骶管蛛网膜囊肿的临床特点及显微手术治疗

目的探讨骶管蛛网膜囊肿的临床特点及治疗方法。方法回顾分析32例经显微手术治疗的骶管蛛网膜囊肿病人的影像学资料,分析其临床特点、手术方法及注意事项。结果骶管蛛网膜囊肿临床症状以骶管内神经受压表现为主,并且与体位有明显关系。X线及CT检查多数没有阳性发现;MRI显示硬膜囊末端为梭形的囊性肿物,且与脑脊液信号相同。本组28例获6个月~3年3个月(平均31.2个月)随访,优:20例,良:6例,可:2例,优良率92.9%。结论MRI是骶管蛛网膜囊肿最好的影像学检查方法,是诊断主要依据。对临床症状重者应考虑手术治疗,显微手术能有效防止术后复发及神经损伤。     

磁共振扫描骶管囊肿30例分析

骶管囊肿是引起腰腿痛的原因之一,临床并不少见,多数学者认为它是先天性的硬膜憩室或蛛网膜疝,是硬膜的一种先天性缺陷,可发生在硬膜囊正中或神经根的硬膜袖处,多数与蛛网膜下腔相通。为探讨骶管囊肿的磁共振成像(MRI)特点,为临床提供诊断依据,现将我院2003年4月～2004年6月骶管囊肿30例MRI扫描结果分析如下。     

MR相位对比电影法在蛛网膜囊肿诊断中应用价值初探

目的：评价磁共振相位对比电影法在蛛网膜囊肿与蛛网膜下腔扩大及囊肿与邻近脑池是否相通的诊断价值。材料和方法：运用磁共振相位对比电影法和流动分析软件对21例影像学疑为蛛网膜囊肿或蛛网膜下腔扩大患者进行检查，并分析其相位幅度图像形态及博动情况,测定相应病变区在相位速度图上的搏动强度。结果：蛛网膜囊肿在相位幅度图上可不清楚显示囊肿与邻近脑池相分隔：同时可显示囊肿内搏动幅度。囊肿内反向流动信号及喷射信号改变，提示与邻近蛛网膜腔相通。而在四脑室扩大者，相位幅度图未见明显囊腔，可见与导水管相通。结论：磁共振相位对比电影法对显示不同部位颅内蛛网膜囊肿的形态、与邻近蛛网膜下腔结构鉴别及了解囊肿内搏动情况判断与邻近脑池是否交通有重要价值。     

CT引导下经皮穿刺医用生物蛋白胶治疗神经根囊肿

目的探讨CT引导下经皮穿刺纤维蛋白粘合剂治疗神经根囊肿的疗效。材料与方法对9例骶神经根囊肿患者,在高分辨力CT引导下定位,行腰穿针经骶孔刺入神经根囊肿内,抽尽囊肿内液体。将医用生物蛋白胶(FG)的主体和催化剂溶解液,同时等量注入囊腔内。结果9例骶神经根囊肿患者经治疗后,神经压迫症状解除,术后随诊1～19个月无神经损伤、无感染、无复发。术后CT复查显示囊肿内CT值增高,无脑脊液存留。MRI示囊肿消失。结论CT引导下经皮穿刺引流囊肿内注射FG粘合剂治疗骶神经根囊肿是一种安全、可靠、经济、有效的新疗法。其远期疗效有待于进一步观察。     

椎管内蛛网膜囊肿的影像诊断

目的分析椎管内蛛网膜囊肿的X线平片、CT及MRI表现,以提高对本病的认识。资料与方法回顾性分析29例经手术病理证实的椎管内蛛网膜囊肿影像特征并评价不同影像方法对该病的诊断价值,X线平片及MRI检查29例,9例行CT检查。结果髓外硬脊膜下及较小的硬脊膜外蛛网膜囊肿X线平片无异常表现。较大的硬脊膜外蛛网膜囊肿X线平片、CT及MRI均显示椎管及椎间孔呈对称性扩大。CT及MRI显示囊肿的密度或信号与脑脊液类似,并能显示伸出椎间孔外的硬脊膜外蛛网膜囊肿有“分叉征”。只有MRI能正确显示囊肿在椎管内的位置,并能显示与蛛网膜下腔相通的裂孔平面的囊肿腔内有“脑脊液喷射征”。结论MRI对大多数椎管内蛛网膜囊肿具有定位和定性诊断价值,并可判断硬脊膜外蛛网膜囊肿与蛛网膜下腔相通的裂孔位置。CT对该病具有一定诊断价值,X线平片诊断意义有限。     

