周囲支持組織を温存しつつ全摘出し得たdumbbell型C2 neurinomaの1例

A Case Involving Complete Removal of C2 Dumbbell Type Neurinoma with Preservation of the Surrounding Supportive Tissue

Ⅰ．はじめに

　脊髄腫瘍に対する手術では，後方到達法，前方到達法，さらには前方後方同時到達法など様々な方法が試みられているが⁷⁾，いずれのアプローチ方法においても頸部筋群，関節などの周囲支持組織をできる限り温存することが，術後脊椎機能を維持するうえで有用である⁹⁾．今回われわれはC2神経根に発生し，拡大したC1/C2椎間孔より傍椎体部に進展したdumbbell型神経鞘腫の1例に対し，後方到達法にてC2棘突起および同部位付着伸展筋群，椎弓，椎間関節などの周囲支持組織を完全に温存しつつ全摘出し得たので，文献的考察を加えて報告する．

We report a case in which C2 neurinoma was completely removed with preservation of the surrounding supportive tissue. A 47-year-old female was admitted to our hospital with gait disturbance and spinal tumor identified in other hospital. Neurological examination on admission revealed hyperreflexia in bilateral limbs and pathological reflexes. Cervical plain X-radiography showed erosion of the left C2 lamina. Axial Gd-enhanced T1 weighted magnetic resonance (MR) images showed partial enhancement of a dumbbell shaped tumor at the C1-2 level,revealing compression of the spinal cord to the right and extending to postero-laterally,and coronal MR images demonstrated that the tumor was clearly surrounded by the semispinalis capitis,semispinalis cervicis and inferior oblique muscles. The tumor was resected through a posterior approach without injuring the surrounding supportive tissue. Post operatively,she did not complain of nuchal pain during neck movement. After a 6-month follow-up period,cervical plain X-radiography showed preservation of cervical alignment,and coronal Gd-enhanced T1-weighted MR images demonstrated preservation of the posterior group of cervical muscles. It is desirable to preserve the surrounding supportive tissue as far as possible in order to minimize the postoperative neck pain and instability of cervical spine,like this case.