変形性頸椎症による椎骨動脈圧迫の手術的療法

SURGICAL TREATMENT OF VERTEBRAL ARTERY COMPRESSION WITH SPONDYLOTIC OSTEOPHYTES

I．はじめに

　めまいを主症状の一つとして来院する患者は次第に増加の傾向にある。めまいの原因は多岐にわたり，その診断，治療が困難であることも少なくないが，頸部主幹動脈にその原因があり，ひいては手術的療法によつて治癒せしめ得るものがあることは，一般にはあまり膾炙されていない。

　特に頭部の同転によつて誘発または増強されるめまいを主徴とする症候群のうち，cervical spondylosisによる椎骨動脈圧迫に基囚するものはde Kleynら（1927）によつてまず注目され，その後屍体における実験または椎骨動脈撮影所見から，めまいの発生原因を椎骨脳底動脈流域の血流不全に求めた報告が多いが，未だ決定的でない。治療に関してもなお確立されておらず，実際に骨棘切除などの手術を行なつた例もHardin （1960）以来少数の報告を散見するに過ぎない。

A case of surgically treated vertebral artery corn-pression with spondylotic osteophytes was reported. A man, aged 48, suffered several attacks of dizziness for past 10 years. Four months before admission syncope had occured and then he noticed vertigo and hemicrania of the left side when he turned his head to the right. Roentgenograms of the cervical spine showed spondylosis and "lipping" of the right Luschka's joint of C^5-6. Vertebral arteriography revealed remarkably compressed and narrowed right vertebral artery with the osteophytes which became narrower in turning head to the right. In addition, each of the vertebral arteries was blocked at just under the axis in turning head to the opposite side. And the first portion of the left anterior cerebral artery was not visualized in bilateral carotid angio-grams suggesting collateral circulatory disturbance of the circle of Willis.

With an anterolateral approach, the osteophytes were rongeured and periarterial sympathetectomy around the right vertebral and subclavian artery was simultaneuosly carried out.

Although, postoperatively his hemicrania and ver-tigo were stopped, aortography revealed the right vertebral artery obstructed at 8mm distal to its origin. From this fact, it was considered that he-micrania and vertigo of this case were caused not by decreased blood flow of the basilar artery but by abnormal sympathetic impulse arising from the compressed vertebral artery with the osteophytes.