椎管内脊膜囊肿的临床特征和治疗方法

目的 探讨椎管内脊膜囊肿的临床表现、诊断和治疗方法。方法 回顾性分析我院自2006年1月至2014年12月收治的39例椎管内脊膜囊肿（不包含骶管囊肿）患者的临床资料。结果 病变累及颈段3例，颈胸段1例，胸段11例，胸腰段18例，腰段5例，全椎管1例。本组35例行囊肿切除术，其中31例囊肿全切，4例囊壁大部切除；4例行囊肿-腹腔分流术。术中22例可见硬膜漏口并对漏口进行结扎或缝合外，或用自体脂肪或生物胶封闭。35例行囊肿切除术患者中，32例术后症状改善，3例无改善。4例行囊肿-腹腔分流术患者中，3例术后症状改善，1例无改善。术后随访3~6个月，影像学复查，囊肿均消失，均未见囊肿复发；39例患者术后Frankel 分级:C级6例，D级22例，E级11例；所有患者切口一期甲级愈合，无脑脊液漏，未有无菌性脑膜炎发生。结论 对于椎管内脊膜囊肿，MRI是首选的检查方法；手术是其有效方法；对于累及长节段脊髓的患者，开放手术难以全切时，可以考虑行囊肿-腹腔分流术以降低囊肿压力，缓解脊髓压迫。

Clinical features and treatment of intraspinal arachnoid cysts

Objective To discuss the clinical manifestation, diagnosis, treatment and prognosis of intraspinal arachnoid cyst. Method The clinical data of 39 patients with intraspinal arachnoid cysts, who were treated in our hospital from January, 2006 to December, 2014, were analyzed retrospectively, including the patients’ gender and age, laboratory examination, sites of the cysts, clinical manifestations, pathological outcomes, treatment and prognoses. Results Of 39 cysts, 3 were found at the cervical segments of the spinal cords, 11 at the thoracic segments, 5 cases at the lumbar segments, 18 cases at the thoracicolumbar segments and 1 from the thoracic to the sacral segments. MRI showed that the cysts were found at the ventral spinal cords in 11 patients and at the dorsal spinal cords in 28 patients. Of 35 patients receiving the excision of the cysts by surgery, 31 received the total excision of the cysts, and 4 the partial excision. The cysto-peritoneal shunt was performed in the other 4 patients. Of 35 patients receiving the excision of the cysts, 32 were improved in the symptoms and 3 not after the surgery. Of 4 patients receiving the cysto-peritoneal shunt, 3 were improved in the symptoms and 1 not. Conclusions MRI examination is very helpful to determining the site, number, size, and morphology of the cyst and its relation with the spinal cord. Surgery is an effective method to treat the intraspinal arachnoid cysts. The cysto-peritoneal shunt should be recommended in the patients with long intraspinal arachnoid cysts involving the multiple segments of the spinal cord in order to relieve the compression of the spinal cord.