骶管内硬膜囊末端脊膜囊肿的临床特点和外科治疗

Clinical features and treatment of sacral spinal meningeal cysts of the thecal tip

目的总结骶管内硬膜囊末端脊膜囊肿临床特点以及治疗策略。方法对2010年1月至2016年12月经手术确诊为骶管内硬膜囊末端脊膜囊肿的23例患者的临床资料进行回顾性分析,囊肿分为Ⅰ型和Ⅱ型,所有病变均在神经电生理检测下进行显微切除,对比不同类型病变的临床特征、手术策略以及预后。结果研究对象23例,其中Ⅰ型15例,Ⅱ型8例。症状包括疼痛,下肢麻木,下肢肌力下降,会阴区麻木、疼痛或感觉异常,以及大小便功能障碍。93.3%的I型患者和12.5%的Ⅱ型患者合并脊髓圆锥低位,93.3%的Ⅰ型患者和12.5%的Ⅱ型患者合并内终丝脂肪浸润。病变均完全切除,2例Ⅰ型患者术后出现伤口愈合不良。随访时间为(25.5±17.8)个月,1例Ⅰ型患者病变复发。改良JOA评分由术前(14.5±1.8)分变为术后(18.2±1.6)分,术后神经功能较术前改善明显(t=-3.21,P=0.001)。Ⅰ型症状改善率为80.0%,Ⅱ型为87.5%。结论骶管内硬膜囊末端脊膜囊肿分为两型,Ⅰ型较Ⅱ更多伴有脊髓拴系综合征和脊髓圆锥低位,治疗时不仅要切除病变、封闭瘘口,还要切断终丝、解除脊髓拴系。总体治疗效果良好。

Objective The clinical features and surgery strategies of sacral spinal meningeal cysts of the thecal tip （TT-SSMCs） were summarized. Methods The clinical data of 23 patients with Tr-SSMC between January 2010 and December 2016 were analyzed retrospectively. TT-SSMC was divided into Type I and Type II and all the lesions were resected by operation with neuroelectrophysiological monitoring. The clinical features, surgical strategies and prognosis of different types were compared. Results Twenty-three TT-SSMC patients were diagnosed including 15 cases of Type I and 8 of Type II. Symptoms included local pain, lower extremities numbness, lower extremities weakness, numbness, pain or paresthesia in the perineal region, and bowel/bladder dysfunction. A total of 93.3 % of Type I patients and 12.5 % of Type II patients were complicated with the low level of the spinal cord. A thickened fatty ilium was found in 93. 3% of Type I patients and 12. 5 % of Type II patients. All lesious were removed completely, and 2 patients of Type I were found the delayed healing wound healing. The follow-up time was （25.5 ± 17.8） months, and 1 case Type I patient had a recurrence after surgery. The pre-operative IJOA score was 14.5 ±1.8 and post-operative BOA score was 18.2±1.6. The difference between pre-operative and post-operative IJOA scores was statistically significant （t = -3.21, P =0. 001 ）, with a significant improvement in neurological function after surgery. The improvement rate of symptoms was 80% in Type I patients and 87. 5% in Type II. Conclusion TT- SSMCs can be divided into Type I and Type II, while Type II has a higher rate of complicated tethered spinal cord syndrome and low conns medullaris than those of Type I . Besides cyst resection and ostium transfixion, the untethering procedure should be considered if tethered spinal cord is suspected. Most patients achieve a significant improvement after surgery.