脊髄神経鞘腫の手術 神経機能温存と合併症対策
神経鞘腫は脊髄腫瘍の中で最も頻度が高く, あらゆる脊椎レベルに発生する. 摘出術により脊髄・神経の圧迫を解除し, 組織型を確認することが治療の基本である. 脊髄神経鞘腫の多くは硬膜内髄外に存在し, 後方アプローチの基本的な手技で摘出可能であるが, 脊髄前面にあるものや大型のもの, ダンベル腫瘍はアプローチ方向・神経根温存・脊椎固定・術後髄液漏予防などにつき十分な術前検討が必要である. 当科での手術戦略を紹介し, 自験例を供覧して神経機能温存と合併症対策について考察する....
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| Published in | 脳神経外科ジャーナル Vol. 31; no. 5; pp. 302 - 312 |
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| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人日本脳神経外科コングレス
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.31.302 |
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| Abstract | 神経鞘腫は脊髄腫瘍の中で最も頻度が高く, あらゆる脊椎レベルに発生する. 摘出術により脊髄・神経の圧迫を解除し, 組織型を確認することが治療の基本である. 脊髄神経鞘腫の多くは硬膜内髄外に存在し, 後方アプローチの基本的な手技で摘出可能であるが, 脊髄前面にあるものや大型のもの, ダンベル腫瘍はアプローチ方向・神経根温存・脊椎固定・術後髄液漏予防などにつき十分な術前検討が必要である. 当科での手術戦略を紹介し, 自験例を供覧して神経機能温存と合併症対策について考察する. |
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| AbstractList | 神経鞘腫は脊髄腫瘍の中で最も頻度が高く, あらゆる脊椎レベルに発生する. 摘出術により脊髄・神経の圧迫を解除し, 組織型を確認することが治療の基本である. 脊髄神経鞘腫の多くは硬膜内髄外に存在し, 後方アプローチの基本的な手技で摘出可能であるが, 脊髄前面にあるものや大型のもの, ダンベル腫瘍はアプローチ方向・神経根温存・脊椎固定・術後髄液漏予防などにつき十分な術前検討が必要である. 当科での手術戦略を紹介し, 自験例を供覧して神経機能温存と合併症対策について考察する. |
| Author | 菅原, 卓 |
| Author_xml | – sequence: 1 fullname: 菅原, 卓 organization: 秋田県立循環器・脳脊髄センター脊髄脊椎外科 |
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| Copyright | 2022 日本脳神経外科コングレス |
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| DOI | 10.7887/jcns.31.302 |
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| References | 8) Kim P, Ebersold MJ, Onofrio BM, Quast LM : Surgery of spinal nerve schwannoma. Risk of neurological deficit after resection of involved root. J Neurosurg 71 : 810-814, 1989. 6) Jiang L, Lv Y, Liu XG, Ma QJ, Wei F, Dang GT, Liu ZJ : Results of surgical treatment of cervical dumbbell tumors : surgical approach and development of an anatomic classification system. Spine (Phila Pa 1976) 34 : 1307-1314, 2009. 7) Kahraman S, Gocmen S, Alpsan Gokmen MH, Acka G, Pusat S : Intraoperative neurophysiologic monitoring for lumbar intradural schwannomas : does it affect clinical outcome? World Neurosurg 2019. [Online ahead of print] 12) Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M : Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors : an institutional experience and review of the current literature. J Neurosurg Spine 31 : 112-122, 2019. 4) Eden K : The dumb-bell tumours of the spine. Br J Surg 28 : 549-570, 1941. 16) Wilson TJ, Hamrick F, Alzahrani S, Dibble CF, Koduri S, Pendleton C, Saleh S, Ali ZS, Mahan MA, Midha R, Ray WZ, Yang LJS, Zager EL, Spinner RJ : Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications. J Neurosurg 135 : 1231-1240, 2021. 1) Ahmad FU, Frenkel MB, Levi AD : Spinal stability after resection of nerve sheath tumors. J Neurosurg Sci 61 : 355-364, 2017. 14) Toyama Y, Fujimura Y, Takahata T, Chiba K, Ueishi S, Matsumoto M, Ogawa J, Hirabayashi K : Clinical analysis of 83 cases of the dumbbell tumors in the spine : morphological classification and surgical management. J Jpn Med Soc Paraplegia 5 : 86-87, 1992. 15) Viereck MJ, Ghobrial GM, Beygi S, Harrop JS : Improved patient quality of life following intradural extramedullary spinal tumor resection. J Neurosurg Spine 25 : 640-645, 2016. 2) Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K : Surgical strategy for cervical dumbbell tumors based on a three-dimensional classification. Spine (Phila Pa 1976) 29 : E10-E14, 2004. 3) Conti P, Pansini G, Mouchaty H, Capuano C, Conti R : Spinal neurinomas : retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol 61 : 34-43 ; discussion 44, 2004. 9) Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH : Surgical strategies in the management of spinal nerve sheath tumors. World Neurosurg 83 : 886-899, 2015. 13) Sugawara T, Itoh Y, Hirano Y, Higashiyama N, Shimada Y, Kinouchi H, Mizoi K : Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery. Neurosurgery 57 (4 Suppl) : 290-294, 2005. 11) Safavi-Abbasi S, Senoglu M, Theodore N, Workman RK, Gharabaghi A, Feiz-Erfan I, Spetzler RF, Sonntag VK : Microsurgical management of spinal schwannomas : evaluation of 128 cases. J Neurosurg Spine 9 : 40-47, 2008. 5) Huang Y, Wang Z, Chen Z, Wu H, Jian F : Posterior hemi–/laminectomy and facetectomy approach for the treatment of dumbbell-shaped schwannomas in the subaxial cervical spine : a retrospective study of 26 cases. Eur Neurol 78 : 188-195, 2017. 10) Safaee MM, Lyon R, Barbaro NM, Chou D, Mummaneni PV, Weinstein PR, Chin CT, Tihan T, Ames CP : Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. J Neurosurg Spine 26 : 103-111, 2017. |
