骶管内囊肿的显微外科治疗

Microsurgical treatment of arachnoid cysts in sacral canal

目的探讨骶管内囊肿的诊断及治疗措施。方法总结27例骶管内囊肿患者的临床表现、影像学特征、是否合并脊髓栓系、显微手术方法和术后疗效及围手术期并发症。结果囊肿完整切除18例,部分切除9例;囊肿切除后,空腔填塞脂肪18例;术后2例出现脑脊液漏,经腰大池引流后治愈。结论 MRI检查是确诊骶管蛛网膜囊肿的有力手段,伴有临床症状、体征者应考虑手术治疗。对囊肿的处理以囊肿切除、严密结扎漏口为主,术中填塞脂肪、严密缝合切口各层及术后合理体位可以有效防止囊肿复发。

Objective To discuss microsurgical treatment of the cycsts in sacral canal. Methods Clinical and neuroimaging features, tethered cord or not, operative approaches and postoperative management of 27 patients with arachnoid cysts in sacral canawere summarized. Results Total resection was achieved in 18 cases, subtotal resection 9 cases. Most cycst space were plunged with a block of fat（ 18 cases）. 2 cases suffered cerebrospinal fluid leakage which was cured by lumbar drainage. Conclusions MRI is the best diagnostic procedure of choice and surgery is curative. Total and partial cyst excision, closure of the dura defect, and plunging with a block of fat have been successfully performed. No cyst recurrence has been reported in 27 cases.