上位頚椎腹側・外側伸展腫瘍に対する側方到達法

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  • High Cervical Lateral Approach for Spinal Tumors in a Ventral or Lateral Location—Technical Note—
  • High Cervical Lateral Approach for Spinal Tumors in a Ventral or Lateral Location—Technical Note—

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  Objective : Technical modifications may be mandatory to safely remove high cervical tumors with ventral or lateral extension. We present our surgical experience with a lateral approach to these tumors and discuss the surgical indications and avoidance of complications.<br>  Methods : Six patients with spinal tumors in a ventral or lateral location of the high cervical spine were included. Three of the 6 cases had intradural tumors including meningiomas and synovial cysts, and 3 cases had extradural tumors including a schwannoma, clear cell carcinoma, and plasmacytoma. The patients were placed in the lateral park-bench position. A retroauricular incision exposed the transverse process of C1.<br>  Subperiosteal muscle dissection exposed the lateral parts of C1 and C2 and the suboccipital condylar fossa. The vertebral artery running in the vascular groove of C1 was well recognized. The horizontal segment of the vertebral artery can be transposed by opening the C1 transverse foramen, if necessary.<br>  Results : A high cervical lateral approach allowed access to the ventral aspect of the spinal cord with little or no retraction. The exposure was straightforward and provided a relatively narrow but shallow operative field. The vertebral artery could be identified early in the exposure. No case experienced major postoperative surgery-related complications.<br>  Conclusion : A high cervical lateral approach can be applied successfully in selected cases, such as those with a tumor with ventral or lateral extension. Safe management of the vertebral artery is one of the key considerations.

収録刊行物

  • 脊髄外科

    脊髄外科 29 (1), 64-68, 2015

    日本脊髄外科学会

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