[1]谢京城 王振宇 陈晓东.骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗[J].中国临床神经外科杂志,2015,(11):651-653,657.[doi:10.13798/j.issn.1009-153X.2015.11.004]
 XIE Jing-cheng,WANG Zhen-yu,CHEN Xiao-dong.Diagnosis and surgical treatment of sacral spinal meningeal cysts of fila terminale complicated with tethered spinal cord syndrome[J].,2015,(11):651-653,657.[doi:10.13798/j.issn.1009-153X.2015.11.004]
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骶管终丝脊膜囊肿合并脊髓拴系综合征的诊断和治疗()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2015年11期
页码:
651-653,657
栏目:
论著
出版日期:
2015-11-24

文章信息/Info

Title:
Diagnosis and surgical treatment of sacral spinal meningeal cysts of fila terminale complicated with tethered spinal cord syndrome
作者:
谢京城 王振宇 陈晓东
100191 北京,北京大学第三医院神经外科;
通讯作者:王振宇,E-mail:wzyu502@hotmail.com
Author(s):
XIE Jing-cheng WANG Zhen-yu CHEN Xiao-dong
Department of Neurosurgery, Third Hospital, Peking University, Beijing 100191, China
关键词:
脊膜囊肿脊髓拴系综合征骶管终丝显微手术
Keywords:
Spinal meningeal cyst Tethered cord syndrome Microsurgery Prognosis
分类号:
R 739.42; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2015.11.004
文献标志码:
A
摘要:
目的 总结骶管内终丝脊膜囊肿的临床特点、影像学特征和治疗经验。方法 回顾性分析2010年7月至2014年3月显微手术及病理证实的11例骶管内终丝脊膜囊肿患者的临床资料。结果 鞍区疼痛、双下肢麻木无力、大小便功能障碍为主要临床表现。MRI检查显示骶管内长T1、长T2囊性信号,囊内可见终丝信号,囊壁无强化,11例均合并脊髓低位。手术行囊壁切除,终丝切断,脊髓拴系松解。手术将囊壁全切或次切切除,术后患者鞍区疼痛消失,双下肢无力及大小便功能障碍逐渐恢复,视觉模拟疼痛评分从术前的(5.23±1.42)分降到术后的(2.03±1.32)分;运动障碍者手术后肌力提高1~2级;JOA括约肌评分从(2.10±0.98)分上升到(2.75±0.53)分。无手术并发症。随访3个月~3.8年,平均1.35年,所有患者神经功能完好,随访期间未见囊肿复发。结论 骶管内终丝脊膜囊肿罕见,临床上以局部疼痛及脊髓牵拉神经功能障碍为表现。在MRI表现为囊肿内脑脊液信号,囊内可见终丝结构,脊髓圆锥低位。手术应在显微镜下剥离囊壁,切断终丝行脊髓拴系松解。
Abstract:
Objective To summarize the clinical manifestation, imaging characteristics of sacral spinal meningeal cysts of fila terminale (SSMCFT) and the experience in the surgical treatment of them. Method The cinical data of 11 patients with SSMCFT complicated with tethered spinal cord syndrome receiving surgical treatment from July, 2010 to March, 2014 were analyzed retrospectively. The main clinical manifestations included the local pain, weakness of the lower extremities and bowl and bladder dysfunctions in the patients with SSMCFT. MRI showed that the cyst located at the sacral spines. The lower T1 and higher T2 signals were found on MRI. There were fila terminale within the cyst which tethered the spinal cord. The cystic walls were removed and the involved fila terminale were cut off, and the tethered spinal cords were relaxed during the operation in all the patients. Results Of 11 patients with SSMCFT, 7 received total cystic walls resection and 4 subtotal. The local pain disappeared and the motive function of the involved lower limbs or bowel and bladder functions were gradually improved after the operation. No post-operative complications occurred in all the patients. The period of follow-up ranged from 3 months to 3.8 years (average, 1.35 years). The neurological function returned to normal and the cysts did not recur in all the patients during the following-up period. Conclusion SSMCFT are uncommon. The main clinical manifestations include the chronic local pain and lower extremities weakness or bowel and bladder dysfunction. MRI is helpful to the diagnosis of SSMCFT complicated with tethered spinal cord syndrome. The curative effect of the surgery including removal of the walls of the cysts and relaxation of the tethered spinal cord on SSMCFT complicated with tethered spinal cord syndrome is satisfactory.

参考文献/References:

[1] Nabors MW, Pait TG, Byrd EB, et al. Updated assessment and current classification of spinal meningeal cysts [J]. J Neurosurg, 1988, 68: 366-377.
[2] Fogel GR, Cunningham PY, Esses SI. Surgical evaluation and management of symptomatic lumbosacral meningeal cysts [J]. Am J Orhhop, 2004, 33: 278-282.
[3] 刘 辉,张剑宁,杨树源,等. 椎管内硬膜外脊膜囊肿的显微外科治疗[J]. 中华神经外科杂志,2008,24:728-730.
[4] 陈晓东,王振宇,谢京城,等. 症状性骶管内囊肿的诊断与治疗[J]. 中国脊柱脊髓杂志,2006,16:138-141.
[5] Sun JJ, Wang ZY, Li ZD, et al. Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers [J]. Sci China Life Sci, 2013, 56: 1007-1013.
[6] Hukuda S, Mochizuki T, Ogata M, et al. Operations for cervical spondylotic myelopathy: a comparison of the results of anterior and posterior procedures [J]. J Bone Joint Surg Br, 1985, 67: 609-615.
[7] McCormick PC, Torres R, Kalmon D, et al. Intramedullary ependymoma of the spinal cord [J]. J Neurosurg, 1990, 72: 523-532.
[8] 邓先波,孔祥泉,刘定西. 正常人脊髓圆锥位置和马尾神经的MRI研究[J]. 临床放射学杂志,2007,26:548-551.
[9] Yamada S, Won DJ, Yamada SM, et al. Adult tethered cord syndrome: relative to spinal cord length and filum thickness [J]. Neurol Res, 2004, 26(7): 732-734.
[10] Lee G, Paradiso G, Tator C, et al. Surgical management of the adult tethered cord syndrome:indications, techniques and longterm outcomes in a series of 60 patients [J]. J Neurosurg Spine, 2006, 4(2): 123-131.

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备注/Memo

备注/Memo:
2015-07-08收稿
更新日期/Last Update: 2015-11-25