BRAIN and NERVE－神経研究の進歩66巻9号

2014年09月発行

特集 痙縮の臨床神経学

痙縮の機能神経外科治療

著者： 鮎澤聡¹ 井原哲² 青木司³

所属機関： ¹筑波技術大学保健科学部 ²東京都立小児総合医療センター脳神経外科 ³つくばセントラル病院脳神経外科

ページ範囲：P.1057 - P.1068

文献概要

痙縮の機能神経外科治療は，いずれかのレベルで伸張反射ループに干渉して過剰な活動を抑制する。選択的末梢神経縮小術は痙縮筋を支配する末梢の運動神経枝を部分切除する。遠心路のα運動神経線維と求心路であるIa線維の両方が切除されるが，伸張反射の永続的な抑制にはIa求心路の活動抑制が本質である。機能的脊髄後根切断術は電気刺激に異常運動反応を呈する脊髄後根細糸を切断することでIa求心路の活動を抑制する。バクロフェン持続髄注療法は神経組織を破壊することなく，脊髄レベルでα運動神経を抑制する。患者の病態に応じてこれらを使い分けることが重要である。

参考文献

1) 内山卓也, 種子田 護: 痙縮に対する末梢神経外科手術. 高倉公朋, 菊池晴彦（編): 機能的脳神経外科の最先端. 先端医療技術研究所, 東京, 2002, pp220-228

2) 平　孝臣, 堀　智勝: 脳性麻痺と脳血管の痙縮の外科治療. 落合直之（編): 脳性麻痺と脳血管障害後片麻痺の手術療法. メジカルビュー社, 東京, 2002, pp98-115

3) 平　孝臣, 堀　智勝: バクロフェン髄注療法. No Shinkei Geka 36: 573-590, 2008

4) Mertens P, Sindou M: Selective peripheral neurotomies for the treatment of spasticity. Sindou M, Abbott R, Keravel Y (eds): Neurosurgery for Spasticity: A multidisciplinary approach. Springer-Verlag, Wien, 1991, pp119-132

5) 師田信人: 痙縮に対する機能的脊髄後根切断術. No Shinkei Geka 38: 209-228, 2010

6) Morota N: Functional posterior rhizotomy: the Tokyo experience. Childs Nerv Syst 23: 1007-1014, 2007

7) Lance JW: Symposium synopsis. Feldman RG, Young RR, Koella WP (eds): Spasticity Disordered Motor Control. Year Book Medical, Chicago, 1980, pp485-494

8) Gros C: Spasticity: clinical classification and surgical treatment. Adv Tech Stand Neurosurg 6: 55-97, 1979

9) Gigante P, McDowell MM, Bruce SS, Chirelstein G, Chiriboga CA, et al: Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. J Neurosurg Pediatr 12: 588-594, 2013

10) Maarrawi J, Mertens P, Luaute J, Vial C, Chardonnet N, et al: Long-term functional results of selective peripheral neurotomy for the treatment of spastic upper limb: prospective study in 31 patients. J Neurosurg 104: 215-225, 2006

11) 鮎澤　聡, 青木　司, 榎本貴夫: 選択的筋皮神経縮小術による肘関節屈曲痙縮の治療に伴う片麻痺患者の歩行機能の改善. 機能的脳神経外科43: 26-31, 2004

12) Peacock WJ, Arens LJ, Berman B: Cerebral palsy spasticity: selective posterior rhizotomy. Pediatr Neurosci 13: 61-66, 1987

13) Sarà M, Sacco S, Cipolla F, Onorati P, Scoppetta C, et al: An unexpected recovery from permanent vegetative state. Brain Inj 21: 101-103, 2007

14) Sarà M, Pistoia F, Mura E, Onorati P, Govoni S: Intrathecal baclofen in patients with persistent vegetative state: 2 hypotheses. Arch Phys Med Rehabil 90: 1245-1249, 2009

15) Taira T: Intrathecal administration of GABA agonists in the vegetative state. Prog Brain Res 177: 317-328, 2009

16) Oyama H, Kito A, Maki H, Hattori K, Tanahashi K: Consciousness recovery induced by intrathecal baclofen administration after subarachnoid hemorrhage: two case reports. Neurol Med Chir (Tokyo) 50: 386-390, 2010

17) Margetis K, Korfias SI, Gatzonis S, Boutos N, Stranjalis G, et al: Intrathecal baclofen associated with improvement of consciousness disorders in spasticity patients. Neuromodulation: 2013 Dec 18．doi: 10.1111/ner.12147

18) Lorenz F: Über chirurgische Behandlung der angeborenen spastischen Gliedstarre. Wien Klin Rundsch 21: 25-27, 1887

19) Stoffel A: The treatment of spastic contractures. Am J Orthop Surg 210: 611-644, 1913

20) Gros C, Frerebeau P, Benezech J, Privat JM: Neurotomie radiculaire sélective. Simon L (ed): Actualités en Rééducation Fonctionnelle et Réadaptation, série 2．Masson, Paris, 1977, pp230-235

