髓内表皮样囊肿全切除一例

Total excision of intramedullary epidermoid cyst in one case

报告1例显微镜下经脊柱后正中入路全切除L3~4椎体节段髓内表皮样囊肿患儿的临床经过。以双足内翻进行性加重、大小便障碍入院,术前影像学检查提示脊柱侧弯、L4~S1椎板不连续,以及L3~4椎管内异常信号。术中于神经电生理监测下全切除髓内囊肿并行脊髓塑形,术后神经症状与体征缓解,未发生无菌性脑膜炎。完整切除表皮样囊肿包膜是防止术后无菌性脑膜炎和囊肿复发的关键,术中严格按照囊肿包膜与脊髓分界进行剥离可避免脊髓损伤。

Clinical experience of total excision in a 14 year old female with intramedullary epidermoid cyst was reported. The patient with L3-4 intramedullary epidermoid cyst underwent total excision through posterior median approach under microscopy. The patient was admitted for progressive strephexopodia and urinary and fecal incontinence. Preoperative imaging examination showed scoliosis, incontionous L4-S1 and abnormal signal of L3-4. Total excision and spinal remodeling were performed under intraoperative neurophysiological monitoning. Epidermoid cyst and its membrane were totally removed without aseptic meningitis after surgery, and the neurologic symptoms of the patient were gradually improved. Completely removing the membrane of epidermoid cyst is the key point to prevent recurrence and aseptic meningitis postoperatively. Dissection should be strictly in accordance with the boundaries of the membrane and the spinal cord, in order to avoid spinal cord injury.