| References_xml | – reference: 15) Viereck MJ, Ghobrial GM, Beygi S, Harrop JS : Improved patient quality of life following intradural extramedullary spinal tumor resection. J Neurosurg Spine 25 : 640-645, 2016. – reference: 16) Wilson TJ, Hamrick F, Alzahrani S, Dibble CF, Koduri S, Pendleton C, Saleh S, Ali ZS, Mahan MA, Midha R, Ray WZ, Yang LJS, Zager EL, Spinner RJ : Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications. J Neurosurg 135 : 1231-1240, 2021. – reference: 12) Sebai MA, Kerezoudis P, Alvi MA, Yoon JW, Spinner RJ, Bydon M : Need for arthrodesis following facetectomy for spinal peripheral nerve sheath tumors : an institutional experience and review of the current literature. J Neurosurg Spine 31 : 112-122, 2019. – reference: 7) Kahraman S, Gocmen S, Alpsan Gokmen MH, Acka G, Pusat S : Intraoperative neurophysiologic monitoring for lumbar intradural schwannomas : does it affect clinical outcome? World Neurosurg 2019. [Online ahead of print] – reference: 3) Conti P, Pansini G, Mouchaty H, Capuano C, Conti R : Spinal neurinomas : retrospective analysis and long-term outcome of 179 consecutively operated cases and review of the literature. Surg Neurol 61 : 34-43 ; discussion 44, 2004. – reference: 5) Huang Y, Wang Z, Chen Z, Wu H, Jian F : Posterior hemi–/laminectomy and facetectomy approach for the treatment of dumbbell-shaped schwannomas in the subaxial cervical spine : a retrospective study of 26 cases. Eur Neurol 78 : 188-195, 2017. – reference: 13) Sugawara T, Itoh Y, Hirano Y, Higashiyama N, Shimada Y, Kinouchi H, Mizoi K : Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery. Neurosurgery 57 (4 Suppl) : 290-294, 2005. – reference: 11) Safavi-Abbasi S, Senoglu M, Theodore N, Workman RK, Gharabaghi A, Feiz-Erfan I, Spetzler RF, Sonntag VK : Microsurgical management of spinal schwannomas : evaluation of 128 cases. J Neurosurg Spine 9 : 40-47, 2008. – reference: 6) Jiang L, Lv Y, Liu XG, Ma QJ, Wei F, Dang GT, Liu ZJ : Results of surgical treatment of cervical dumbbell tumors : surgical approach and development of an anatomic classification system. Spine (Phila Pa 1976) 34 : 1307-1314, 2009. – reference: 10) Safaee MM, Lyon R, Barbaro NM, Chou D, Mummaneni PV, Weinstein PR, Chin CT, Tihan T, Ames CP : Neurological outcomes and surgical complications in 221 spinal nerve sheath tumors. J Neurosurg Spine 26 : 103-111, 2017. – reference: 1) Ahmad FU, Frenkel MB, Levi AD : Spinal stability after resection of nerve sheath tumors. J Neurosurg Sci 61 : 355-364, 2017. – reference: 14) Toyama Y, Fujimura Y, Takahata T, Chiba K, Ueishi S, Matsumoto M, Ogawa J, Hirabayashi K : Clinical analysis of 83 cases of the dumbbell tumors in the spine : morphological classification and surgical management. J Jpn Med Soc Paraplegia 5 : 86-87, 1992. – reference: 8) Kim P, Ebersold MJ, Onofrio BM, Quast LM : Surgery of spinal nerve schwannoma. Risk of neurological deficit after resection of involved root. J Neurosurg 71 : 810-814, 1989. – reference: 2) Asazuma T, Toyama Y, Maruiwa H, Fujimura Y, Hirabayashi K : Surgical strategy for cervical dumbbell tumors based on a three-dimensional classification. Spine (Phila Pa 1976) 29 : E10-E14, 2004. – reference: 9) Nanda A, Kukreja S, Ambekar S, Bollam P, Sin AH : Surgical strategies in the management of spinal nerve sheath tumors. World Neurosurg 83 : 886-899, 2015. – reference: 4) Eden K : The dumb-bell tumours of the spine. Br J Surg 28 : 549-570, 1941. |
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| Snippet | 神経鞘腫は脊髄腫瘍の中で最も頻度が高く, あらゆる脊椎レベルに発生する. 摘出術により脊髄・神経の圧迫を解除し, 組織型を確認することが治療の基本である. 脊髄神経鞘腫の多くは硬膜内髄外に存在し, 後方アプローチの基本的な手技で摘出可能であるが, 脊髄前面にあるものや大型のもの,... |
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| Subtitle | 神経機能温存と合併症対策 |
| Title | 脊髄神経鞘腫の手術 |
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