脊髄外科手術での術中超音波画像診断によるモニタリング

Abstract

Objective : Improvements in the quality of ultrasound instrumentation have led to its increasing use during neurosurgery. However, as there are fewer reports on intraoperative ultrasound (IOUS) monitoring during spinal-than during intracranial surgery, we discuss its usefulness m spinal surgeiy.Methods : Between February 2006 and June 2007, 65 patients underwent spinal surgery with IOUS monitoring (GE LOGIQ g and 8c microconvex probe). Of these patients. 2 underwent foramen magnum decompression (FMD) for Chiari malformation. 10 laminoplasty, 4 cervical anterior fixation, 9 hemilaminectomy for lumbar canal stenosis, 31 were treated for lumbar disc hemiation, and g underwent tumor removal.Results : In patients undergoing FMD and cervical laminoplasty, pulsation of the cerebellar tonsil and the spinal cord and subarachnoid space anterior to the spinal cord confirmed sufficient decompression. In patients undergoing anterior fixation, decompression of the spinal cord and nerve root was obtained. At surgery for lumbar canal stenosis. decompression of the nerve root ipsi-and contralateral to the approach side was ascertained. During the removal of lumbar disc hemiation, nerve root decompression and residual hemiated material were identified. In patients undergoing removal of a spinal cord tumor. confirmation of its location just after laminectomy facilitated appropriate dural opening.Conclusion : Although IOUS is not widely used by neurosurgeons, it is easily performed. inexpensive, and provides real-time information that cannot be obtained under direct vision. We have found IOUS useful in spinal cord surgery.