脊髓髓内蛛网膜囊肿的临床特点及手术疗效  

The clinical features and surgical outcomes of spinal intramedullary arachnoid cysts

作　　者：刘鹏飞[1] 董阳[1] 孙剑瑞[1] 庞长河[1] Liu Pengfei;Dong Yang;Sun Jianrui;Pang Changhe(Department of Neurosurgery,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院神经外科,郑州450052

出　　处：《中华神经外科杂志》2023年第1期41-45,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨脊髓髓内蛛网膜囊肿的临床特点及手术疗效。方法回顾性分析2015年7月至2020年12月郑州大学第一附属医院神经外科收治的9例脊髓髓内蛛网膜囊肿患者的临床资料。9例患者均经脊髓背侧正中入路行囊肿减压并囊壁切除术。术前、术后短期及末次随访采用McCormick分级评估患者的脊髓神经功能。随访期间复查MRI,以观察囊肿有无复发。结果脊髓髓内蛛网膜囊肿约占同期收治的脊髓髓内占位性病变的3.86%(9/233);发病年龄为10~61岁,成年患者男女比例为2/5。首发症状主要为躯体疼痛(6/9)和肢体无力(4/9),可伴有急性病程(4/9);术前McCormick分级Ⅰ级1例,Ⅱ级4例,Ⅲ级4例。9例患者中,7例囊肿大部分切除,2例囊肿部分切除,术后均经病理学检查确诊。术后MRI提示囊肿均明显缩小。术后短期(术后1周)内4例症状完全缓解,5例部分缓解,其中4例随访期间症状进一步改善。1例失访,另外8例患者的随访时间为12~61个月,随访期间症状无复发,残留囊肿无增大。末次随访时,8例患者的McCormick分级均为Ⅰ级。结论脊髓髓内蛛网膜囊肿临床罕见,成人中女性多发,有症状的患者应积极行手术治疗,其临床预后良好。Objective To investigate the clinical characteristics and surgical outcomes of spinal intramedullary arachnoid cysts.Methods The clinical data of 9 patients with spinal intramedullary arachnoid cysts admitted to the Department of Neurosurgery of the First Affiliated Hospital of Zhengzhou University from July 2015 to December 2020 were retrospectively analyzed.All 9 patients underwent cyst decompression and cyst wall resection via dorsomedial approach.The McCormick classification was used to evaluate the spinal cord function of the patients before operation,short-term after operation,and at the final follow-up.During the follow-up period,MRI was re-examined to observe whether the cyst recurred.Results Intramedullary arachnoid cysts in the spinal cord accounted for about 3.86%(9/233)of space-occupying lesions in the spinal cord during the same period.Ages at onset ranged from 10 to 61 years,and the male to female ratio in adults was 2/5.The primary symptoms were mainly bodily pain(6/9)and limb weakness(4/9),sometimes accompanied by an acute course(4/9).Preoperative McCormick gradeⅠwas revealed in 1 case,Ⅱin 4 cases,andⅢin 4 cases.Among the 9 patients,most of the cysts were removed in 7 cases,and partial cysts were removed in 2 cases,all of which were confirmed by pathological examination after operation.Postoperative MRI showed that the cysts were significantly shrunk.The symptoms were completely relieved in 4 cases and partially relieved in 5 cases shortly after operation,and the symptoms of 4 cases were further improved during the follow-up period.Except for 1 case lost to follow-up,the follow-up time of the other 8 patients ranged from 12 to 61 months.During the follow-up period,there was no recurrence of symptoms or no enlargement of residual cysts.At the last follow-up,the McCormick grades of the 8 patients were all gradeⅠ.Conclusions Intramedullary arachnoid cysts of the spinal cord are rare clinical entities which are more common in women than in men,and patients with symptoms should be actively trea

关 键 词：蛛网膜囊肿 脊髓 神经外科手术 疾病特征 治疗结果 

分 类 号：R651.2[医药卫生—外科学]