[1]谢京城 陈晓东 杨 军.成人脊髓纵裂畸形导致的脊髓拴系综合征的治疗[J].中国临床神经外科杂志,2020,(06):344-347.[doi:10.13798/j.issn.1009-153X.2020.06.003]
 XIE Jing-cheng,CHEN Xiao-dong,YANG Jun..Surgical treatment for adult patients with tethered cord syndrome due to split cord malformation[J].,2020,(06):344-347.[doi:10.13798/j.issn.1009-153X.2020.06.003]
点击复制

成人脊髓纵裂畸形导致的脊髓拴系综合征的治疗()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年06期
页码:
344-347
栏目:
论著
出版日期:
2020-06-15

文章信息/Info

Title:
Surgical treatment for adult patients with tethered cord syndrome due to split cord malformation
文章编号:
1009-153X(2020)06-0344-04
作者:
谢京城 陈晓东 杨 军
100191 北京,北京大学第三医院神经外科(谢京城、陈晓东、杨 军)
Author(s):
XIE Jing-cheng CHEN Xiao-dong YANG Jun.
Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
关键词:
脊髓拴系综合征脊髓纵裂成人脊柱裂显微手术
Keywords:
Tethered cord syndrome Split cord malformation Spina bifida Microsurgery Adult patient
分类号:
R 739.42; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2020.06.003
文献标志码:
A
摘要:
目的 总结成年脊髓纵裂畸形(SCM)导致的脊髓拴系综合征(TCS)的临床特点及手术治疗经验。方法 回顾性分析2007年9月至2019年3月手术治疗的21例成年SCM导致的TCS病人的临床资料。采用后路椎板切除、骨性或软骨性及纤维中隔分离切除、脊髓拴系松解、脊膜囊重建术。结果 21例中,男6例,女15例;年龄18~65岁,平均28.7岁;Ⅰ型7例, Ⅱ型14例。21例显微手术将中隔切除,脊髓拴系达Ⅰ级松解,无手术并发症。术后疼痛缓解或消失,双下肢无力及大小便功能障碍逐渐恢复。术后随访9个月至12年,平均5.8年;神经功能稳定及好转;随访期间未见拴系复发。结论 成人由SCM引发的TCS少见,以慢性腰腿痛为主要临床表现,手术在显微镜下行中隔分离切除、脊髓拴系松解及硬膜重建,疗效满意
Abstract:
Objective To summarize the clinical manifestation, imaging characteristic and experience of surgical treatment of tethered cord syndrome (TCS) due to split cord malformation (SCM) in adults. Methods The clincal data of 21 adult patients with TCS due to SCM who were surgically treated under microscope from September 2007 to March 2019 were retrospectively analyzed. Results There were 6 males and 15 females with an average age of 28.7 years (range, 18~65 years). Clinically, all the patients presented with chronic back and legs pain and lower extremities weakness or bowel and bladder dysfunction. Preoperative CT and MRI imaging showed spina bifida, characteristic bony, cartilaginous, or fibrous septum, and associated anomalies. According to CT and MRI features, 7 patients were categorized into Type Ⅰand 14 into type Ⅱ. All the patients had low-lying conus medullaris and thickened filum terminale and 3 patients had meningeal cyst of filum terminal at sacral spine. 21 operations had been performed including resection of the median septum, de-tethering the spinal cord, and reconstruction of the dura sac. No operative complication occurred. The local pain was relieved, and the lower limbs weakness or bowel and bladder dysfunction were gradually relieved after the operation. The period of follow-up ranged from 9 months to 12 years, with an average of 5.8 years. The neurological function was improved or stable in all the patients. Conclusions TCS due to SCM in adults is rare, which is characterized with insidious onset and chronic progressive procedure. The surgical treatment including resection of the median septum, untethering of spinal cord, reconstruction of dura sac under microscope have good outcomes

参考文献/References:

