椎管内硬脊膜下蛛网膜囊肿的临床特点与外科手术治疗

Clinical features and surgical treatment of spinal canal subdural arachnoid cysts

目的分析椎管内硬膜下蛛网膜囊肿的临床特点与外科手术方法以及预后。方法回顾性分析2010年11月至2018年11月于中国科学技术大学附属第一医院(安徽省立医院)神经外科接受手术治疗的9例椎管内髓外硬膜下蛛网膜囊肿的临床资料,包括其临床症状、影像学特点、手术方法、并发症以及预后。结果囊肿位于胸段5例,腰段4例。临床表现以疼痛4例,肢体乏力4例,肢体麻木伴感觉障碍3例,疼痛伴肢体麻木、无力1例。所有患者均采用外科手术治疗,术中尽量切除囊壁,与脊髓粘连紧密的不必勉强切除。术后随访1年到6年,术后5例症状完全缓解,2例症状缓解,2例症状缓解不明显。结论对于有症状椎管内硬脊膜下蛛网膜囊肿患者,手术是首选治疗方案。术中完全切除囊壁是减少术后复发的关键,但与脊髓的粘连程度是影响囊壁能否全切的主要因素。

Objective To analyze the clinical features,surgical methods and prognosis of spinal intradural arachnoid cysts.Methods Between November 2010 and November 2018,9 patients in the Department of Neurosurgery the First Affiliated Hospital of USTC(Anhui Provincial Hospital) with spinal intradual arachnoid cysts were treated,and the authors conducted a retrospective review of these cases for demographics,medical history,presenting symptoms,imaging findings,operative procedures,complications,and outcomes.Results In total,9 cases including the presented cases have been analyzed.5 arachnoid cysts were located in the thoracic cord,4 in the lumbar cord.4 patients were presented with symptoms of pain,3 of limb weakness,3 of sensory loss and limb numbness,1 of pain,limb weakness and numbness.All patients were treated with surgical treatment,intraoperative to excision of the cyst wall,close and don’t have the nerve root adhesion resection,but there is a leak to suture or repair.All patients were followed up for 1 to 6 years after operation.The symptoms were completely relieved in the 5 cases.The symptoms were relieved in the 2 cases,and the symptom relief was not obvious in the 2 cases.Conclusion For patients with symptomatic intraspinal arachnoid cysts,surgery is the first choice of treatment.The total excision of the cyst wall is the key to reduce postoperative recurrence,and the extent of adhesion with spinal cord is the main factor of total excision.