Laidlaw John D
Department of Neurosurgery and Department of Surgery, University of Melbourne, The Royal Melbourne Hospital, Parkville, Vic., Australia.
J Clin Neurosci. 2003 Sep;10(5):606-12. doi: 10.1016/s0967-5868(03)00198-x.
A 36-year-old female patient with a long-standing asymptomatic lower thoracic scoliosis presented with sensory symptoms involving all limbs. MRI scan demonstrated a rounded ventral intradural mass causing major deformity of the cervical cord at C6 and C7 levels. Unlike most previously reported neurenteric cysts, the MRI signal characteristics of this mass were such that it could not be determined if it is cystic or solid, being iso-intense on T1- and hyperintense T2-weighted images. Resection was performed through a median corporectomy of C6 and C7, the lesion being found to be a neurenteric cyst with an attachment to the anterior median fissure of the cord. Strut graft and cervical locking plate fixation from C5 to C6 was facilitated by extending the cervical incision into the sternal notch, with detachment of left-sided strap muscle insertion. The patient made an excellent recovery with complete resolution of neurological symptoms and solid fusion. The postoperative course was complicated by an anterior cervical CSF collection which resolved spontaneously within 2 months. The literature regarding this rare condition and its management is reviewed. Although the majority of intraspinal neurenteric cysts are situated ventral to the cord, most reports of excision have been from a dorsal approach. Drainage and subtotal excision of neurenteric cysts have been previously advocated; however, the recurrence rate is such that complete excision is advocated. This is facilitated by a ventral approach. A simplified method of utilising the sternal notch exposure is reported. The literature regarding the anatomical peculiarities pertinent to the sternal notch approach, and the reported literature regarding spinal neurenteric cysts is reviewed.
一名36岁女性患者，长期患有无症状性下胸椎脊柱侧弯，现出现累及四肢的感觉症状。MRI扫描显示硬膜内腹侧有一圆形肿块，导致颈髓在C6和C7水平出现严重畸形。与大多数先前报道的神经肠囊肿不同，该肿块的MRI信号特征无法确定其为囊性还是实性，在T1加权像上呈等信号，在T2加权像上呈高信号。通过C6和C7椎体次全切除术进行切除，发现病变为神经肠囊肿，附着于脊髓前正中裂。通过将颈部切口延伸至胸骨切迹，并分离左侧带状肌附着点，便于进行从C5到C6的支撑植骨和颈椎锁定钢板固定。患者恢复良好，神经症状完全缓解，植骨融合牢固。术后出现颈前脑脊液聚集，2个月内自行消退。本文回顾了关于这种罕见疾病及其治疗的文献。尽管大多数脊髓内神经肠囊肿位于脊髓腹侧，但大多数切除报告采用的是后路手术。先前有人主张对神经肠囊肿进行引流和次全切除；然而，复发率较高，因此主张进行完全切除。前路手术有助于实现这一点。本文报道了一种利用胸骨切迹暴露的简化方法。回顾了与胸骨切迹手术相关的解剖学特点以及关于脊髓神经肠囊肿的报道文献。
