Brisman Jonathan L, Li Maria, Hamilton Dean, Mayberg Marc R, Newell David W
Neurosurgical Service, Seattle Neuroscience Institute at Swedish Providence Hospital, Seattle, Washington, USA.
Neurosurgery. 2006 Mar;58(3):E585; discussion E585. doi: 10.1227/01.neu.0000197486.65781.88.
The ventriculus terminalis of the conus, or "fifth ventricle" refers to the ependymal-lined space in the middle of the conus that is present in childhood and whose persistence into adulthood is rare. A number of cases of cystic dilatation of the ventriculus terminalis have been described in adulthood. Patients tend to present with either pain alone or gradually progressive conus or cauda equina syndromes with varying degrees of recovery after cyst drainage. Presentation with an acute cauda equina syndrome and its successful surgical management has not been previously reported.
A 57-year-old woman experienced back pain and bilateral sciatica ascribed to diabetic neuropathy for 2 years. Over a 24-hour period she developed bilateral lower extremity weakness, saddle anesthesia, and bowel and bladder incontinence. Lumbosacral magnetic resonance imaging demonstrated a large cystic dilatation of the ventriculus terminalis.
She was taken for emergency surgical decompression and cyst drainage. Immediately after surgery, she experienced significant increase in lower extremity strength and has since regained continence.
Cystic dilation of the ventriculus terminalis should be part of the differential diagnosis for a cauda equina syndrome; surgical decompression with simple cyst drainage can result in excellent clinical results.
圆锥终室，即“第五脑室”，指的是儿童期存在于圆锥中部的由室管膜衬里的腔隙，其持续至成年期的情况较为罕见。成年期有若干例圆锥终室囊性扩张的病例被描述。患者往往仅表现为疼痛，或逐渐进展的圆锥或马尾综合征，囊肿引流后有不同程度的恢复。此前尚未有急性马尾综合征及其成功手术治疗的报道。
一名57岁女性因糖尿病性神经病变出现背痛和双侧坐骨神经痛2年。在24小时内，她出现双侧下肢无力、鞍区感觉缺失以及大小便失禁。腰骶部磁共振成像显示圆锥终室有巨大囊性扩张。
她接受了急诊手术减压及囊肿引流。术后即刻，她的下肢力量显著增强，此后恢复了大小便自控能力。
圆锥终室囊性扩张应作为马尾综合征鉴别诊断的一部分；单纯囊肿引流的手术减压可取得优异的临床效果。
