骶部硬膜外囊肿的影像学评估

目的 探讨引起腰腿痛原因之一的骶部硬膜外囊肿的影像学检查诊断价值及临床意义。方法 回顾性地分析了16例经手术证实的骶部硬膜外囊肿的X线、CT及MRI表现。结果 对临床误诊椎间盘病变及腰椎管病变、X线片及CT均未明确诊断的骶部硬膜外囊肿病例,MRI能作出明确诊断、表现为骶管内囊状边界清楚长T1长T2异常信号。结论 骶部硬膜肿在临床上常常被误诊或漏诊,普遍X线片及CT不易发现,MRI能明确诊断骶部硬膜外囊肿,定位、定位准确且对患者无任何伤害、无痛苦,能为临床手术治疗提供解剖学依据。     

骶部硬膜外囊肿的临床影像学表现与外科治疗(18例报告及文献综述)

[目的]结合文献探讨骶部硬膜外囊肿（SEC）的临床表现、影像学特点与外科治疗，以便提高对该病的临床诊断和治疗水平。[方法]本组18例，其中腰骶部钝痛17例（95％）、下肢放射性疼痛和间歇性跛行16例（90％）、神经功能损害14例（77％）、盆腔或下腹部无痛渐进性肿块并压迫临近器官2例（11％）。18例均行腰骶部及骨盆X线片检查，其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行CTM扫描。[结果]本病临床误诊率为78％，X线诊断率17％，CT诊断率72％；MRI检查、脊髓造影、CTM扫描诊断率100％。18例均手术切除，病理报告为硬膜外囊肿，椎管内型、积液型、单发囊肿为多数；随访15～32个月，平均24个月，未发现症状加重和复发病例。[结论]骶部硬膜外囊肿临床与影像学具有特征性表现；微创术和腹腔镜、脊髓或椎管镜摘除骶椎管内囊肿的临床应用疗效有待于定论；显微外科技术的应用提高了SEC全切除率，手术是治疗和防止本病复发的最主要和最可靠方法。     

腰椎间盘突出合并骶管内蛛网膜囊肿的诊治

目的探讨腰椎间盘突出症合并骶管内蛛网膜囊肿的诊断治疗方法。方法对2001年1月至2004年4月收治的该类患共6例。均采用一次手术除突出的髓核及处理骶管内蛛网膜囊肿，并对其影像学检查方法及临床表现进行分析。结果本病的临床特点是以神经根性腰腿痛为主，伴有骶神经压迫症状；CT扫描及X线片容易漏诊，MRI能显示囊肿的部位、形态、大小及对周围的压迫情况，其影像学表现与手术所见一致；除突出髓核及处理骶管囊肿一次手术完成能彻底解除压迫．疗效显。结论MRI检查是诊断腰椎间盘突出症合并骶管内蛛网膜囊肿的有效方法．同时处理突出的髓核及骶管囊肿．能收到较好的疗效。     

腰骶部硬膜外囊肿的诊断与治疗

目的　探讨腰骶部硬膜外囊肿的临床与影像学特点 ,以提高临床诊治水平。方法　结合14例病人的诊治体会 ,对其临床表现与影像学特点进行分析。结果　腰骶部硬膜外囊肿的临床表现无特异性 ,脊髓造影和 MRI检查意义较大 ,治疗有手术和非手术治疗。结论　对原因不明的腰腿痛患者 ,应进行必要的影像学检查 ,以确定是否为硬膜外囊肿。脊髓造影和 MRI检查对本病具有诊断和鉴别诊断价值 ,症状严重者以手术治疗为主     

脊髓造影在腰椎管疾病诊断中的应用

目的探讨脊髓造影存腰椎管疾病诊断中的应用价值。方法通过32例手术证实脊髓造影诊断符合率及与CT、MRI影像比较。结果55例造影阳性49例，手术32例中与造影诊断完全符合27例，占84．4％。结论对临床症状、体征疑似腰椎管病变，而CT、MRI显示不明显或影像与体征不符者，可选用脊髓造影进一步明确诊断，以减少手术探查的盲目性，获得最好的治疗效果。     

骶管内囊肿的诊断及其发生机制的探讨

目的：探讨骶管内蛛网膜囊肿的影像学特点发生机制。方法：观察24例手术证实的骶管内蛛网膜囊肿病人的X线片、CT、造影后CT、MRI等影像资料，分析其临床特点及术中的病理特点。结果：5例X线片显示骶骨侵蚀性改变，5例CT显示骶骨侵蚀性改变及骶管内囊肿，1例造影后CT囊肿内造影剂显影，22例MRI显示囊肿呈长T1及T2信号，信号强度与脑脊液一致。临床症状以骶管内神经受压表现为主，囊肿与硬膜囊一般有交通孔。交通孔为瓣膜样。结论：MRI是最好的影像学诊断方法；骶管内蛛网膜囊肿的发生是由于先天的硬膜缺陷所致；瓣膜样交通孔是病程进展的结果。     

