Conti Carlo, Lunardi Pierpaolo, Bozzao Alessandro, Liccardo Giovanni, Fraioli Bernardo
Department of Neuroscience and Neurosurgery, University of Rome Tor Vergata, Rome, Italy.
Spine (Phila Pa 1976). 2003 Jul 15;28(14):E279-83.
This is a case report of a 37-year-old woman who sought treatment for a large syringomyelic cavitation extending from C3 to the entire medulla, a tetraventricular hydrocephalus, and a cystic cavitation in the posterior cranial fossa communicating with the fourth ventricle (Blake's pouch cyst). The patient underwent a decompressive craniectomy, a C1 laminectomy, and the opening of the cysts to enable communication with the subarachnoid spaces. After an initial period of symptom remission, reassured by the magnetic resonance images indicating a reduction of the syringomyelia, the patient's neurologic conditions deteriorated because of further dilation of the ventricular cavities, which was resolved by the insertion of a ventriculoperitoneal shunt.
To suggest the treatment of choice in a patient with syringomyelia and hydrocephalus caused by Blake's pouch cyst.
Blake's pouch cyst is an entity often poorly understood, deriving from nonperforation of the primitive foramen of Magendie, causing a precarious equilibrium of the cerebrospinal fluid flow resulting from a defect in communication between the fourth ventricle and the encephalic and spinal subarachnoid spaces. Authors report the association of Blake's pouch cyst with cervicodorsal syringomyelia and tetraventricular hydrocephalus.
A case of syringomyelia associated with hydrocephalus and Blake's pouch cyst is described.
Symptoms of syringomyelia and hydrocephalus disappeared only after positioning of a ventriculoperitoneal shunt.
The treatment of choice for a case of syringomyelia associated with Blake's pouch cyst and hydrocephalus is the application of a ventriculoperitoneal shunt or, even better, an endoscopic third ventriculostomy.
本文是一例37岁女性的病例报告。该患者因巨大的脊髓空洞症（空洞自C3延伸至整个延髓）、四脑室脑积水以及后颅窝与第四脑室相通的囊性空洞（Blake囊肿）而寻求治疗。患者接受了减压颅骨切除术、C1椎板切除术，并打开囊肿以使其与蛛网膜下腔相通。在最初症状缓解期，磁共振成像显示脊髓空洞症有所减轻，患者因此感到安心，但随后由于脑室腔进一步扩张，其神经状况恶化，最终通过插入脑室腹腔分流管得以解决。
提出针对由Blake囊肿引起的脊髓空洞症和脑积水患者的首选治疗方法。
Blake囊肿是一种常未被充分理解的病症，源于马让迪氏原始孔未穿孔，导致脑脊液流动的不稳定平衡，这是由于第四脑室与脑和脊髓蛛网膜下腔之间的连通缺陷所致。作者报告了Blake囊肿与颈胸段脊髓空洞症和四脑室脑积水的关联。
描述一例伴有脑积水和Blake囊肿的脊髓空洞症病例。
仅在放置脑室腹腔分流管后，脊髓空洞症和脑积水的症状才消失。
对于伴有Blake囊肿和脑积水的脊髓空洞症病例，首选治疗方法是应用脑室腹腔分流管，或者更好的是内镜下第三脑室造瘘术。
