Neurological Surgery 脳神経外科47巻1号

2019年01月発行

特別寄稿 脳神経外科コントロバーシー2019

（4）くも膜囊胞に対する治療—内視鏡治療かシャント手術か

著者： 埜中正博¹ 淺井昭雄¹

所属機関： ¹関西医科大学脳神経外科

ページ範囲：P.39 - P.48

Ⅰ．はじめに
　くも膜囊胞は，脳脊髄の表面や頭蓋底部などにおいて，くも膜により形成された囊胞壁の中に脳脊髄液が貯留し，ときに周囲脳を圧迫する先天性の異常である．多くは無症候性であり治療の対象とならないが，脳や脊髄への圧迫による症状を認める例に対しては手術が行われる．
　治療法としては，囊胞壁を切除する方法，囊胞の開窓を行い脳室や脳槽との間に髄液が交通するようにする方法，囊胞と腹腔をシャント（ventriculoperitoneal［VP］シャント）し，囊胞内の髄液を腹腔に流してしまう方法がある．また，囊胞の開窓については，顕微鏡下に実施する方法と，内視鏡を用いて行う方法がある．近年は，手術による侵襲性の低さから内視鏡による開窓術を第一選択とする考え方が普及している一方，囊胞の縮小効果が高い囊胞腹腔シャント（cyst peritoneal［CP］シャント）術が好ましいとする意見もある．

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