腰骶神经根囊肿的临床诊断和治疗探讨

目的：探讨腰骶神经根囊肿的临床诊断及治疗方法。方法：27例神经根囊肿患者，男17例，女10例，年龄42～65岁，平均53．6岁。其中有7例保守治疗，20例行手术治疗。手术中13例行囊肿大部分切除，残余部分缝合包绕囊内神经根；7例行囊肿大部分切除后用骶棘肌填塞交通孔。并对腰骶神经根囊肿的临床表现以及CT、脊髓造影、MRI等影像学资料进行分析。结果：CT扫描可见椎体后缘凹陷性压迹9例。脊髓造影显示神经根有囊状充盈11例。MRI显示囊肿在Tl加权像呈低信号，T2加权像呈高信号，信号与脑脊液一致。结论：MRI对本病诊断和鉴别诊断具有重要的临床价值；对保守治疗无效者，应行椎板开窗减压和囊肿摘除术。     

骶部硬膜外囊肿诊治体会

目的 总结骶部硬膜外囊肿的诊治要点。方法 1994－1999年7例患者,分析其临床、影像学表现,行囊肿全部或部分切除＋囊颈结扎术,显微外科操作3例,回顾文献探讨病因、发病学。结果 5例经CT或／和MRI得到术前诊断,MRI诊断率100％。7例术后均取得优良效果,随访例无复发,时间4个月－5年。结论 MRI是诊断骶部硬膜外囊肿的可靠方法,囊肿切除＋囊颈结扎是有效的手术方法,粘连重者应行显微外科操作。     

CT硬膜外造影对腰椎管狭窄症的诊断价值

目的：探讨硬膜外造影后CT(CT-E)对腰椎管狭窄症的诊断价值及影像特征。方法：对27例腰椎管狭窄症患者行腰椎X线平片及单纯CT检查后再行CT-E检查。CT—E扫描椎体下1／3、椎间隙、椎体上缘平面，结合单纯CT及手术所见行对比分析。结果：CT-E诊断中央管狭窄3例，中央管伴侧隐窝狭窄2例，侧隐窝狭窄16例，神经根管狭窄4例，椎问孔狭窄2例。与于术所见吻合25例，诊断准确率达93％；单纯CT与手术所见吻合23例．诊断准确率为85％。结论：CT—E对腰椎管狭窄症更具有定性、定位诊断作用，可为有限化手术提供依据。     

骶管硬膜外蛛网膜囊肿的临床特点及治疗(附7例报告)

目的：探讨骶管硬膜外蛛网膜囊肿的临床特点及治疗方法。方法：本组7例，男2例，女5例，年龄28－76岁，平均44．2岁，病变全部位于S1、S2节段。临床特点：腰骶部钝痛，下肢痛与体位改变有关，膀胱功能障碍。X线检查：7例中骶骨骨质侵蚀4例，有腰骶部先天畸形2例，MRI检查：硬膜囊末端均为梭型的囊性肿物。治疗：全部采取手术摘除。结果：7例中6例得到随访5月－5年，平均3．8年，全部病人腰骶部症状缓解。结论：骶管硬膜外蛛网膜囊肿临床上少见，容易误诊，其诊断靠病史、体征及影像学检查，其治疗则采用手术摘除，疗效满意。     

Chronic perineal pain related to sacral meningeal cysts.

Chronic perineal pain is an often encountered problem that is difficult to evaluate. Based on a series of 17 patients in whom urological, gynecological, and anorectal pathology was excluded, the authors compared magnetic resonance imaging (MRI) with computed tomographic (CT) scan with myelography in the investigation of chronic perineal pain. After a clinical neurological examination, patients underwent radiodiagnostic imaging of both techniques. Thirteen patients (76%) had one or more sacral meningeal cysts (MC) on MRI scan, whereas CT scan with myelography of the lumbar and sacral region revealed 7 patients (41%) with sacral MC. Sacral MC may be the etiology of chronic perineal pain in many instances, and MRI scan appears to be superior to CT scan with myelography in demonstrating sacral MC. Ten patients with sacral MC were operated on with moderate to excellent results 6 months after operation. Early postoperative results are encouraging, but further follow-up and larger series are required.     

Computed tomographic epidurography: an aid to understanding deformation of the lumbar dural sac by epidural injections.

