D'Andrea Giancarlo, Trillò Giuseppe, Roperto Raffaelino, Celli Paolo, Orlando Epimenio Ramundo, Ferrante Luigi
Department of Neurological Sciences, "La Sapienza" University, Rome, Italy.
Neurosurg Rev. 2004 Apr;27(2):75-80; discussion 81-2. doi: 10.1007/s10143-003-0296-3. Epub 2003 Oct 15.
The goal of this article is to report our experience on intradural lumbar disc herniation, consider the causes of this pathology, and analyze it from clinical, diagnostic, and therapeutic perspectives with a particular emphasis on the role of MRI in preoperative diagnosis. We analyzed nine patients treated surgically for intradural lumbar disc hernia. All of them underwent surgery, and hemilaminectomy was performed. In six cases, the diagnosis of intradural herniation was definitive and, in the three remaining, it was confirmed at surgery. In five cases, CT (with no contrast medium) of the lumbar area revealed disc herniation, but none could it confirm its intradural location. Myelography was performed in two cases but also could not prove intradural extrusion. Magnetic resonance imaging study was used in four cases. In five, the postoperative outcome has been excellent. Patients 6 and 9 recovered anal function postoperatively; patient 6 suffered from occasional and mild micturition urgency. The three patients previously operated (1, 2, 7) showed good outcome. Presently, we believe that radiologic diagnosis of intradural herniation is possible in carefully selected patients, thanks to MRI with gadolinium.
本文的目的是报告我们关于硬膜内腰椎间盘突出症的经验，探讨这种病理状况的病因，并从临床、诊断和治疗角度进行分析，特别强调磁共振成像（MRI）在术前诊断中的作用。我们分析了9例接受硬膜内腰椎间盘突出症手术治疗的患者。他们均接受了手术，且均进行了半椎板切除术。其中6例硬膜内突出的诊断明确，其余3例在手术中得到证实。5例患者的腰椎CT（未使用造影剂）显示有椎间盘突出，但均无法证实其位于硬膜内。2例患者进行了脊髓造影，但也未能证明有硬膜内突出。4例患者使用了磁共振成像检查。5例患者术后效果极佳。患者6和患者9术后恢复了肛门功能；患者6偶尔有轻度尿急。之前接受手术的3例患者（患者1、2、7）效果良好。目前，我们认为，借助钆增强MRI，在经过精心挑选的患者中对硬膜内突出进行影像学诊断是可行的。
