Neurological Surgery 脳神経外科47巻4号

2019年04月発行

解剖を中心とした脳神経手術手技

Insular gliomaにおけるsurgical anatomyと手術手技

著者： 齊藤邦昭¹

所属機関： ¹杏林大学医学部脳神経外科

ページ範囲：P.405 - P.418

Ⅰ．はじめに
　島領域のグリオーマ（insular glioma）は，比較的深部に位置することと，周囲に重要な構造物が多いことから摘出が困難である．島を覆う弁蓋部皮質および周囲白質線維には，運動機能に関わる領域や，優位半球であれば言語機能を有する領域が存在する．また，中大脳動脈やその穿通枝が島の表面や内部，深部を走行しており，損傷により運動障害を来す恐れがある．それら重要構造物を温存しながら摘出を行うのは困難を極めるが，グリオーマにおいては摘出率を上げることにより予後改善が見込めるという報告が多く^12,15,16,20)，insular gliomaにおいても例外ではない^7,13,19,23)．近年，ナビゲーションや電気生理学的モニタリング，術中蛍光診断などの手術支援装置の発展により，insular gliomaにおいても十分な摘出が可能となってきているが^7,17)，合併症を来さない範囲で可及的な摘出を行うためには，周辺の解剖を把握した上で手術を行う必要がある．
　本稿では，島および周囲構造の解剖について解説した上で，解剖に留意したinsular gliomaの手術について自験例を示しながら解説する．

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