Local anaesthetics injected into the epidural space may deform the dural sac to a variable degree, thereby contributing to variability in the extent of the block. We investigated deformation of the lumbar dural sac after injection into the lumbar epidural space. The subjects were 26 patients with low-back pain who underwent lumbar epidurography and computed tomographic (CT) epidurography, of whom seven also underwent myelography and computed tomographic myelography. The epidural space was entered via the sacral hiatus in 24 patients and through the L5/S1 interspace in two patients. Ten millilitres of local anaesthetic was then injected into the epidural space followed by 20 mL of contrast medium. Computed tomographic epidurography was undertaken approximately 30-min after the epidural injection at the mid-vertebral and mid-discal levels from the first lumbar through to the first sacral vertebrae. The dural sac usually showed an oval or hexagonal shape on the transverse views at the first and second lumbar vertebral levels, and the shape of an inverted triangle below the level of the third lumbar vertebra. A median line of translucency was also observed on the posteroanterior epidurographic view in 25 of the 26 patients. This line was though to be a manifestation of the dural deformation to the inverted triangle. Dural sac deformation usually shows a specific pattern, although there are individual variations. Dural deformability is an important consideration in any analysis of the spread of epidural block or of the changes of epidural pressure after epidural injection of local anaesthetics.     

Microsurgical excision of symptomatic sacral perineurial cysts: a study of 15 cases

BACKGROUND: The widespread use of magnetic resonance imaging (MRI), now the first line investigation for back and leg pain, reveals cystic sacral lesions more often than myelography did in the past. There is agreement that symptomatic perineurial sacral cysts should be treated surgically. However, it is still debated whether the preference should be given to the curative option, consisting of excision of the cyst with duraplasty, or to drainage of the cyst to relieve symptoms. In this retrospective study the efficacy of microsurgical cyst resection with duraplasty is evaluated. METHODS: In 15 patients presenting with pain and neurologic deficits, myelography and/or MRI detected sacral cysts. The clinical features suggested that the space-occupying lesions caused the disturbances. Microsurgical excision of the cyst along with duraplasty or plication of the cyst wall was performed in all the cases. Postoperative care included bed rest and CSF drainage for several days. RESULTS: In 13 out of 15 patients the preoperative radicular pain disappeared after surgery. The 2 patients with motor deficits and the 6 patients with bladder dysfunction recovered completely. In all except 1 of the 10 patients complaining of sensory disturbances a significant improvement was achieved. No complications were observed. CONCLUSION: Microsurgical excision of the cyst combined with duraplasty or plication of the cyst wall is an effective and safe treatment of symptomatic sacral cysts and, in the view of the authors, the method of choice.     

椎管内蛛网膜囊肿临床表现及其手术方式

目的:分析椎管内蛛网膜囊肿的临床表现、手术方式及其治疗效果,为椎管内蛛网膜囊肿诊断和手术治疗方案的合理选择提供依据.方法:回顾分析21例椎管内蛛网膜囊肿临床表现、手术方式及术后效果,男9例,女12例;年龄21～55岁,平均36.15岁;病程2个月～3年,平均6.2个月.21例椎管内蛛网膜囊肿中1例发生于颈段、1例发生于胸段、19例发生于骶部,表现为受累神经支配区的放射性疼痛、感觉异常、功能障碍.16例经CT结合椎管造影明确诊断,其余通过MRI明确诊断.8例采用囊肿切除、囊颈部结扎、硬膜重叠紧缩缝合手术;11例囊肿壁与神经难以分离,采用囊肿壁部分切除、交通口肌肉堵塞、硬膜紧缩缝合手术;2例串珠状囊肿,其交通口未能找到,采用囊肿开窗引流、囊壁部分切除、硬膜重叠紧缩缝合、游离肌肉压迫固定.结果:19例患者获得随访,随访时间2个月～5年3个月,平均21.2个月.囊肿切除、囊颈部结扎手术组的优良为6例,囊肿壁部分切除、交通口肌肉堵塞组的优良为8例.结论:椎管内蛛网膜囊肿是蛛网膜的先天性畸形,以骶部椎管好发,大多数临床表现为受累神经的功能异常;具有手术指征的病例,术中应根据囊肿开口、囊肿壁是否能与神经分离等情况选择不同的囊肿处理方法.     

Tarlov cyst: Case report and review of literature

We describe a case of sacral perineural cyst presenting with complaints of low back pain with neurological claudication. The patient was treated by laminectomy and excision of the cyst. Tarlov cysts (sacral perineural cysts) are nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion. The incidence of Tarlov cysts is 5% and most of them are asymptomatic, usually detected as incidental findings on MRI. Symptomatic Tarlov cysts are extremely rare, commonly presenting as sacral or lumbar pain syndromes, sciatica or rarely as cauda equina syndrome. Tarlov cysts should be considered in the differential diagnosis of patients presenting with these complaints.     

