Neurological Surgery 脳神経外科36巻12号

2008年12月発行

症例

Dermal sinusに合併した脊髄髄内外巨大膿瘍の1例

著者： 栗栖宏多¹ 飛騨一利¹ 矢野俊介¹ 山口秀¹ 茂木洋晃¹ 久保田佳奈子² 岩﨑喜信¹

所属機関： ¹北海道大学医学部神経外科 ²北海道大学医学部病理部

ページ範囲：P.1127 - P.1132

Ⅰ．はじめに

　先天性皮膚洞（congenital dermal sinus）は神経管の閉鎖不全によって生じる比較的稀な疾患で，硬膜内の感染症の原因となることはよく知られている⁷⁾．これらを認知せずに放置した場合，重篤な神経脱落症状を来すことがあるため^1,12)，機能予後の改善のためには早期の発見と積極的な加療が重要である．

　今回，われわれはdermal sinus（皮膚洞）に起因した脊髄髄内外巨大膿瘍の1例を経験した．本症例は，先天性dermal sinusを合併した児の神経学的予後を改善する上で重要な症例と考えられたので，若干の文献的考察を加えて報告する．

参考文献

1）Ackerman LL, Menezes AH：Spinal congenital dermal sinuses：a 30-year experience. Pediatrics 112：641-647, 2003

2）Bunyaratavej K, Desudchit T, Pomgpunlert W：Holocord intramedullary abscess due to dermal sinus in a 2-month-old child successfully treated with limited myelotomy and aspiration. Case Report. J Neurosurg 104：269-274, 2006

3）Chan CT, Gold WL：Intramedullary abscess of the spinal cord in the antibiotic era：clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infec Dis 27：619-626, 1998

4）DiTullio MV Jr：Intramedullary spinal abscess：a case report with a review of 53 previously described cases. Surg Neurol 7：351-354, 1997

5）el-Gindi S, Fairburn B：Intramedullary spinal abscess as a complication of a congenital dermal sinus. J Neurosurg 30：494-497, 1969

6）Elton S, Oakes W：Dermal sinus tracts of the spine. Neurosurgery Focus 10：e4, 2001

7）French BN：Midline fusion defects and defects of formation. pp1081-1235 (Youmans JR ed：Neurological Surgery. WB Saunders, Philadelphia, 1982)

8）Hart J：Case on encysted abscess in center of the spinal cord. Dublin Hosp Rep 5：522-524, 1830

9）Hung PC, Wang HS, Wu CT, Lui TN, Wong AM：Spinal intramedullary abscess with an epidermoid secondary to a dermal sinus. Pediatric Neurol 37：144-147, 2007

10）Morandi X, Mercier P, Fourineier HD, Brassier G：Dermal sinus and intramedullary spinal cord abscess：report of 2 cases and review of the literature. Childs Nerve Syst 15：202-208, 1999

11）Schenk JP, Herweh C, Gunther P, Rohrschneider W, Zieger B, Troger J：Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants. Eur J Radiol 58：3-14, 2006

12）Simon JK, Lazareff JA, Diament MJ, Kennedy WA：Intramedullary abscess of the spinal cord in children：a case report and review of the literature. Pediatr Infect Dis J 22：186-192, 2003

13）Tacconi L, Arulampalam T, Johnston FG, Thomas DG：Intramedullary spinal cord abscess：case report. Neurosurgery 37：817-819, 1995

14）Tsurubuchi T, Matsumura A, Nakai K, Fujita K, Enomoto T, Iwasaki N, Nose T：Reversible holocord edema associated with intramedullary spinal abscess secondary to an infected dermoid cyst. Pediatr Neurosurg 37：282-286, 2002

15）Walker RM, Dyke SC：Abscess of the spinal cord. Lancet 1：1413-1414, 1936