Parker F, Aghakhani N, Tadié M
Service de Neurochirurgie, Centre Hospitalier Universitaire Bicêtre, Faculté de Médecine Paris-Sud, Le Kremin-Bicêtre.
Neurochirurgie. 1999 Jun;45 Suppl 1:67-83.
We conducted a retrospective study of 32 patients treated for syringomyelia associated with non-traumatic arachnoid scarring. We selected the cases with documented history of arachnoiditis with pre and post-operative clinical evaluation of the neurological status and anatomical study on MRI with a minimal follow-up of one year. Extensive arachnoid scarring (Group I) was noted in 18 cases, after spinal meningitis in 15 cases (tuberculosis in 9 cases, listeria in 3 cases, pyogenic meningitis in 3 cases), subarachnoid hemorrhage in 3 cases. Focal arachnoid scarring (Group II) occurred in 10 cases, related to spinal surgery in 5 cases (meningiomas: 2, neurinomas: 2, thoracic discectomy: 1), to peridural anesthesia in 1 case, thoracic disc herniation in 1 case, Pott's disease in 1 case, no obvious cause in 2 cases. Basal arachnoid scarring without hindbrain herniation (Group III) was associated with birth injuries in 4 cases. Shunting of the syrinx to the subarachnoid or peritoneal cavity was associated with a recurrence rate of 60% whereas microsurgical dissection of the arachnoid scar and decompression of the subarachnoid space with a recurrence rate of 33%, with a mean follow-up period of 28 months. Successful long-term management of the syrinx was associated with basal or focal spinal arachnoid scarring, no history of spinal meningitis, microsurgical dissection of the arachnoid scar and decompression of the subarachnoid space.
我们对32例因非创伤性蛛网膜瘢痕形成所致脊髓空洞症接受治疗的患者进行了一项回顾性研究。我们选择了有蛛网膜炎记录病史的病例，并对其进行术前和术后神经功能状态的临床评估以及MRI解剖学研究，随访时间至少为1年。18例患者出现广泛蛛网膜瘢痕形成（I组），其中15例继发于脊髓膜炎（9例为结核性，3例为李斯特菌性，3例为化脓性脑膜炎），3例继发于蛛网膜下腔出血。10例患者出现局灶性蛛网膜瘢痕形成（II组），其中5例与脊柱手术有关（2例为脑膜瘤，2例为神经鞘瘤，1例为胸椎椎间盘切除术），1例与硬膜外麻醉有关，1例与胸椎椎间盘突出症有关，1例与脊柱结核有关，2例病因不明。4例患者出现无后脑疝的基底蛛网膜瘢痕形成（III组），与出生时损伤有关。将脊髓空洞分流至蛛网膜下腔或腹腔的复发率为60%，而蛛网膜瘢痕显微手术切除及蛛网膜下腔减压的复发率为33%，平均随访期为28个月。脊髓空洞的成功长期治疗与基底或局灶性脊髓蛛网膜瘢痕形成、无脊髓膜炎病史、蛛网膜瘢痕显微手术切除及蛛网膜下腔减压有关。