症状性骶管内囊肿的诊断与治疗

目的：探讨症状性骶管内蛛网膜囊肿的诊断与治疗方法.方法：对12例以骶管内神经受压表现为主,如腰骶部疼痛、下肢痛、会阴部疼痛,鞍区麻木不适,大小便障碍,下肢无力患者,行MRI检查.结合临床症状、体征及MRI表现明确诊断为症状性骶管内囊肿后行手术治疗.手术均在显微镜下操作.对未见明显交通孔的7例中5例行囊壁大部切除后残存囊壁修补缝扎,2例因硬脊膜缺如,无法修补而行囊肿部分切除旷置;5例有交通孔的患者中,2例囊肿大部切除后用肌肉填塞交通孔,2例因交通孔处理困难未作特殊处理,1例囊肿大部切除后,切开交通孔处硬脊膜以扩大交通孔至脑脊液通畅流出,消除交通孔的单向阀门作用.严密缝合切口,术后采取头低臀高俯卧位.结果：骶管内囊肿在MRI上表现为骶管内单发或多发类圆形或椭圆形的软组织影,呈长T1、长T2表现,信号与脑脊液相同.术后2例出现少量皮下积液,加压包扎2～3个月后自行吸收,无1例脑脊液漏.随访3个月～4年6个月,平均18.3个月,症状完全缓解8例,部分缓解3例,1例3个月后症状复发,MRI检查示囊肿较术前轻微扩大,未再次手术.结论：MRI检查是正确诊断骶管内蛛网膜囊肿的有力手段,伴有临床症状、体征者应考虑手术治疗.对囊肿的处理以囊肿大部切除为主,严密缝合切口各层及术后合理体位可以有效防止并发症的发生.     

The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging

The accuracy of computed tomography (CT), myelography, CT-myelography (myelo-CT) and magnetic resonance imaging (MRI) for the diagnosis of lumbar herniated nucleus pulposus (HNP) is compared prospectively in 59 patients, all of whom underwent surgical exploration. All tests were read independently of each other and the level of confidence in each diagnosis was recorded. The results are based on the negative (61) as well as positive (59) findings at the 120 disc sites (level and side) explored. Magnetic resonance imaging was the most accurate test (76.5%) compared with myelo-CT (76.0%), CT (73.6%), and myelography (71.4%). The false positive rate was lowest for MRI (13.5%) followed by myelography (13.7%), CT (13.8%), and myelo-CT (21.1%). The false negative rate was lowest for myelo-CT (27.2%) followed by MRI (35.7%), CT (40.2%), and myelography (44.1%). In that subset of 19 patients who had prior surgery, myelography was the most accurate means of diagnosing lumbar HNP (88.8%), followed by MRI (83.3%), myelo-CT (78.4%), and CT (72.6%). The false positive rates in these patients were 11.6% for myelography, 13.2% for MRI, 14.5% for CT, and 16.4% for myelo-CT; the false negative rates were 22.7% for MRI, 24.4% for myelography, 29.5% for myelo-CT, and 47.7% for CT. Magnetic resonance imaging compares very favorably with other currently available imaging modalities for diagnosing lumbar HNP. Magnetic resonance imaging is painless, has no known side effects or morbidity, no radiation exposure, and is noninvasive. The authors recommend it as the procedure of choice for the diagnosis of most lumbar disc herniations.     

Sacral perineural cyst--report of a case

The presence of cysts within the sacral spinal canal, so-called sacral cysts, is described in literature. These include 'sacral perineural cyst', 'sacral extradural cyst', 'occult intrasacral meningocele' and 'anterior sacral meningocele'. Sacral perineural cyst in these cystic disorders was first described as an incidental autopsy finding by Tarlov in 1938. Since then, several reports have been made describing the sign and symptom, neurological findings, roentgenographic diagnosis and cause and origin of the sacral perineural cysts, although many problems are not yet solved satisfactorily. This cyst occurs on the extradural components of sacral or coccygeal nerve roots. Although most are asymptomatic, these occasionally cause low back pain, sciatic and sacrococcygeal pain, sensory and motor disturbance in the lower extremities, and urinary dysfunction, which symptoms are similar to those brought on by lumbar disc herniation. In 1948, Tarlov reported a case of sciatic pain due to a perineural cyst, the removal of which relieved the symptoms. Symptoms occur because adjacent nerve roots are impinged upon by the thin-walled, fluid-filled cysts, which are formed in a space between the endoneurium and the perineurium. Microscopically, the cyst walls consist of peripheral nerve fibers or ganglionic cells covered with meningeal epithelium. Communication of the cyst with subarachnoid cerebrospinal fluid may be poor, but myelogram and CT myelogram demonstrate the cysts filling with contrast media. With the advent of magnetic resonance imaging (MRI), imaging of the sacral perineural cysts has improved. Recently we had the opportunity to evaluate a patient in whom perineural cysts had caused considerable erosion of the sacrum.(ABSTRACT TRUNCATED AT 250 WORDS)