Reina M A, Pulido P, Castedo J, Villanueva M C, López A, De Andrés J A, Sola R G
Servicio de Anestesiología, Hospital Madrid Montepríncipe, Madrid.
Rev Esp Anestesiol Reanim. 2007 Mar;54(3):173-83.
Epidural fat is a reservoir of lipophilic substances that cushions the pulsatile movements of the dural sac, protects nerve structures, and facilitates the movement of the dural sac over the periosteum of the spinal canal during flexion and extension. Excessive epidural fat can compress the underlying structures, however, and affect the placement of catheters and the distribution of injected solutions. This review discusses changes in epidural fat related to various diseases and events: lipomatosis, epidural lymphoma, arachnoid cysts, epidural hematoma, meningiomas, angiolipomas, spondylolysis, scoliosis, spinal stenosis, and liposarcoma. Also discussed are the sequencing and protocols for magnetic resonance imaging that enable epidural fat to be observed and distinguished from neighboring structures. The relevance of epidural fat in spinal surgery is considered. Finally, we discuss the possible anesthetic implications of the abnormal deposition of epidural fat, to explain the unexpected complications that can arise during performance of epidural anesthesia.
硬膜外脂肪是亲脂性物质的储存库，可缓冲硬脊膜囊的搏动性运动，保护神经结构，并在脊柱屈伸过程中促进硬脊膜囊在椎管骨膜上的移动。然而，硬膜外脂肪过多会压迫其下方的结构，并影响导管的放置和注射溶液的分布。本综述讨论了与各种疾病和事件相关的硬膜外脂肪变化：脂肪增多症、硬膜外淋巴瘤、蛛网膜囊肿、硬膜外血肿、脑膜瘤、血管脂肪瘤、椎弓根峡部裂、脊柱侧弯、椎管狭窄和脂肪肉瘤。还讨论了磁共振成像的序列和方案，这些序列和方案能够观察硬膜外脂肪并将其与相邻结构区分开来。考虑了硬膜外脂肪在脊柱手术中的相关性。最后，我们讨论了硬膜外脂肪异常沉积可能对麻醉产生的影响，以解释硬膜外麻醉过程中可能出现的意外并发症。
