Neurological Surgery 脳神経外科38巻2号

2010年02月発行

解剖を中心とした脳神経手術手技

3次元T2強調画像を用いた腰仙部脂肪腫の手術

著者： 森岡隆人¹ 橋口公章² 迎伸孝¹ 佐山徹郎¹ 佐々木富男²

所属機関： ¹九州労災病院脳神経外科 ²九州大学脳神経外科

ページ範囲：P.117 - P.130

Ⅰ．はじめに

　腰仙部脂肪腫の病態，分類，臨床症状，診断，手術適応に関してはこれまでに多くの優れた報告^1-6,14,15)があるので，ここでは省略する．この腰仙部脂肪腫に対する手術目標は言うまでもなく，脊髄係留解除（untethering of the spinal cord）と脂肪腫の可及的切除（debulking of the lipoma）であり，この手術手技に関しても多くの報告がある^{2,3,5,10,14-16)}．脊髄のuntetheringと脂肪腫の可及的debulkingとは，すなわち，脊髄周囲に髄液腔を形成することである⁵⁾．MRIの3次元heavily T2強調画像（3 dimensional heavily T2 weighted image：3D hT2WI）はいわゆるMR cisternographyまたはMR myelographyで，強い高信号を示す脳脊髄液（すなわち髄液腔）を背景として，その中を走行する神経や血管を明瞭に描出するので，術前にこの髄液腔と脊髄，神経根や脂肪腫との解剖学的関係を把握し，手術計画を立てるのに極めて有用である⁷⁾．本稿ではこの3D hT2WIを用いたわれわれの手術手技を脊髄円錐部脂肪腫（transitional type）の2例を用いて紹介する．

参考文献

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