骶管内蛛网膜囊肿的外科治疗

Surgical treatment of the arachnoid cysts in sacral canal: analysis of 23 cases

目的探讨骶管内蛛网膜囊肿的诊断及治疗方法。方法23例骶管内蛛网膜囊肿患者行椎板减压术后,分别对囊肿进行处理。13例行囊肿大部切除后,重新缝合残余部分以包绕囊内神经根;8例囊肿大部切除后用肌肉填塞交通孔;2例囊肿切开旷置。随访时间3个月～11年2个月,平均30.2个月,观察疗效,并对其临床表现,术中的病理特点,术后并发症,以及X线片、CT、CTM、MRI等影像学资料进行分析。结果MRI可清晰地显示囊肿呈长T1及T2信号,信号强度与脑脊液一致。临床症状以骶管内神经受压表现为主,囊肿与硬膜囊一般有交通孔。囊肿切除后重新缝合包绕神经组与囊肿切除肌肉填塞组优良率并无统计学差异。术后并发症有皮肤糜烂和颅内感染。结论骶管内蛛网膜囊肿的发生是由于先天性硬脊膜缺陷所致。对囊肿的处理以囊肿切除、肌肉填塞封堵交通孔最为合理。术后以不放引流条及忌平卧为宜。

Objective To study the diagnosis and the treatment of the arachnoid cysts in the sacral canal. Methods After decompression laminectomy of the sacral canal, the arachnoid cysts were dealt with in three ways: 13 cases with excision of the most of the cyst wall and suture of redundant wall around the intracystic nerves, 8 cases with the excision of the most of the cyst wall and plugging the communicating hole with a block of muscle, 2 cases with excision of most of the cyst wall and leaving cystic wound unsutured. The clinical results were studied with 30.2 months follow up. The radiological changes including X-ray, CT, CTM and MRI were evaluated as well as their clinical behaviors, pathologies and post operative complications. Results Long T1 and T2 signals of the cysts could be clearly showed in MRI, and the signal density was the same as that of cerebrospinal fluid. Clinical symptoms were caused by compression of sacral nerve. Generally, there were communicating holes between cysts and thecal sacs. There were no statistical differences between the results of the first two surgical methods. The post operative complications included the wound erosion and intracranial infection. Conclusion The cyst seems to arise as a result of congenital defect of the thecal dura. Excision of the most of the cyst wall and plugging the communicating hole with a block of muscle seems to be a reasonable surgical method. No drain tube should be used and a supine position should not be allowed so as to reduce the complications