椎管内蛛网膜囊肿临床表现及其手术方式

Clinical manifestation and operative method of the arachnoid cyst in spinal canal

目的:分析椎管内蛛网膜囊肿的临床表现、手术方式及其治疗效果,为椎管内蛛网膜囊肿诊断和手术治疗方案的合理选择提供依据.方法:回顾分析21例椎管内蛛网膜囊肿临床表现、手术方式及术后效果,男9例,女12例;年龄21～55岁,平均36.15岁;病程2个月～3年,平均6.2个月.21例椎管内蛛网膜囊肿中1例发生于颈段、1例发生于胸段、19例发生于骶部,表现为受累神经支配区的放射性疼痛、感觉异常、功能障碍.16例经CT结合椎管造影明确诊断,其余通过MRI明确诊断.8例采用囊肿切除、囊颈部结扎、硬膜重叠紧缩缝合手术;11例囊肿壁与神经难以分离,采用囊肿壁部分切除、交通口肌肉堵塞、硬膜紧缩缝合手术;2例串珠状囊肿,其交通口未能找到,采用囊肿开窗引流、囊壁部分切除、硬膜重叠紧缩缝合、游离肌肉压迫固定.结果:19例患者获得随访,随访时间2个月～5年3个月,平均21.2个月.囊肿切除、囊颈部结扎手术组的优良为6例,囊肿壁部分切除、交通口肌肉堵塞组的优良为8例.结论:椎管内蛛网膜囊肿是蛛网膜的先天性畸形,以骶部椎管好发,大多数临床表现为受累神经的功能异常;具有手术指征的病例,术中应根据囊肿开口、囊肿壁是否能与神经分离等情况选择不同的囊肿处理方法.

Objective： To analyze the clinical manifestaion, operative method and outcomes of arachnoid cyst in spinal canal and to provide basis for the diagnosis and operation choice. Methods：The clinical manifestation,operative method and postoperative outcome in 21 patients with arachnoid cyst in spinal canal were reviewed.Among them,9 cases were male and 12 were fernale,ranging in age from 21 to 55 years（mean 36.15 years） ,ranging in course from 2 months to 3 years, with an average of 6.2 months. Nineteen cysts occurred in sacral canal. Only 2 cysts were respectively situated in cervical spinal canal and thoracic spinal canal. There were such symptoms as radiating pain in the involved innervation area, paresthesia and nerve dysfunction. Sixteen patients were definitely diagnosed with CT and spinal canal myelography, and the others with MRI. Eight patients were treated by cyst neck ligation, cyst excision and imbricate tightly suture of dura mater. Eleven patients were treated by partial cyst wall excision, blocking communicating hole with free autologous muscle and tight suture of dura mater because the cyst wall and nerves were adhesion. Two patients of cluster-pearls-like cyst were treated by partial cyst wall excision, imbricate suture, free autologous muscle compressive fixation. Results： Nineteen patients were followed-up for average of 21.2 months （ranged from 2 months to 63 months）. The result of excellent and good of patients of cyst neck ligation, cyst excision, imbrication suture were in 6 cases and that of patients of partial cyst excision,communicating hole blocked with free autologous muscle were in 8 cases. Conclusion：Arachnoid cyst of spinal canal is congenital abnormality of arachnoid and often occurres in sacral canal. Its manifestation is disfunction of involved nerve. The choice of operation depends on the condition of hole of cyst and the adhesion between nerve and cyst.