采用显微外科手术切除椎管内硬膜外蛛网膜囊肿的疗效观察

Intraspinal epidural arachnoid cysts treated by microsurgery

目的探讨椎管内硬膜外蛛网膜囊肿的诊疗方法及预后。方法回顾分析2014年6月至2018年6月贺州市中医医院行显微外科手术切除的5例椎管内硬膜外蛛网膜囊肿的病历资料。完善术前准备及检查,观察术后病理、腰痛减轻程度、下肢肌力恢复情况、下肢麻木感等。结果术后病理符合蛛网膜组织形态特征,病理诊断为蛛网膜囊肿。术后随访6个月以上,5例患者腰痛症状消失,下肢肌力恢复,能正常行走,下肢麻木感好转4例,1例遗留小腿外侧少许麻木感,能正常生活。术后复查MRI示蛛网膜囊肿完全切除,3例硬膜受压完全缓解,未见复发;内固定器位置良好,未见移位,椎板获得骨性愈合。结论椎管内硬膜外蛛网膜囊肿无明显特异性表现,确诊需依靠手术及术后病理检查。应用显微外科手术可实现完整切除,术后并发症少,不易复发。

Objective To investigate the diagnosis,surgical treatment and prognosis of intraspinal epidural arachnoid cysts.Methods Five cases of intraspinal epidural arachnoid cysts treated by microsurgery were retrospectively analyzed in Hezhou Traditional Chinese Medicine Hospital between June 2014 and June 2018.Preoperative preparation and examination were completed.The postoperative pathology,reduction of low back pain,recovery of lower limb muscle strength and numbness of lower limbs were observed.Results Postoperative pathology was consistent with arachnoid tissue,and diagnosed as arachnoid cysts.After 6 months of follow-up,the symptoms of low back pain disappeared,the muscle strength of the lower limbs recovered,and the walking backed normal in 5 cases.The numbness of the lower extremities improved in 4 cases,and 1 case left a little numbness on the outside of the calf and could live normally.Postoperative MRI showed a complete resection of arachnoid cysts,3 cases of dural compression were completely relieved,no recurrence;internal fixation was in good position,no displacement,laminar bone healing.Conclusion There is no specific manifestation of epidural arachnoid cyst in spinal canal,and surgical resection is the best method for the diagnosis of spinal epidural arachnoid cysts.Microscopic resection can achieve complete resection with fewer complications and less recurrence.