Neurological Surgery 脳神経外科47巻2号

2019年02月発行

解剖を中心とした脳神経手術手技

右前頭葉病変に対する高次脳機能温存型覚醒下手術

著者： 中田光俊¹ 木下雅史¹ 中嶋理帆² 篠原治道³

所属機関： ¹金沢大学医薬保健研究域医学系脳・脊髄機能制御学（脳神経外科） ²金沢大学医薬保健研究域保健学系リハビリテーション科学領域 ³金沢大学医薬保健研究域医学系機能解剖学分野

ページ範囲：P.179 - P.197

Ⅰ．はじめに
　脳神経外科手術において，右前頭葉病変は後方の運動機能領域に留意する以外は比較的アクセスしやすく，摘出術後の重篤な合併症が少ないと認識されている．それは経験的に，右前頭葉の，特に中心前溝より前方の脳をある程度損傷しても，日常生活に支障を来す合併症に直結しないからである．また，右前頭葉機能が長らくブラックボックスであったことにも起因する．右前頭葉は，運動機能を有する以外は主に高次脳機能を担っており，その詳細な機能局在やネットワークについての知見が近年蓄積されつつある^{21,30,40,43,44,69)}．これまで高次脳機能障害は客観的な指標による評価が難しく，障害とみなしにくい歴史があった．しかし，社会生活を行う上で，明らかに大きな障壁となることから，社会的にも認知度が高まり注目されている．
　このような背景の中で，生存期間の延長を目標としてきたグリオーマに対する脳神経外科医療をさらに上の段階へ押し上げるには，生存期間の延長のみならず，高次脳機能を温存し，患者のquality of lifeの維持を目標にした手術を計画することは必然的な方向性であると考える．本稿では，右前頭葉の解剖と機能局在を概説し，同病変に対して高次脳機能を温存する覚醒下手術の方法を詳述する．

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