胸腰段椎管内硬膜外脊膜囊肿的手术治疗  

Surgical treatment of intra-spinal extradural meningeal cysts in thoracolumbar spine levels

作　　者：谢京城[1] 王振宇[1] 陈晓东[1] XIE Jing-cheng;WANG Zhen-yu;CHEN Xiao-dong(Department of Neurosurgery,The Third Hospital,Peking University Beijing 100191,China)

机构地区：[1]北京大学第三医院神经外科,北京100191

出　　处：《中国临床神经外科杂志》2018年第8期513-515,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的总结胸腰段椎管内硬膜外脊膜囊肿的治疗经验。方法回顾性分析2007年1月至2017年6月手术治疗的20例胸腰段椎管内硬膜外脊膜囊肿的临床资料。结果囊壁次全切除16例,大部分切除4例;瘘口严密缝合17例,用附近残留囊壁缝合并以肌肉及脂肪加固3例。术前腰背痛20例,术后视觉模拟疼痛量表(VAS)评分[(2.14±2.02)分]较术前[(6.17±1.07)分]明显降低(P<0.05)。术前放射性下肢痛17例,术后VAS评分[(1.97±3.15)分]较术前[(7.09±2.11)分]明显降低(P<0.05)。15例运动障碍术后远端肌力提高1~3级。8例括约肌功能障碍术后日本骨科协会评分[(2.75±1.32)分]较术前[(1.97±2.01)分]明显增高(P<0.05)。术后随访6个月~10.5年,脊髓功能状态按Mc Cormick分级标准,均达到Ⅰ级;末次随访MRI检查证实囊肿无复发,脊柱序列及曲度完好,未见脊柱不稳定。结论胸腰段椎管内长节段硬膜外脊膜囊肿以慢性进行性脊髓及马尾神经受压神经功能障碍为主要表现;手术应采取对脊柱生物力学影响最小入路,显微镜下剥离切除囊壁,修补脑脊液瘘口,疗效满意。Objective To summarize the experience in surgically treating intra-spinal thoracolumbar extradural meningeal cysts(ITEMC).Method The clinical data of 20 patients with ITEMC who underwent microsurgery from January,2007 to June,2017 were analyzed retrospectively.Results The meningeal cysts had been subtotally or partially resected and cerebrospinal fluid(CSF)fistulae were repaired.The histological examination showed typical meningeal cyst tissues in all the cases.There was no postoperative complications occurred in all the patients.The lower limbs weakness or bowel and bladder dysfunction were gradually relieved after the operation.The period of follow-up was ranged from 6 months to 10.5 years(mean,3.8 years).The neurological function is normal.There was no recurrence of the meningeal cyst.MRI showed that the structures of the spinal cord and cauda equina were normal and the alignment and lordosis of spine were kept and the spinal stability is good in all the patients.Conclusions The ITEMCs were characterized by chronic decompression of spinal cord and nerve.The surgical treatment includes dissection of the cystic wall and repairing the CSF leakage under a microscope which are the key to the satisfactory outcomes of surgical treatment.

关 键 词：脊膜囊肿 胸腰段椎管 显微手术 疗效 

分 类 号：R739.42[医药卫生—肿瘤] R651.11[医药卫生—临床医学]