21) Sindou M, Mertens P: Selective neurotomy of the tibial nerve for treatment of the spastic foot. Neurosurgery 23: 738-744, 1988

22) Feve A, Decq P, Filipetti P, Verroust J, Harf A, et al: Physiological effects of selective tibial neurotomy on lower limb spasticity. J Neurol Neurosurg Psychiatry 63: 575-578, 1997

23) Deltombe T, Jamart J, Hanson P, Gustin T: Soleus H reflex and motor unit number estimation after tibial nerve block and neurotomy in patients with spastic equinus foot. Neurophysiol Clin 38: 227-233, 2008

24) Buffenoir K, Decq P, Hamel O, Lambertz D, Perot C: Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot. Acta Neurochir (Wien) 155: 1731-1743, 2013

25) Dengler R, Konstanzer A, Hesse S, Schubert M, Wolf W: Collateral nerve sprouting and twitch forces of single motor units in conditions with partial denervation in man. Neurosci Lett 97: 118-122, 1989

26) Berard C, Sindou M, Berard J, Carrier H: Selective neurotomy of the tibial nerve in the spastic hemiplegic child: an explanation of the recurrence. J Pediatr Orthop B 7: 66-70, 1998

27) Collins WF, Mendell LM, Munson JB: On the specificity of sensory reinnervation of cat skeletal muscle. J Physiol 375: 587-609, 1986

28) Sindou MP, Simon F, Mertens P, Decq P: Selective peripheral neurotomy (SPN) for spasticity in childhood. Childs Nerv Syst 23: 957-970, 2007

29) Buffenoir K, Decq P, Lefaucheur JP: Interest of peripheral anesthetic blocks as a diagnosis and prognosis tool in patients with spastic equinus foot: a clinical and electrophysiological study of the effects of block of nerve branches to the triceps surae muscle. Clin Neurophysiol 116: 1596-1600, 2005

30) Buffenoir K, Rigoard P, Lefaucheur JP, Filipetti P, Decq P: Lidocaine hyperselective motor blocks of the triceps surae nerves: role of the soleus versus gastrocnemius on triceps spasticity and predictive value of the soleus motor block on the result of selective tibial neurotomy. Am J Phys Med Rehabil 87: 292-304, 2008

31) 内山卓也, 中野直樹, 布川知史, 奥田武司, 種子田 護: び漫性下肢痙縮に対する選択的末梢神経縮小術. 機能的脳神経外科41: 13-18, 2002

32) Sitthinamsuwan B, Chanvanitkulchai K, Phonwijit L, Nunta-Aree S, Kumthornthip W, et al: Surgical outcomes of microsurgical selective peripheral neurotomy for intractable limb spasticity. Stereotact Funct Neurosurg 91: 248-257, 2013

33) 青木　司, 鮎澤　聡, 松村　明: 痙縮に対する選択的末梢神経縮小術の中長期的予後. 機能的脳神経外科47: 159-164, 2008

34) Rousseaux M, Buisset N, Daveluy W, Kozlowski O, Blond S: Comparison of botulinum toxin injection and neurotomy in patients with distal lower limb spasticity. Eur J Neurol 15: 506-511, 2008

35) Decq P, Cuny E, Filipetti P, Keravel Y: Role of soleus muscle in spastic equinus foot. Lancet 352: 118, 1998

36) Silfverskiöld N: Reduction of the uncrossed two-joints muscles of the leg to one-joint muscles in spastic conditions. Acta Chir Scand 56: 315-330, 1924

37) Baroncini M, Baïz H, Wavreille G, Demondion X, Maurage CA, et al: Anatomical bases of tibial neurotomy for treatment of spastic foot. Surg Radiol Anat 30: 503-508, 2008

38) Taira T, Hori T: The role of neurosurgical interventions for control of spasticity in neurorehabilitation: new findings on functional microanatomy of the tibial nerve. Acta Neurochir Suppl 87: 103-105, 2003

39) Decq P, Filipetti P, Cubillos A, Slavov V, Lefaucheur JP, et al: Soleus neurotomy for treatment of the spastic equinus foot. Groupe d'Evaluation et de Traitement de la Spasticite et de la Dystonie. Neurosurgery 47: 1154-1160; discussion 1160-1161, 2000

40) Foerster O: On the indications and results of the excision of postrior spinal nerve in men. Surg Gynecol Obstet 16: 463-474, 1913

41) Gros C, Ouaknine G, Vlahovitch B, Frerebeau P: La radicotomie sélective postérieure dans le traitement neurochirurgical de l'hypertonie pyramidale. Neurochirurgie 13: 505-518, 1967

42) Privat JM, Benezech J, Frerebeau P, Gros C: Sectorial posterior rhizotomy, a new technique of surgical treatment for spasticity. Acta Neurochir (Wien) 35: 181-195, 1976

43) Fasano VA, Urciuoli R, Broggi G, Barolat-Romana G, Benech F, et al: New aspects in the surgical treatment of cerebral palsy. Acta Neurochir (Wien) Suppl 24: 53-57, 1977

