椎管内硬脊膜外蛛网膜囊肿的临床特点及手术治疗

目的 探讨椎管内硬脊膜外蛛网膜囊肿的临床表现、手术方法及疗效。方法 2005年1月至2015年1月手术治疗椎管内硬脊膜外蛛网膜囊肿28例，其中采用囊肿全切+交通孔封闭术治疗5例，囊肿部分切除+交通孔封闭术治疗17例，囊肿切开+带蒂竖脊肌置入缝合术治疗6例。结果 术后随访5~72个月，平均51.6个月；症状完全消失18例，明显改善8例，无明显变化2例；术后复查脊椎MRI，仅1例复发。2例囊肿长度16 cm左右，术后出现较明显的脊柱后突畸形。结论 椎管内硬脊膜外蛛网膜囊肿建议采用囊肿全切+交通孔封闭术；若术中无法行囊肿全切或难以找到交通孔，则采用囊肿部分切除+交通孔封闭术或囊肿切开+带蒂竖脊肌置入缝合术，也是有效的手术方式。

Clinical features and surgical treatment of the spinal extradural arachnoid cyst

Objective To explore the clinical manifestations, pathogenesis, surgical treatment and surgical outcomes of spinal extradural arachnoid cysts (SEDAC). Methods The clinical data of 28 patients with SEDAC treated by surgery from January, 2005 to January, 2015 were analyzed retrospectively. Of 28 patients with SEDAC, 5 underwent total excision of SEDAC and fistula closure, 17 partial excision of SEDAC and fistula closure and 6 cyst dissection and the implantation of erector spinae. Results All the patients were followed up from 5 to 72 months (mean, 51.6 months). The symptoms completely disappeared in 18 patients, were significantly improved in 8, and insignificantly changed in 2. MRI showed that SEDAC recurred in 1 patient and there were obvious postoperative kyphos in 2 patients with the length more than 16 cm cysts during the following-up. Conclusions The classical surgical method is total excision of SEDAC and fistula closure. SEDAC sometimes cannot be totally excised or the communicating fistula cannot be closed, in the patients with SEDAC, in whom the partial excision of SDEAC and fistula closure or cyst dissection and the implantation of erector spinae should be performed.