Brodbelt A R, Stoodley M A
The Prince of Wales Medical Research Institute, University of New South Wales, and the Department of Neurosurgery, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia.
Acta Neurochir (Wien). 2003 Aug;145(8):707-11; discussion 711. doi: 10.1007/s00701-003-0071-9.
Three cases of syringomyelia associated with arachnoid webs are reported. Each patient presented with progressive myelopathy and had thoracic syringes detected on magnetic resonance imaging (MRI). In one patient the web was also visible. At operation a thoracic arachnoid web was found, obstructing the subarachnoid compartment in each patient. One patient had intraoperative ultrasound, which demonstrated caudal web movement with each cardiac systole. The webs were divided and shunts inserted into the syringes. All patients improved clinically, and on follow-up MRI. Arachnoid webs are likely to represent a focal band of arachnoiditis and are difficult to visualise on standard preoperative MR imaging. A reduction in the subarachnoid space compliance with resultant increase in pulse pressure and potentiation of an arterial pulsation driven perivascular flow could explain the associated syringes. Treatment should be aimed at restoring compliance, and involve division of the web with or without shunt insertion.
报告了3例与蛛网膜粘连相关的脊髓空洞症病例。每位患者均表现为进行性脊髓病，磁共振成像（MRI）检查发现有胸段脊髓空洞。其中1例患者的粘连也可见。手术中发现胸段蛛网膜粘连，阻塞了每位患者的蛛网膜下腔。1例患者术中进行了超声检查，显示每次心脏收缩时粘连向尾端移动。分离粘连并在脊髓空洞内置入分流管。所有患者临床症状均有改善，随访MRI检查亦如此。蛛网膜粘连可能代表蛛网膜炎症的一个局灶带，在标准术前MR成像上难以显示。蛛网膜下腔顺应性降低，导致脉压增加以及动脉搏动驱动的血管周围血流增强，这可以解释相关的脊髓空洞形成。治疗应旨在恢复顺应性，包括分离粘连，可选择或不选择置入分流管。