骶椎脊膜囊肿的MRI评价

骶椎脊膜囊肿通常是偶然发现的,目前无明确的影象学标准确定其是否可引发临床症状。标准MRI可精确显示脊膜囊肿的位置和大小,脊椎内肿物在T_1加权象上为低信号强度,在T_2加权象上为高信号强度,类似脑脊液(CSF)的信号强度。传统上使用X线平片或CT的脊髓造影来确定蛛网膜下腔与脊膜囊肿相通的情况。现在可应用MRI的流空效应研究脊膜囊肿内的液体流动。作者回顾性地研究了19例24个MRI的图象上的骶椎脊膜囊肿的大小和与蛛网膜下腔相通情况,患者年龄25～79岁,     

新生儿脑的脑脊液囊性病变的超声诊断

在婴儿使用实时前囟声学显像揭示了广泛的病理学范围和各种易混淆的囊性病变。本文目的是明确含有脑脊液囊肿的超声特征和构造。采用Har-wood-Nash 和Fitz(1976)的分类,分为:1.包裹的脑室—先天或获得性脑脊液流出道梗阻,造成部分或全部脑室内积液。2.蛛网膜囊肿—在蛛网膜与软脑膜之间的局部积液或与蛛网膜下腔相通的积液。3.穿通性脑囊肿—目前用于描述任何可能与脑室相通或不通的脑凹陷或腔的复合组畸形。这组又可分为2个简单的组:(a)脑裂,由于宫内畸形     

症状性骶管囊肿介入治疗研究进展

骶管囊肿是骶管内的囊性病变,其临床表现与腰椎间盘突出症、椎管内占位及椎管狭窄症等疾病相似,MRI是诊断的金标准.治疗的关键是降低囊内压及阻塞交通孔.目前对症状性骶管囊肿的最佳治疗方法虽然存在争议,但介入治疗以低风险、低费用、并发症少以及可反复使用等优点应用越来越广泛.本文对症状性骶管囊肿的介入治疗进行一系统总结.     

肝囊肿在DSA机器监控下介入治疗的探讨

目的：探讨DSA与B超结合监控下治疗肝脏囊肿的优点。方法：本组总结了近两年来我科20例病例，在B超引导下将穿刺针穿入囊肿，抽吸囊腔内的液体后注入造影剂，在DSA机器监测下可进一步了解探针的深度将探针插入适宜的深度后抽吸囊腔内的液体及向其内注入造影剂，使囊腔内的液体达到我们理想的量后再向囊腔内注入硬化剂，反复几次后再通过体位的改变达到充分破坏囊肿壁使囊肿消失的目的。结果：20例病例中，囊肿全部消失，2年内无复发为16例，占80％，术后复发仍可再次进行介入治疗，患者及其家属均对其可以接受。这20例患者均有较重的临床症状主要为消化道症状，巨大者产生黄疸（压迫所致）。有部分患者为肝脏被膜下囊肿其临床表现为肝区胀痛，短期内囊肿迅速增大有破裂造成腹水并发弥漫性腹膜炎的危险。结论：通过对本组20例病例的分析，证明此方法为治疗肝囊肿的一种安全有效的方法。     

脊蛛网膜囊肿的临床及X线同预后的关系

本文报告6例硬膜外和9例硬膜内脊蛛网膜囊肿的临床和X 线表现。蛛网膜囊肿沿蛛网膜下腔纵向伸展,并常通过相应窄小的颈与蛛网膜下腔相通。由于压迫脊髓或神经根常常可引起神经系统症状,甚或引起邻近骨侵蚀,其诊断通常以脊髓造影     

MR imaging of traumatic spinal arachnoid cyst

We report a case of post-traumatic lumbar arachnoid cyst, which enlarged the spinal canal and eroded the posterior elements. Computed tomographic myelography and magnetic resonance (MR) were complementary, and both correctly characterized the cystic nature of the lesion. Communication between the cyst and the subarachnoid space was demonstrated on CT myelography, which also clearly showed bone changes in the spinal canal. Continuity of the cyst with the spinal subarachnoid space was seen clearly on sagittal MR, and the MR signal characteristics of the cyst were identical with CSF.     

MRI of symptomatic sacral perineural cyst.

Sacral perineural cyst is a relatively rare condition. To our knowledge, reports of MR findings associated with sacral perineural cyst have been limited to only six cases. We present for the first time high field MR findings in a case of sacral perineural cyst. The cyst appeared as a cystic lesion in the sacral spinal canal and had intermediate signal intensity on T1W images and high signal intensity on T2*W images compared with CSF. Slight erosion remodeling of the sacrum was also seen anteriorly. Our case was symptomatic and present with radiculopathy (sciatic pain). Surgical treatment was done to result in dramatic improvement of the sciatic pain.     

