側方到達法による上位頚髓病変の手術

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The technique of the lateral surgical approach to tumors and arteriovenous malformations (AVM's) located ventral or lateral to the upper cervical cord is described. With a patient in a lateral position, a J-shaped skin incision is made along the posterior margin of the sternocleidomastoid muscle. After anterior and inferior reflection of the sternocleidomastoid and posterior cervical muscles, respectively, the lateral aspect of the upper cervical spine is exposed, using blunt and sharp dissection. According to location and size of the lesion, hemilaminectomy and facetectomy are carried out. If necessary, the transverse foramen is opened and the vertebral artery is secured and transposed. After removal of a tumor or AVM, the dura is closed and, in case large parts of the facets have been resected, an iliac bone graft is carried out to fix the vertebrae. The lateral approach has the following advantages : 1) the approach provides a lateral exposure of the lesion-cord interface, which allows safe dissection without retraction of the cord; 2) the vertebral artery can be exposed and transposed under direct vision, permitting earlier interruption of blood supply to the lesion and safe dissection between the lesion and the artery; 3) for tumors with lateral extension such as dumbbell neurinomas, the intra- and extradural portions can be removed in a single operation; 4) the operative field can be easily extended to the lateral and ventral aspect of the brain stem by combining with suboccipital craniectomy. This approach has been applied to fourteen patients harboring intra- and/or extradural tumors, AVM's and a hematoma. Thirteen of them showed a good postoperative course, but one who presented with tetraparesis and respiratory disturbance remains severely disabled.
日本脊髄外科学会の論文
2000-06-30

側方到達法による上位頚髓病変の手術

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