http://hdl.handle.net/10564/1568 2005-02 2026-04-10T15:42:05Z http://hdl.handle.net/10564/125 タイトル: 稀な原因による脊髄空洞症の3例 著者: 朴, 永銖; 木村, 僚太; 中瀬, 裕之; 榊, 壽右 抄録: In many cases, syringomyelia is associated with Chiari malformation and spinal cord tumor. We report three cases of syringomyelia due to unusual causes. [Case 1] 64 years old, a woman. She had painful numbness and weakness of the right hand. MRI showed broad syringomyelia, which extended from C2 to Th2 and severe spinal cord compression at C6/7 level derived from spondylotic spur formation. Dynamic cervical X-ray revealed mild anterior sliding at C4/5. We performed anterior decompression and fusion with titanium cylindrical cages for two segments (C4/5 and C6/7). Since syrinx had regressed three months later on MRI, we suspected that dynamic cervical movement had gradually caused syringomyelia. [Case 2] 61 years old, a man. He had suffered bilateral leg numbness and gait difficulty for several years. On MRI examination, intramedullary cystic mass and syrigomyelia were detected at thoracic spine. In operation, thickened and turbid arachnoid membrane was widely dissected and free cerebrospinal fluid collection pathway was preserved after duroplasty with fascia. Syrinx regressed on MRI after three months, so we diagnosed syrigomyelia due to idiopathic adhesive arachnoiditis. [Case 3] 73 years old, a man. Over 40 years before, he was surgically treated for thoracic vertebral caries. He had gradually developed gait disturbance and paraparesis for several years. MRI revealed intramedullary cyst (syrinx formation) at ThlO. Concurrently meningeal thickening was found. We judged that syringomyelia occurred as a late complication of tuberculous meningitis. Unfortunately our surgical procedure, syringostomy and dissection of arachnoid membrane, did not improve his deficits. 2005-02-27T15:00:00Z http://hdl.handle.net/10564/124 タイトル: SPINAL EXTRADURAL ARACHNOID CYST IN THE THORACIC 著者: Kim, Yeong-Jin; Nakase, Hiroyuki; Park, Young-Su; Shin, Yasushi; Sakaki, Toshisuke 抄録: Spinal extradural arachnoid cysts are relatively rare, and the pathogenesis is still unclear. Here, we report a case with a Type I-A lesion by Nabors' classification (extradural arachnoid cyst without spinal nerve root fiber involvements) treated surgically. A 38-year-old female patient presented with a complaint of low back pain and bilateral hypesthesia of the legs. Physical examination showed no abnormality. Magnetic resonance imaging (MRI) showed an extradural cerebrospinal fluid (CSF)-containing lesion without involvement of the posterior epidural fat at Thll-Ll. CT with bone algorithms revealed bone erosion with widening of the canal, foraminal enlargement and scalloping of the vertebral body. Resection of the cyst wall and closure of the ostium were easily performed. This procedure resulted in the relief of her symptoms. Postoperative MRI demonstrated that both the cystic lesion and nerve root compression had disappeared. Histological examination showed clusters of meningothelial cells, which are a typical feature of arachnoid cysts. Radical cyst removal and dura defect closure are the surgical intervention of choice in patients with symptomatic extradural arachnoid cyst. 2005-02-27T15:00:00Z http://hdl.handle.net/10564/123 タイトル: DYSPHAGIA CAUSED BY ANTERIOR CERVICAL OSTEOPHYTES 著者: Nakase, Hiroyuki; Shin, Yasushi; Park, Young-Su; Sakaki, Toshisuke 抄録: Although cervical spondylosis is a common disorder, dysphagia induced by osteophyte formation is uncommon. Reports in the literature show that vertebral hypertrophic spurs causing dysphagia result from bony degeneration or idiopathic causes (diffuse idiopathic skeletal hyperosteosis: DISH) (Forestier's disease). We present a case suffering dysphagia secondary to cervical osteophytes. A 62-year-old male patient presented with a complaint of dysphagia. Physical examination showed no abnormality. A cervical X-ray and computed tomography (CT) showed a large bone spur originating from the anterior surface of the C3/4. Barium esophagography revealed osteophytic spurs in the anterior aspect of C3/4 vertebrae, in close approximation to the inlet of the esophagus, obstructing the esophagus passage by external compression. Anti-inflammatory therapy administered did not provide relief of the patient's complaint. Functional improvement was immediate after surgical removal of the osteophyte using ultrasonic bone curettage via an anterior cervical approach. Surgery is mandatory if medical care fails and dysphagia is complete. 2005-02-27T15:00:00Z http://hdl.handle.net/10564/122 タイトル: RADICULOMYELOPATHY DUE TO TUMORAL CALCIFICATION OF THE LIGAMENTUM FLAVUM OF THE CERVICAL SPINE 著者: Nanase, Hiroyuki; Park, Young-Su; Shin, Yasushi; Sakai, Toshisuke; Goda, Kazuo; Aoyama, Nobufusa 抄録: A case of a 68-year-old woman with radiculomyelopathy caused by unilateral tumoral calcification of the ligamentum flavum of the cervical spine is reported. The patient developed the left shoulder pain and tetraparesis in the previous two years, and the symptoms has deteriorated in spite of conservative therapy. Neurological examination revealed motor weakness, hyperreflexia and hypesthesia in the four extremities. Neuroradiologically, a unilateral nodular opacification was shown in the left C4-C5 level. CT scan revealed nodular calcification, and MRI showed marked compression of the cervical cord by the calcified mass. Removal of the calcification through the left hemilaminectomy was performed using ultrasonic bone curettage. Light microscopic examination showed calcified deposits in the ligamentum flavum without crystals of calcium pyrophosphate dihydrate (CPPD). The patient was discharged from the hospital with improvement of the neurological symptoms 2005-02-27T15:00:00Z