The radiology of sacral cysts

The radiological findings in 10 patients with sacral cysts were retrospectively reviewed and classified. The cysts were an incidental finding on computed tomography (CT) in four patients. The expansion of sacral foramina or the sacral canal as seen on plain films suggested the diagnosis in three. In only two of the five patients who had myelograms did the cysts fill with contrast. In eight, CT showed remodelling and expansion of the sacral foramina, or the canal, or both, by a homogeneous mass with a density of 5-20 Hounsfield units. One of the patients underwent magnetic resonance imaging which confirmed that the lesion was fluid-filled. We found that sacral cysts can be either symptomatic or asymptomatic, that they may or may not communicate with the subarachnoid space, and that they have a characteristic CT appearance.     

骶部硬膜外囊肿的临床影像学表现与病理分析(18例报告及文献综述)

目的探讨骶部硬膜外囊肿的临床影像学与病理特点。方法本组18例均行腰骶部及骨盆X线平片检查,其中17例行CT扫描、11例行MRI检查、7例行脊髓造影、4例行脊髓造影CT(CTM)扫描,结合文献分析其影像学表现。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13例、椎管外型3例及混合型2例。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为椎管内或椎管外通过颈口与蛛网膜下腔相通的硬膜外囊性肿物,临床和影像学具有特征性表现。     

磁共振相位对比电影对蛛网膜囊肿与蛛网膜下腔扩大的鉴别诊断

目的：应用磁共振相位对比法,揭示脑与脑脊液运动的相互关系,以评价此方法对鉴别蛛网膜囊肿与蛛网膜下腔扩大的诊断价值。材料与方法：运用磁共振相位对比电影和流动分析软件,对１０例健康人脑与脑脊液运动规律相关性进行研究和１０例影像学疑蛛网膜囊肿或蛛网膜下腔扩大患者的脑脊液运动进行最化分析,绘出一个心动周期不同时相脑脊液流量贡线和时间、信号强度曲线,并进行分析比较。结果：脑脊液流动是由脑运动驱动引起,而脑运     

MR imaging of hindbrain deformity in Chiari II patients with and without symptoms of brainstem compression

We examined the MR appearance of the hindbrain deformity, including the upper cervical spinal canal and craniovertebral junction, in 33 patients with Chiari II malformation. In this disorder, there is impaction at birth of the medulla and cerebellar vermis into the upper cervical spine, resulting in obliteration of the subarachnoid space and scalloping of the dens. Spinal canal enlargement during the child's growth, combined with dorsal displacement of neural tissue, eventually causes marked widening of the precervical subarachnoid space. This enlargement may simulate an intradural mass. Our series documents the changes seen at birth and the progression of the widened precervical space through the first and second decades. Twelve (36%) of the 33 patients studied were symptomatic, with brainstem or longtract symptomatology, and 11 of these required surgery. This group was compared with the remaining 21 asymptomatic Chiari II patients to identify MR features associated with clinical deterioration. The level of descent of the hindbrain hernia was critical; eight of 12 symptomatic patients had a cervicomedullary kink at C4 or lower, while no asymptomatic patients had a fourth ventricle, medulla, or kink below C3-C4. The precervical cord subarachnoid space was slightly wider in asymptomatic patients, although there was great overlap. In five patients with follow-up scans, this space was seen to increase in width after laminectomy. A CSF flow void was present in the precervical space in about 25% of patients in both groups. In nine of 12 symptomatic patients, C1 arch indentation of the dura (causing significant compression) was confirmed surgically. However, seven (33%) of the 21 asymptomatic patients also had this appearance. Absolute measurement of the anteroposterior diameter of the canal at C1 ranged from 11 to 25 mm in both groups. Retrocollis, which persisted despite sedation for MR, was seen in two patients, both symptomatic. Recognition of the vermis, medullary kink, cervical cord, C1 arch, fourth ventricle, and precervical space in Chiari II patients is fundamental to the analysis of symptoms in     

Symptomatic spinal epidural collections after lumbar puncture in children

BACKGROUND AND PURPOSE: Complications from lumbar puncture (LP) include headache; mild puncture-site pain; and, rarely, subdural, epidural, or subarachnoid hemorrhage. In infants, asymptomatic leakage of CSF documented with ultrasound is common. We report the MR imaging findings and clinical course of 25 symptomatic patients with spinal epidural collections after LP. MATERIALS AND METHODS: MR imaging and clinical records of 25 children with new symptoms following LP were retrospectively reviewed. RESULTS: All patients had abnormal dorsal spinal epidural collections. Signal-intensity characteristics of the collections were most commonly isointense to CSF on all pulse sequences. Significant anterior displacement of the dura with effacement of the subarachnoid space was frequently noted. All patients had fluid surrounding small foci of epidural fat, elevating them from their native interspinous fossa, resulting in a "floating" appearance. Eighteen collections involved the thoracic and lumbar spine; 4 involved the thoracic, lumbar, and sacral spine; 2 extended from the lumbar to the cervical level; and 1 was isolated to the lumbar spine. Five patients had follow-up MR imaging showing complete resolution of collections. The size of the collections was not directly related to the number of puncture attempts. Clinical symptoms resolved with time in all patients with conservative management. CONCLUSION: Symptomatic epidural fluid collections after LP are often extensive and may compromise the thecal sac. These collections are not usually the result of a difficult LP and have signal intensity characteristics most consistent with CSF leak rather than hemorrhage. Signs and symptoms typically resolve with time, without treatment and with no serious sequelae.     

