Yoshimi Nagatomo

Lateral Approach to C2 Root Schwannoma Located Ventral to the Spinal Cord: A Case Report

脊髄腹側にあるC2前根糸由来の神経症腫に対し側方進入にて手術施行したので報告する．（症例）31歳男性．2003年2月上位頚椎のdumb-bell腫瘍に対し，後方進入にて環椎後弓切除・腫瘍摘出術施行．病理はschwannomaであった．myelopathyは軽快するも，MRI上脊柱管内に腫瘍は遺残．2004年9月左上肢の筋力低下出現．手術目的にて2005年6月入院．四肢DTRの亢進，左上下肢の筋力低下を認め，JOA scoreは11/17．脊髄は環椎レベルで腹側から著明に圧迫されており，側方進入摘出術を施行．胸鎖乳突筋後方より進入，腫瘍を内減圧し骨削除は行わずに全摘し得た．腫瘍はC2神経根前根と連続していた．術後大後頭神経領域の知覚低下出現するもmyelopathyは軽快した．（考察）上位頚椎部の脊髄腫瘍は呼吸麻痺や重篤な麻痺を来しうるため，特に良性の場合全摘が望ましい．腫瘍が脊髄腹側に存在する場合，側方進入摘出術は有用な方法と考える．

A Case Report of Localized Pigmented Villonodular synovitis Presenting Limited Flexion of the Knee.

We treated of localized pigmented villonodular synovitis limiting a flexion of the right knee. The case was a 33-year-old male who complained of a limited flexion because of knee pain. Our clinical examinations, there was a mass in the anterolateral femorotibial joint space, restriction of knee motion (0-90°), clear yellow joint fluid. We suspected of a meniscal injury, but MR images demonstrated an intra-articular mass on the lateral side below the patella, suggesting an intra-articular tumor. We opened the joint to recognize the yellow-brown tumor originating in the synovium on the lateral side below the patella, and resected it with surrounding synovia. The pathologic diagnosis of the mass was pigmented villonodular synovitis. At present, 4 months postoperatively, the patient is free of pain, although the motion range of the knee of 0° to 135°.