44) Peacock WJ, Arens LJ: Selective posterior rhizotomy for the relief of spasticity in cerebral palsy. S Afr Med J 62: 119-124, 1982

45) Fasano VA, Broggi G, Barolat-Romana G, Sguazzi A: Surgical treatment of spasticity in cerebral palsy. Childs Brain 4: 289-305, 1978

46) Decandia M, Provini L, Taborikova H: Mechanisms of the reflex discharge depression in the spinal motoneurone during repetitive orthodromic stimulation. Brain Res 4: 284-291, 1967

47) Steinbok P, Keyes R, Langill L, Cochrane DD: The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy. J Neurosurg 81: 354-361, 1994

48) Cahan LD, Kundi MS, McPherson D, Starr A, Peacock W: Electrophysiologic studies in selective dorsal rhizotomy for spasticity in children with cerebral palsy. Appl Neurophysiol 50: 459-462, 1987

49) McLaughlin JF, Bjornson KF, Astley SJ, Graubert C, Hays RM, et al: Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol 40: 220-232, 1998

50) Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, et al: A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol 39: 178-184, 1997

51) Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S: Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol 40: 239-247, 1998

52) O'Brien DF, Park TS: A review of orthopedic surgeries after selective dorsal rhizotomy. Neurosurg Focus 21: 1-8, 2006

53) Penn RD, Savoy SM, Corcos D, Latash M, Gottlieb G, et al: Intrathecal baclofen for severe spinal spasticity. N Engl J Med 320: 1517-1521, 1989

54) Penn RD, Kroin JS: Long-term intrathecal baclofen infusion for treatment of spasticity. J Neurosurg 66: 181-185, 1987

55) Penn RD, Kroin JS: Continuous intrathecal baclofen for severe spasticity. Lancet 2: 125-127, 1985

56) Penn RD, Kroin JS: Intrathecal baclofen alleviates spinal cord spasticity. Lancet 1: 1078, 1984

57) Macdonell RA, Talalla A, Swash M, Grundy D: Intrathecal baclofen and the H-reflex. J Neurol Neurosurg Psychiatry 52: 1110-1112, 1989

58) Stokic DS, Yablon SA, Hayes A, Vesovic-Potic V, Olivier J: Dose-response relationship between the H-reflex and continuous intrathecal baclofen administration for management of spasticity. Clin Neurophysiol 117: 1283-1289, 2006

59) Stokic DS, Yablon SA: Neurophysiological basis and clinical applications of the H-reflex as an adjunct for evaluating response to intrathecal baclofen for spasticity. Acta Neurochir Suppl 97: 231-241, 2007

60) Fulkerson DH, Boaz JC, Luerssen TG: Interaction of ventriculoperitoneal shunt and baclofen pump. Childs Nerv Syst 23: 733-738, 2007

61) Ginsburg GM, Lauder AJ: Progression of scoliosis in patients with spastic quadriplegia after the insertion of an intrathecal baclofen pump. Spine 32: 2745-2750, 2007

62) Shilt JS, Lai LP, Cabrera MN, Frino J, Smith BP: The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy. J Pediatr Orthop 28: 684-687, 2008

63) 根本明宣, 植田尊善, 片山容一, 君塚　葵, 平　孝臣, 他: ギャバロン髄注（バクロフェン）シンクロメッドポンプシステム特定使用成績調査――中間報告. 臨床医薬28: 1059-1099, 2012

64) Albright AL, Turner M, Pattisapu JV: Best-practice surgical techniques for intrathecal baclofen therapy. J Neurosurg 104: 233-239, 2006

65) Vender JR, Hester S, Waller JL, Rekito A, Lee MR: Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg 104: 9-15, 2006

66) Sindou M, Jeanmonod D, Mertens P: Surgery in the dorsal root entry-zone: microsurgical DREZ-tomy (MDT) for the treatment of spasticity. Sindou M, Abbott R, Keravel Y (eds): Neurosurgery for Spasticity: A multidisciplinary approach. Springer-Verlag, Wien, 1991, pp165-182

67) Cook AW, Weinstein SP: Chronic dorsal column stimulation in multiple sclerosis. Preliminary report. NY State J Med 73: 2868-2872, 1973

68) Gybels J, Van Roost D: Spinal cord stimulation for spasticity. Sindou M, Abbott R, Keravel Y (eds): Neurosurgery for Spasticity: A multidisciplinary approach. Springer-Verlag, Wien, 1991, pp73-81

69) 寺尾　亨, 田屋圭介, 沢内　聡, 沼本ロバート知彦, 村上成之, 他: 低酸素脳症後の痙縮に脊髄刺激療法が奏功した1例――痙縮の改善機序に関する検討. No Shinkei Geka 32: 613-618, 2004

70) Francisco GE, Boake C: Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study. Arch Phys Med Rehabil 84: 1194-1199, 2003

71) Schiess MC, Oh IJ, Stimming EF, Lucke J, Acosta F, et al: Prospective 12-monthstudy of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement. Neuromodulation 14: 38-45, 2010