Characteristics of CSF Velocity-Time Profile in Posttraumatic Syringomyelia

BACKGROUND AND PURPOSE:The development of syringomyelia has been associated with changes in CSF flow dynamics in the spinal subarachnoid space. However, differences in CSF flow velocity between patients with posttraumatic syringomyelia and healthy participants remains unclear. The aim of this work was to define differences in CSF flow above and below a syrinx in participants with posttraumatic syringomyelia and compare the CSF flow with that in healthy controls.MATERIALS AND METHODS:Six participants with posttraumatic syringomyelia were recruited for this study. Phase-contrast MR imaging was used to measure CSF flow velocity at the base of the skull and above and below the syrinx. Velocity magnitudes and temporal features of the CSF velocity profile were compared with those in healthy controls.RESULTS:CSF flow velocity in the spinal subarachnoid space of participants with syringomyelia was similar at different locations despite differences in syrinx size and locations. Peak cranial and caudal velocities above and below the syrinx were not significantly different (peak cranial velocity, P = .9; peak caudal velocity, P = 1.0), but the peak velocities were significantly lower (P < .001, P = .007) in the participants with syringomyelia compared with matched controls. Most notably, the duration of caudal flow was significantly shorter (P = .003) in the participants with syringomyelia.CONCLUSIONS:CSF flow within the posttraumatic syringomyelia group was relatively uniform along the spinal canal, but there are differences in the timing of CSF flow compared with that in matched healthy controls. This finding supports the hypothesis that syrinx development may be associated with temporal changes in spinal CSF flow.

Syringomyelia is a neurologic condition characterized by the development of a syrinx, a fluid cyst in the spinal cord. It is commonly associated with conditions that obstruct spinal CSF flow such as spinal cord injury,¹ Chiari type I malformation, and spinal tumors. Syrinxes form and enlarge in either the central canal of the spinal cord or in the cord parenchyma. For a syrinx to enlarge, the laws of mechanics require that the syrinx pressure exceed the pressure in the surrounding cord tissue and spinal subarachnoid space. However, the mechanism of CSF flow into a syrinx in the presence of this reverse pressure gradient is poorly understood and remains controversial. Computational models suggest that CSF could be driven by cardiac pulsations fromthe spinal subarachnoid space into the spinal cord via periarterial spaces, including toward a syrinx.² Besides CSF, another possible source of syrinx fluid could be extracellular fluid. It has recently been shown that after spinal cord injury, the blood–spinal cord barrier is damaged for an extended time³ and fluid could hence pass from the vasculature into a syrinx. However, the source of fluid in the syrinx has yet to be identified because the chemical composition of CSF and extracellular fluid is indistinguishable.⁴Understanding the characteristics of CSF dynamics in the spinal subarachnoid space and the way they change in conditions associated with syringomyelia may help elucidate the mechanism of the disease. Characterizing CSF flow in syringomyelia may also improve clinical management because syrinx morphology from MR anatomic images alone is insufficient to predict disease progression and surgical outcomes. Current treatment techniques for posttraumatic syringomyelia, such as shunting, are associated with syrinx recurrence. Therefore, understanding the CSF flow characteristics in these patients may help in developing effective techniques to manage this complex condition.CSF flow in the spinal subarachnoid space consists of pulsatile caudal and rostral flow during systole and diastole, respectively.⁵ Caudal flow in the spinal subarachnoid space commences approximately 100 ms after the onset of systole in healthy individuals, and the timing of its onset is affected by age and CSF obstructions in the spinal subarachnoid space. Detailed mechanisms that underpin the earlier onset of peak caudal CSF are not yet well-established and may be influenced by compliance in the craniospinal system. In the spinal subarachnoid space of healthy individuals, peak caudal and cranial velocities and their onset vary with spinal level. However, these variables are different in those with Chiari malformation.⁶Despite numerous studies in the literature of CSF flow in participants with Chiari type I malformation with and without syrinxes, there is a lack of understanding of spinal CSF dynamics in those who have sustained a spinal cord injury. Therefore, this study aimed to determine the CSF velocity-time profiles adjacent to the syrinx in participants with spinal cord injury and compare them with those in healthy controls. It is hypothesized that the peak CSF velocities and timing of the profile would be significantly altered in patients with posttraumatic syringomyelia.