Neurological Surgery 脳神経外科45巻7号

2017年07月発行

連載 脳腫瘍の手術のための術前・術中支援

（9）大後頭孔近傍腫瘍に対する開頭術

著者： 鰐渕昌彦¹

所属機関： ¹札幌医科大学医学部脳神経外科

ページ範囲：P.645 - P.654

Ⅰ．はじめに
　大後頭孔部に発生する腫瘍は髄膜腫が最も多く，頭蓋頚椎移行部に発生する良性髄外腫瘍の60〜77%を占める^{1,11,18-20,30)}．大後頭孔部髄膜腫は全髄膜腫の0.3〜3.2%，後頭蓋窩髄膜腫の4.2〜20%を占め，68〜98%は腹側面から発生する^{11,12,18,20,23)}．大後頭孔腹側部髄膜腫に対しては背側から到達するposterior approach，外側から到達するlateral approach，腹側から到達するanterior transoral approachがあるが，midline posterior approachでは延髄や上位頚髄越しの手術となり，anterior transoral approachでは，術後の髄液漏や髄膜炎が危惧されるため，われわれは外側からのアプローチを用いている．本稿では，頭蓋頚椎移行部の外側からの解剖と，大後頭孔腹側面に発生した髄膜腫の摘出術の実際について解説する．

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