苦慮する場合がある^8）．

　また，小児期は脊髄・脊椎を含め身体は発達段階にあり，治療方針を決定するにあたって十分注意を必要とする^8）．

The authors report a series of 10 children under 15 years of age with primary intraspinal neoplasm who underwent surgical resection from 1981 to 1994. The tumors consisted of 4 intramedullary tumors (myxo-papillary ependymoma, pilocytic astrocytoma, subpial lipoma, cavernous angioma), 2 intradural extramedul-lary tumors (2 neurinomas), and 4 extradural tumors (ganglioneuroma, chordoma, osteochondroma, rhabdo-myosarcoma). The initial symptoms in these patients were gait disturbance (50%), weakness of lower extre-mities (50%), pain (40%), weakness of upper extremi-ties (10%), and tetraparesis (10%). The neurological findings on admission in these patients revealed motor paresis (90%), sensory disturbance (60%), abnormality of deep tendon reflex (60%), pathological reflex (30%), neurogenic bladder (30%), and Lasegue's sign (10%). All patients were treated surgically; laminectoy was performed in 8 patients, laminoplasty in one patient, and transoral approach in one patient. Five patients (50%) underwent a grossly total resection, 3 (30%) had a sub-total resection, and 2 (20%) had a partial resection. Mean follow-up period was 5.6 years. One (10%) pa-tient died due to recurrence and dissemination of the tumor at eight months after surgery in a case of rhab-domyosarcoma. 9 (90%) have had no recurrent tumor and have improved neurologically. In 4 patients (40%) spinal deformity developed, and 2 patients required op-erative treatment for the spinal deformity. We empha-sized the advantage of laminoplasty to prevent postope-rative spinal deformity in children.