侵攻性椎体血管腫に対する切除手術の長期成績

Long-term outcomes of excision surgery for aggressive vertebral hemangiomas.

• Makoto Handa
• Satoru Demura
• Satoshi Kato
• Kazuya Shinmura
• Noriaki Yokogawa
• Noritaka Yonezawa
• Takaki Shimizu
• Norihiro Oku
• Ryo Kitagawa
• Ryohei Annen
• Hideki Murakami
• Norio Kawahara
• Hiroyuki Tsuchiya

抄録

目的:

腫瘍全摘出後の侵攻性椎体血管腫（AVH）患者の臨床転帰を記載し、AVHの治療オプションについて議論する。

PURPOSE: To describe the clinical outcomes in patients with aggressive vertebral hemangiomas (AVHs) after total tumor excision and discuss the treatment options for AVHs.

METHODS:

1996年から2018年の間に全摘出術を受けたAVH患者15例（男性6例、女性9例）のレトロスペクティブデータレビューを行った。

METHODS: A retrospective data review of 15 patients (6 men, 9 women) with AVHs who underwent total excision between 1996 and 2018 was performed.

結果:

Weinstein-Boriani-Biagini分類に基づくA-D型腫瘍8例、B-D型腫瘍7例の胸部病変13例、腰部病変2例を対象とした。すべての腫瘍はT1強調MRIで低または低iso信号強度（SI）を示した。すべての患者は、術前の動脈塞栓術と腫瘍縁を含む腫瘍全摘出術を併用した。11例が最初の手術として腫瘍全摘出術を受けた（全摘出術＝10例、断片的腫瘍全摘出術＝1例）、4例は効果のないラミネクトミー切除術の2週間後に再手術として、または長期経過観察（4～14年）では断片的腫瘍全摘出術として受けた。術中出血量は150～3400mL（平均1314mL）であった。平均追跡期間128.4±88.6ヶ月の間に再発した症例はなかった。

RESULTS: In total, 13 thoracic and 2 lumbar lesions were involved with 8 type A-D tumors and 7 type B-D tumors based on Weinstein-Boriani-Biagini classification. All tumors showed low or low-iso signal intensity (SI) by T1-weighted MRI. All patients received a combination of preoperative transarterial embolization and total tumor excision including the tumor margins. Eleven patients underwent total tumor excision as the initial surgery (total en bloc spondylectomy = 10 patients, piecemeal total tumor excision = 1 patient) and 4 underwent it either as a revision procedure 2-weeks after ineffective laminectomy or in the long-term follow-up (4-14 years) as a piecemeal total tumor excision. Intraoperative blood loss ranged from 150 to 3400 mL (mean, 1314 mL). None of the cases had a recurrence during the mean follow-up period of 128.4 ± 88.6 months.

結論:

T1強調MRI上の低SIはAVH患者全員に認められた。術前の経動脈塞栓術と腫瘍全摘出術の長期臨床成績は満足のいくものであった。AVHでは減圧的不完全腫瘍切除の効果は一時的であり，長期的には腫瘍再発のため，繰り返しの腫瘍切除が必要となる可能性がある。初回手術時の信頼性の高い腫瘍全摘出術が望ましい。

CONCLUSION: Low SI on T1-weighted MRI was observed in all the patients with AVHs. The long-term clinical results of the preoperative transarterial embolization and total tumor excision were satisfactory. The effect of decompressive incomplete tumor excision is temporary for AVHs and repeated tumor excision may be necessary because of tumor recurrence in the long-term. Reliable total tumor excision during the initial surgery is desirable.

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