神経血管減圧術により呼吸障害の著明な改善を認めた延髄圧迫症候群の1例

Successful Microvascular Decompression of the Medulla Oblongata for a Case with Respiratory Failure: Case Report

Ⅰ．はじめに

　延髄圧迫症候群の中で神経血管減圧術（microvascular decompression：MVD）の有効性が最も知られているのは，血管圧迫による神経性高血圧症である^2,5,7,9)．近年，椎骨動脈（vertebral artery：VA）の延髄圧迫によると考えられる，錐体路障害や球麻痺などの多様な症状を呈した症例に対し，MVDが有効であるとの報告が散見されるようになった^4,6,8,10,12)．しかしVAによる延髄圧迫のために呼吸障害を来した症例の報告は少なく，さらにMVDによる治療が奏功した症例の報告は極めて稀である¹¹⁾．今回われわれは中枢性呼吸障害で発症した延髄圧迫症候群の症例に対してMVDを施行し，良好な治療成績を得た1例を経験したので，文献的考察を加えて報告する．

　We report a case of the medulla oblongata syndrome successfully treated by microvascular decompression surgery. The patient was a 75-year-old woman and had been suffering from gradual progressive dyspnea since July,2009. Two month later,intubation and medial ventilator treatments were began because of severe respiratory problems. The central respiratory problems were considered in extensive testing by the physician. The head MR imaging showed that the left vertebral artery had markedly compressed the medulla oblongata. We thought that her respiratory problems were associated with this vertebral artery compression of the medulla oblongata. We performed the microvascular decompression surgery by left trans-condylar fossa approach. Her hypoventilation graduately improved after the surgery and she needed neither ventilator nor oxygen in several months. She is able to perform daily activities by herself. We report the case,and discuss the cause of respiratory problems especially by compression of the medulla oblongata.