頸髓軟膜下脂肪腫の1例  [in Japanese] A Case of Non-dysraphic Intramedullary Cervical Spinal Lipoma  [in Japanese]

脊髄披裂を伴わない脊髄脂肪腫は, 全脊髄腫瘍の約1%を占める良性腫瘍である.脊髄圧迫症状で, 発症時には症状の改善, 進行停止が治療目標になる.一般的に外科的治療が選択されるが, 腫瘍全摘出術は症状の悪化を招くために部分摘出術や外減圧術が選択されている.われわれは自制困難な頸部痛, 肩痛にて発症した頸部脊髄脂肪腫に対して腫瘍部分摘出術と椎弓形成術を施行した.SEPモニター下に後脊髄静脈に続く脂肪腫内静脈を温存しつつ可及的に腫瘍を摘出し症状の軽減を得た.脊髄静脈とつながる脂肪腫内の静脈損傷は静脈灌流障害による神経障害をきたす可能性があるために, 術前にMRI画像を十分検討して手術に望む必要がある.

A rare case of cervical intradural lipoma is reported. Spinal cord lipoma without spina bifida is a benign tumor, which accounts for about 1% of all spinal neoplasms. When symptoms develop with slow growth, the purpose of medical treatment is neurological improvement. The operative approach to spinal cord lipoma is direct and the same as for any intramedullary process. We performed cervical laminoplasty over the length of the lesion and substantial debulking of the lipoma under SEP monitoring. Intraoperative recording of SEP was useful for surgical decompression during the operative procedure. We preserved a vein in the lipoma connected with the dorsal spinal vein and radiculomedullary vein. Damaging the spinal vein might cause neuropathy by venous congestion and edema of the spinal cord. Magnetic resonance imaging was useful for delimitating the anatomy of the lipoma in planning the operation.