Elhammady Mohamed Samy, Farhat Hamad, Aziz-Sultan Mohammad Ali, Morcos Jacques J
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
J Neurosurg Spine. 2009 Mar;10(3):234-9. doi: 10.3171/2008.12.SPINE08158.
Juxtafacet cysts of the atlantooccipital joint that present with isolated hypoglossal nerve palsy are rare and may mimic more common pathological entities. The authors report on the third such case in the literature and discuss the differential diagnosis, imaging hallmarks, preoperative recognition, and surgical management of this lesion, and provide a review of the literature. The authors discuss their experience with the treatment of a 67-year-old woman who presented with an isolated hypoglossal nerve palsy caused by a nonenhancing cystic septated lesion abutting the lateral medulla just medial to the left hypoglossal canal. The lesion was presumed to be a necrotic hypoglossal schwannoma or epidermoid tumor. Intradural surgical exploration failed to demonstrate an intradural lesion, but confirmed the presence of an extradural mass caudal to the hypoglossal nerve. Extradural exploration revealed a synovial cyst of the atlantooccipital joint, which was then resected. Postoperatively, the patient developed worsening dysphagia and hoarseness. Failure to recognize this rare entity preoperatively resulted in unnecessary intradural exploration and cranial nerve morbidity. In retrospect, the preoperative diagnosis of this lesion was suggested by lack of central enhancement, absence of dumbbell formation and the presence of erosive synovial changes. Regardless, the extreme rarity of this lesion at this location will always make its recognition challenging.
枕寰关节旁囊肿伴孤立性舌下神经麻痹的情况罕见，可能会被误诊为更常见的病理实体。作者报告了文献中第三例此类病例，并讨论了该病变的鉴别诊断、影像学特征、术前识别及手术治疗，并对文献进行了综述。作者阐述了他们治疗一名67岁女性患者的经验，该患者因一个无强化的囊性分隔病变导致孤立性舌下神经麻痹，该病变紧邻左侧舌下神经管内侧的延髓外侧。该病变推测为坏死性舌下神经鞘瘤或表皮样肿瘤。硬脊膜内手术探查未发现硬脊膜内病变，但证实舌下神经尾侧存在硬膜外肿块。硬膜外探查发现枕寰关节滑膜囊肿，随后将其切除。术后，患者出现吞咽困难和声音嘶哑加重。术前未能识别这种罕见实体导致了不必要的硬脊膜内探查及脑神经并发症。回顾来看，术前该病变的诊断可依据缺乏中央强化、无哑铃状形成及存在侵蚀性滑膜改变。尽管如此，该病变在这个位置极为罕见，其识别始终具有挑战性。