[1] Pang D, Dias MS, Ahab-Barmada M. Splitcord malforma-tion: PartⅠ: A unified theory of embryogenesis for double spinal cord malformations [J]. Neurosurgery, 1992, 31(3): 451-480.
[2] Pang D. Split cord malformation: PartⅡ: Clinical syndrome [J]. Neurosurgery, 1992, 31(3): 481-500.
[3] Kim YD, Sung JH, Hong JT, et al. Split cord malformation combined with tethered cord syndrome in an adult [J]. J Korean Neurosurg Soc, 2013, 54(4): 363-365.
[4] D’Agostino EN, Calnan DR, Makler VI, et al. TypeⅠsplit cord malformation and tethered cord syndrome in an adult patient: a case report and literature review [J]. Surg Neurol Int, 2019, 10(90): 1-7.
[5] Hoffman HJ, Taecholarn C, Hendrick EB, et al. Managementof lipomyelomeningoceles: experience at the hospital for sick children, toronto [J]. J Neurosurg, 1985, 62(1): 1-8.
[6] Kirollos RW, Van Hille PT. Evaluation of surgery for the tethered cord syndrome using a new grading system [J]. Br J Neurosurg, 1996, 10(3): 253-260.
[7] Hukuda S, Mochizuki T, Ogata M, et al. Operations for cer-vical spondylotic myelopathy: a comparison of the results of anterior and posterior procedures [J]. J Bone Joint Surg (Br), 1985, 67(4): 609-615.
[8] Hoffman HJ, Hendrick EB, Humphreys RP. The tethered spinal cord: its protean manifestations, diagnosis and surgi-cal correction [J]. Childs Brain, 1976, 2(3): 145-155.
[9] Yamada S, Zinke DE, Sanders D. Pathophysiology of tether-ed cord syndrome [J]. J Neurosurg, 1981, 54(4): 494-498.
[10] Ozturk E, Sonmez G, Mutlu H, et al. Split-cord malforma-tion and accompanying anomalies [J]. J Neuroradiol, 2008, 35(3): 150-156.
[11] Maiti TK, Bhat DI, Devi BI, et al. Teratoma in split cord malformation: an unusual association: a report of two cases with a review of the literature [J]. Pediatr Neurosurg, 2010, 46(3): 238-241.
[12] Er?ahin Y. Split cord malformation types Ⅰ and Ⅱ: a per-sonal series of 131 patients [J]. Childs Nerv Syst, 2013, 29(9): 1515-1526.
[13] Beuriat PA, Di Rocco F, Szathmari A, et al. Management of splitcordmalformation in children: the Lyon experience [J]. Childs Nerv Syst, 2018, 34(5): 883-891.
[14] Akay KM, Izci Y, Baysefer A, et al. Split cord malformation in adults [J]. Neurosurg Rev, 2004, 27(2): 99-105.
[15] Klekamp J. Tethered cord syndrome in adults [J]. J Neuro-surg Spine, 2011, 15(3): 258-270.
[16] Dulfer SE, Drost G, Lange F, et al. Long-term evaluation of intraoperative neurophysiological monitoring-assisted tethered cord surgery [J]. Childs Nerv Syst, 2017, 33(11): 1985-1995.
[17] 谢宝树,王 宇,贾 锋,等. 神经电生理监测下显微手术治疗成人脊髓拴系综合征[J]. 中国临床神经外科杂志,2015,20(11): 658-660.
[18] Barutcuoglu M, Selcuki M, Selcuki D, et al. Cutting filum terminale is very important in split cord malformation cases to achieve total release [J]. Childs Nerv Syst, 2015, 31(3): 425-432.
[19] Lee JY, Phi JH, Cheon JE, et al. Preuntethering and postun-tethering courses of syringomyelia associated with tethered spinal cord [J]. Neurosurgery, 2012, 71(1): 23-29.

相似文献/References:

[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.[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,(06):651.[doi:10.13798/j.issn.1009-153X.2015.11.004]
[2]苏卢海 综述 张世渊 审校.脊髓拴系综合征的外科治疗进展[J].中国临床神经外科杂志,2018,(03):220.[doi:10.13798/j.issn.1009-153X.2018.03.029]

备注/Memo

备注/Memo:
(2020-03-18收稿,2020-04-15修回)
更新日期/Last Update: 2020-06-15