脊髄血管芽腫の外科的治療 : 特に深部に存在するタイプについて

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Background ; Spinal cord hemangioblastoma(HB) is a well circumscribed intramedullary tumor, predominantly located in the dorsal subpial layer of the cord. Occasionally a deeply and/or ventrally located HB presenting some surgical difficulties is encountered. Purpose of this study ; The authors divided HBs into two groups ; dorsally and superficially located one (dorsal type), and deeply and/or ventrally located one (deep type). This study was conducted to evaluate clinical differences of these two types and to propose several surgical techniques in terms of extirpating the deep type. Materials and results ; Nine consecutive HBs including 3 dorsal and 6 deep type were evaluated. No apparent differences were noted in patient's age distribution and gender as well as tumor locations in the two groups. However, deep type had shorter preoperative period with positive motor disturbance and exhibited larger size, associated with long T2 lesions next to the tumor. All tumors were totally removed. Via posterior midline spinal cord splitting subsequent to osteoplastic laminotomy was employed to extirpate the deep type tumors, 4 cases of which experienced transient postoperative neurological deteriorations lasted within a few months. Discussions ; The deep type has different biological behaviors compared with the dorsal type. While proposing other approaches to a deep type such as an anterior approach, a posterolateral approach and the midline posterior approach is another main route to access and remove the tumor. To complete this surgical procedure with minimum morbidities, some surgical techniques are proposed ; Preoperative embolization of the feeding vessels if possible, wider opening of the dorso-medial sulcus cephalad and caudal to the tumor, obtaining earlier exposure of tumor cysts, meticulous dissection on the tumor plane, coagulation and reducing the volume of tumor to perform an "en block" fashion removal, and careful detachment of small vessels from the anterior medial fissure on the spinal piamater and of the ventral roots. Functional monitoring of spinal cord function is mandatory during surgery.
日本脊髄外科学会の論文
2005-03-31

脊髄血管芽腫の外科的治療 : 特に深部に存在するタイプについて

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