胸腰段长节段硬膜外脊膜囊肿的诊断和治疗  

Diagnosis and surgical treatment of spinal extradural meningeal cysts at throco - lumbar spine

作　　者：刘振武[1] 刘利[1] 颜继英[1] 

机构地区：[1]河北省邯郸市中心医院骨一科,056001

出　　处：《中华神经外科杂志》2012年第6期598-601,共4页Chinese Journal of Neurosurgery

摘　　要：目的 总结胸腰段硬膜外长节段脊膜囊肿的临床特点、影像学特征和治疗经验。方法回顾性分析显微手术及病理证实的10例胸腰段硬脊膜囊肿患者的临床资料。本组男4例，女6例，年龄7～54岁，平均年龄26．5岁。双下肢麻木无力、大小便功能障碍为主要症状。MRI检查显示T10～L3水平不同节段区域硬膜囊背侧至双侧椎间孔长T1、长他囊性信号，囊壁无强化。显微镜下行囊壁切除，脑脊液漏口修补术，术后患者俯卧位7d。结果手术将囊壁全切或次全切除，病理检查均符合脊膜囊肿，术后患者双下肢无力及大小便功能障碍逐渐恢复，无手术并发症。随访3个月至10年，平均4．1年，所有患者神经功能完好，胸腰椎生理曲度完好，随访期间未见囊肿复发。结论胸腰段椎管内长节段脊膜囊肿罕见，临床上以慢性脊髓及神经压迫为表现。在MRI上表现为脑脊液信号，囊壁无强化。手术应在显微镜下剥离囊壁，同时修补脑脊液漏口，手术疗效满意。Objective To summarize the clinical manifestation, imaging characteristic and experience of surgical treatment of extradural meningeal cyst at thoraco - lumbar spine. Methods The authors retrospectively analyzed a series of 10 patients with extradural meningeal cyst at thoraco - lumbar spine surgically treated under microscope from 2001 to 2011. There were 4 males and 6 fameles with average age of 26. 5 yaers （ rang from 7 to 54 years old）. The weakness of lower extremities, bowl and bladder dysfunction were the main clinical manifestation. MRI inmaging showed the cyst located dorsal to the spinal cord and extending to the neural formen with lower signal in T1 and higher signal in T2 seriers without enhancement. The lesions located at thoraco - lumbar spine range from T10 and L3. 10 operations had been performed with the cyst resection and fistula repairment under microscope. The patients remained prone position until 7 days post - operition. Results The meningeal cyst had been gross total or subtotal resected and histological examination showed typical meningeal cyst tissue in all cases. There was no operative complication happened. The lower limbs weakness or bowel and bladder dysfunction were gradually relieved post -operation. The period of follow -up was ranged from 3 months to 10 years （average 4. 1 years）. All the patients with neurological intact, there were no recurrence of the cyst and the alignment and lordosis of spine were kept evaluated with MRI investigation during follow - up period. Conclusions The extradural meningeal cyst at thoraco - lumbar spine are rare found and characterized by chronic decompression of spinal cord and nerve, the manifestation in MRI imaging is cystolic CSF signal both in T1 and T2 series without enhancement. The surgical treatment including dissection of the wall of the cyst, find and repair the CSF leakage under microscope, the outcome of surgical treatment is satisfactory.

关 键 词：脊柱 显微外科手术 脊膜囊肿 

分 类 号：R651.2[医药卫生—外科学]