頸部上部に発生した背側頭下神経鞘腫と腹側髄膜腫の併発症例

Concurrent dorsal subpial schwannoma and ventral meningioma arising at the same upper cervical level: a case report.

• Yu Suematsu
• Osahiko Tsuji
• Narihito Nagoshi
• Satoshi Nori
• Satoshi Suzuki
• Eijiro Okada
• Mitsuru Yagi
• Kaori Kameyama
• Nobuyuki Fujita
• Kota Watanabe
• Masaya Nakamura
• Morio Matsumoto

抄録

序論:

多発性脊髄腫瘍は遺伝的素因を伴わずに発生することは稀であり、同じ脊髄レベルで発生した離散的な病理学的特徴を有する同時多発腫瘍は最も稀である。ここでは、同じ上部頸部レベル（C1-C2）で発生した背側神経鞘腫と腹側髄膜腫の同時発生例を報告する。

INTRODUCTION: Multiple spinal cord tumors rarely occur without genetic predisposition, and concurrent tumors with discrete pathologies developed at the same spinal level are most rare. Here, we report a case of concurrent dorsal schwannoma and ventral meningioma arising at the same upper cervical level (C1-C2).

症例発表:

55 歳女性が 1 年前から頸部痛と上肢・下肢のしびれを呈した．頸椎の磁気共鳴画像検査でC1-C2に部分的に円周状のC型硬膜外髄質内腫瘍を認めた。画像診断に基づく術前診断は円周状に進展した硬膜外髄膜腫であった。外科的切除を行い，背側頭下腫瘍と腹側腫瘍を検出した．術中病理診断は背側腫瘍は神経鞘腫、腹側腫瘍は髄膜腫であった。両腫瘍とも全摘出後、円周硬膜切除術と硬膜形成術（Simpsonグレード1切除）を行った。術後すぐに脳脊髄液減少症に関連する症状が出現したが、数日以内に消失した。術後2年の時点では、軽度の後弯性頚椎症を伴う局所再発は確認されていない。

CASE PRESENTATION: A 55-year-old woman presented with neck pain and upper and lower extremity numbness for 1 year. Magnetic resonance imaging of the cervical spine showed a partially circumferential C-shaped intradural extramedullary tumor at C1-C2. The preoperative diagnosis based on imaging was intradural extramedullary meningioma with circumferential development. Surgical resection was performed, and dorsal subpial and ventral tumors were detected. Intraoperative pathological diagnosis was schwannoma for the dorsal tumor and meningioma for the ventral tumor. Both tumors were completely resected, followed by circumferential durotomy and duroplasty (Simpson grade 1 resection). Although symptoms related to cerebrospinal fluid hypovolemia occurred immediately after surgery, they disappeared within several days. At 2 years postoperatively, no local recurrence has been identified with mild kyphotic cervical malalignment.

DISCUSSIONS:

これまでに同一頚椎レベルで病理組織型が異なる多発性脊椎腫瘍の同時多発例は9例しか報告されていないが、髄膜腫と棘下神経鞘腫を併発した最初の症例である。また、腹側部に髄膜腫が存在するため切除が不十分な場合が多いが、円周方向の硬膜形成術を併用して硬膜を含めた全摘出を行った。術後の経過観察は慎重かつ逐次的に行われている。

DISCUSSIONS: Only nine cases of concurrent multiple spinal tumors with discrete histopathological types at the same cervical level have been reported to date, however, this is the first case of meningioma combined with subpial schwannoma. Furthermore, although the ventral location of meningioma often compelled inadequate resection leaving behind a dura mater from which meningioma originated, a gross total resection including dura mater was achieved accompanied with circumferential duroplasty. Careful and sequential postoperative follow-up is ongoing for this individual.