自发性颅内低压的磁共振脊髓造影研究

Analysis of magnetic resonance myelography in spontaneous intracranial hypotension

目的:探讨自发性颅内低压患者的磁共振脊髓造影(MRM)特征及在治疗中的应用价值。方法:回顾性分析2014年8月至2019年8月就诊于郑州大学第一附属医院,并行MRM检查的15例自发性颅内低压患者的临床资料、MRM特征及治疗方法。依据治疗方式将其中9例患者纳入保守治疗组,另外6例患者纳入联合硬膜外血贴治疗组。比较两组患者间性别、年龄、发病至MRM检查时间间隔、脑脊液压力及MRM特征的差异。采用SPSS 20.0软件进行统计分析。结果:15例自发性颅内低压患者均表现为直立性头痛。脑脊液压力0~55(29.67±19.77)mmH 2O(1 mmH 2O=0.0098 kPa)。自发病至MRM检查时间间隔为7~90(33.07±24.22)d。15例患者均发现有神经根周围漏,4例存在脊髓腹侧硬膜外积液,6例有脊髓背侧硬膜外积液,8例有高颈段脊髓后软组织积液。漏点数目2~32(10.20±7.87)个。在合计153个漏点中,位于颈椎58个(37.9%),位于胸椎77个(50.3%),位于腰椎18个(11.8%),位于颈胸连接段(C 7~T 1至T 1~2)和上胸段(T 2~3至T 6~7)61个(39.9%)。依据漏点位置,5例患者初次行靶向自体硬膜外血贴治疗有效,1例患者行2次靶向硬膜外血贴治疗有效。保守治疗组和联合硬膜外血贴治疗组间的性别、年龄、发病至MRM检查时间间隔、脑脊液压力、漏点数目及位置未见显著差异。结论:颈胸段脑脊液神经根周围漏是自发性颅内低压脊髓造影最常见的特征。MRM可明确脑脊液漏的存在及位置,协助自发性颅内低压的诊断,指导靶向硬膜外血贴治疗。

Objective To investigate the characteristics of magnetic resonance myelography(MRM)and its application in the treatment of spontaneous intracranial hypotension(SIH).Methods The clinical data,MRM characteristics,and treatment of 15 patients with SIH who underwent MRM examination in the First Affiliated Hospital of Zhengzhou University from August 2014 to August 2019 were retrospectively analyzed.According to treatment methods,nine patients were divided into conservative treatment group and six patients were divided into combined epidural blood patch treatment group.The gender,age,time interval from onset to MRM examination,cerebrospinal fluid pressure and MRM characteristics between the two groups were compared.SPSS 20.0 software was used for statistical description,and independent sample t-test was applied to compare the differences between groups.Results All of the 15 cases reported orthostatic headache.Their cerebrospinal fluid pressure was(29.67±19.77,range 0-55)mmH2O(1 mmH2O=0.0098 kPa),and onset-MRM interval was(33.07±24.22,range 7-90)days.The MRM characteristics were observed,including all 15 cases with periradicular leaks,four cases with anterior epidural fluid collections,six cases with posterior epidural fluid collections,and eight cases with high cervical(C1-2 to C2-3)retrospinal cerebrospinal fluid collections.There were 2 to 32 leak sites with an average of(10.20±7.87)sites.Among the 153 leak sites,58(37.9%)sites were located at cervical vertebra,77(50.3%)sites at thoracic vertebra,18(11.8%)sites at lumbar vertebra,and 61(39.9%)sites at either the cervicothoracic junction(C7-T1 to T1-2)or the upper thoracic region(T2-3 to T6-7).Five patients responded well to one-time targeted autologous epidural blood patch on the basis of the location of the cerebrospinal fluid leakage.Besides,one patient improved with targeted epidural blood patch twice.There were no statistically significant differences in gender,age,onset-MRM interval,cerebrospinal fluid pressure,number and location of leak sites between the conservative treatment group and combined treatment group.Conclusions The periradicular leaks of cerebrospinal fluid at cervical vertebra and thoracic vertebra are the most common feature of MRM in patients with SIH.MRM can identify the existence and location of cerebrospinal fluid leakage,assist in the diagnosis of SIH,and guide targeted epidural blood patch.