脊髓神经管原肠性囊肿的显微手术治疗及分析

目的探讨脊髓神经管原肠性囊肿的临床、组织病理及形态学特点,分析手术切除方式对预后的影响。方法回顾性分析自1998年1月至2010年12月8例脊髓神经管原肠性囊肿病例的临床资料。其中4例首发症状为局部脊髓节段疼痛伴肢体乏力、感觉减退、肌肉萎缩,3例以神经根性疼痛症状发病,1例表现为Brown-Sequard综合征。8例患者的影像学表现均为髓外硬膜下型,均给予脊髓后路手术切除。结果全部手术的8例患者中,5例全切,2例部分切除行囊腔旷置,1例部分切除行囊腔蛛网膜下腔分流术。术后8例患者症状均有不同程度缓解,影像学、电话及门诊随访6例(4例完全切除、1例部分切除行旷置术、1例部分切除行囊腔-蛛网膜下腔分流术)(25.0±9.0)月(12～38)月,症状均无再次加重。结论神经管原肠性囊肿可通过后正中入路手术全切或部分切除获得治愈,应尽早手术治疗。

Microneurosurgery of neurenteric cysts of spine

Objective To probe into the clinical, histopathology and morphology of neurenteric cysts of spine （NEC） and analyze the relationship between operation modes and sttrgical restdts. Methods The clinical data of 8 patients with NEC from January 1998 to December 2010 were analyzed retrospectively. Limbs pain, weakness, hypesthesia or myatrophy presented in 4 cases, radiculalgia in 3 cases and Brown-Sequard symptom in 1 case due to the relevant spine sections and nerve roots compression. All NECs were located in the intradural/extramedullary compartment and had been removed via the posterior approach. Results Among all the cases, gross total resection （GTR） was achieved in 5 cases, partial resection （PR） in 2 cases, and partial resection and cystosubarachnoid shunting （PR ＋CAS） in 1 case. Symptoms of all the patients were improved post-operation. Six patients （4 GTR, 1PR, 1 PR ＋CAS） were followed up by telephone or clinic service for 12-38 months （mean, 25.0±9.0 months）. None of them got deterioration. Conclusion For patients with NEC, operation is recommended to perform as early as possible, for it can be cured by gross total resection or partial resection via the posterior approach.