術前にAdamkiewicz動脈を同定した胸腔内ダンベル型神経鞘腫の1例

Intrathoracic Dumbbell-shaped Schwannoma with Preoperative Identification of the Artery of Adamkiewicz：Report of a Case

はじめに　ダンベル型神経鞘腫はしばしば遭遇する疾患であるが，下位胸椎に発生した症例に対する手術の際はAdamkiewicz動脈（AKA）の存在に注意する必要がある．同動脈の損傷により術後対麻痺を生じる可能性があるためである．われわれは術前3D-CTで同動脈を同定し安全に手術を施行した，左下位胸椎に発生したダンベル型神経鞘腫の1例を経験したので報告する．

A woman in her 30s with a left posterior mediastinal tumor incidentally found on a chest computed tomography （CT） was referred to our hospital. Chest CT revealed a dumbbell-shaped tumor of 37 mm in diameter located on the paravertebral region at the left Th9/10 level. The tumor extended into the Th9 intervertebral foramen, but did not extend into the spinal canal. Three dimensional （3D）-CT showed the artery of Adamkiewicz （AKA） with a hair-pin turn form the 11th left intercostal artery. We performed surgical treatment. First, the nerve root was dissected by the posterior approach. Next, the tumor was resected by thoracoscopic surgery. The postoperative pathological diagnosis was neurinoma. In surgical resection of posterior mediastinal tumors （especially on the left side） located between the eighth thoracic vertebra and the first lumbar vertebra, it is considered important to identify AKA preoperatively in order to prevent postoperative paraplegia.