- 著者
- 髙石 吉將 荒井 篤 岡田 真幸 藤原 大悟 鵜山 淳 近藤 威
- 出版者
- 日本脊髄外科学会
- 雑誌
- 脊髄外科 (ISSN:09146024)
- 巻号頁・発行日
- vol.33, no.2, pp.179-183, 2019 (Released:2019-09-10)
- 参考文献数
- 16
Various complications are found in ventriculo-peritoneal shunts (V-P shunts) used in hydrocephalus. Overdrainage can be the source of some of these complications and is the primary cause of orthostatic headache, nausea, and vomiting. Here, we report a case of overshunting-associated myelopathy with progressive tetraparesis. A 56 year-old female had undergone placement of a V-P shunt four years prior to presentation in our clinic. She presented with progressive spastic tetraparesis and dysarthria but had no headache. In a brain magnetic resonance image (MRI), enlargement of the bilateral subdural space was noted. Gadolinium enhanced MRI showed dural enhancement. The presence of intracranial hypotension was suspected. Engorgement of the epidural vein at the C2 level in the cervical epidural space was also observed in the gadolinium enhanced cervical MRI. Since overdrainage of the V-P shunt was obviously present, a programmable valve was placed, and the flow of cerebrospinal fluid was controlled. The symptoms improved, and the epidural enhanced lesion diminished in subsequent MRIs. Here, we report a case of overshunting-associated myelopathy after placement of a V-P shunt and a review of the currently available literature.
1 0 0 0 OA 成人期発症の二分脊椎を伴った脊髄脂肪腫の1手術例
- 著者
- 中村 直人 高石 吉將 荒井 篤 鵜山 淳 近藤 威 岩橋 洋文
- 出版者
- 日本脊髄外科学会
- 雑誌
- 脊髄外科 (ISSN:09146024)
- 巻号頁・発行日
- vol.32, no.3, pp.329-333, 2018 (Released:2019-01-24)
- 参考文献数
- 16
A 49-year-old man with lumbar spinal lipoma was surgically treated because of intractable pain. The lipoma was originally asymptomatic and found incidentally 10 years before. He began to have occasional dysesthesia in the right lower limb 8 years before. The symptom became severe 1 year before he visited our hospital for the first time. The dysesthesia was in the L5 region of his right lower limb. Muscle weakness and urinary incontinence were not found. The magnetic resonance imaging demonstrated low-set conus (L3/L4) associated with spinal lipoma, which extended from the extradural part (from L4/L5 to L5/S1) to the intradural part (from L2/L3 to L3/L4). Computed tomography revealed hypoplasia in the laminae of L4, L5, and S1. We observed him for a year, and the dysesthesia became intolerable while the lipoma size was unchanged. Untethering was performed with L2-L5 laminectomy. The extradural part of the lipoma was completely removed with the adhered dural membrane. The intradural part was detached from dural membrane and partially removed. A GORE-TEX patch was used for dural membrane closure. The mechanism of adult-onset spinal lipoma is considered tethered cord syndrome or spinal cord compression. As spinal lipoma is usually adhered with the spinal cord, the appropriate surgical strategy seems to be untethering and partial resection of the lipoma.
1 0 0 0 カイロプラクティック施術に関連した頚部外頚動脈仮性動脈瘤の1例
- 著者
- 岡田 真幸 鵜山 淳 岡村 有祐 三宅 茂 寺薗 貴浩 山本 一宏 髙石 吉將 近藤 威
- 出版者
- 医学書院
- 雑誌
- Neurological Surgery 脳神経外科 (ISSN:03012603)
- 巻号頁・発行日
- vol.47, no.7, pp.799-804, 2019-07-10
Ⅰ.はじめに 頚部の外傷が原因で動脈解離や動脈瘤形成などの血管損傷を来すことはよく知られている5,14,22,27).内頚動脈系・椎骨動脈系の損傷は脳虚血症状を引き起こすため,脳神経外科医が治療を担うことが多い.外頚動脈の動脈瘤形成の多くは仮性動脈瘤であり,脳への血行動態に影響を及ぼさず,有痛性(ときには無痛性)の腫瘤で発症し,出血破綻の程度によっては出血性ショックや気道閉塞に至る15,24,25).過去には,原因不明の頚部腫瘤としてドレナージや生検を試みて大出血を来したことが報告されている20,21).一方で,特発性とされるものの中に出血のない真性の動脈瘤も含まれているようで,長期間経過観察のみで何ら病状の進行がなかったとの報告2,11)も散見され,症状が進行性であるかどうかを見極める必要がある. 形成外科,耳鼻科,血管外科などで治療されることが多いが,アテローム性頚部頚動脈疾患を治療する機会の多い脳神経外科医にとっては日常よく経験している手術領域であり,直達術あるいは血管内治療のどちらの治療法にも熟達していることにより,症例ごとに適切な治療の選択が可能である.今回われわれは,脳神経外科医にとっては遭遇する機会の少ない,頚部外頚動脈仮性動脈瘤を直達術にて治療したので,文献的考察を加えて報告する.