Ergun Tarkan, Lakadamyali Hatice
Department of Radiology, Baskent University School Medicine, Alanya Teaching and Medical Research Center, Alanya, Turkey.
Neurologist. 2009 Nov;15(6):347-50. doi: 10.1097/NRL.0b013e318194022e.
Extradural spinal cyst is a rare cause of compression myelopathy. It is usually solitary and its typical location is posterior to the spinal cord. We present a case of multiple spinal arachnoid cysts causing diffuse myelomalacia secondary to a significant compression of the spinal cord with no symptom relief after surgical decompression.
A 35-year-old female patient presented to our hospital complaining of progressive weakness and numbness of both lower extremities for the last 2 months, being more prominent on the right side. Her history was significant for back pain that started after a vaginal delivery 1 year ago. Spinal MRI revealed multiple extradural arachnoid cysts and diffuse myelomalacia. A T4-T6 level laminectomy was performed. The cyst was nearly totally resected. There was partial symptomatic relief after surgery, but 5 months later her symptoms worsened. MRI revealed nodular syringomyelia and atrophy of the thoracic spinal cord.
Extradural spinal arachnoid cyst is to be considered in the differential diagnosis of spinal cord compression. Vaginal delivery may accelerate the process and symptoms by a sudden increase in the cyst size. In cases of myelomalacia secondary to cyst pressure postoperative results are quite poor.
硬脊膜外脊髓囊肿是压迫性脊髓病的罕见病因。它通常为单发，典型位置在脊髓后方。我们报告一例多发性脊髓蛛网膜囊肿导致弥漫性脊髓软化的病例，该囊肿对脊髓造成显著压迫，手术减压后症状未缓解。
一名35岁女性患者因过去2个月双下肢进行性无力和麻木前来我院就诊，右侧症状更为明显。她有1年前阴道分娩后开始出现背痛的病史。脊髓磁共振成像（MRI）显示多个硬脊膜外蛛网膜囊肿和弥漫性脊髓软化。进行了T4 - T6节段椎板切除术。囊肿几乎完全切除。术后症状部分缓解，但5个月后症状加重。MRI显示结节性脊髓空洞症和胸段脊髓萎缩。
硬脊膜外脊髓蛛网膜囊肿应列入脊髓压迫症的鉴别诊断。阴道分娩可能通过囊肿大小突然增加而加速病情发展和症状出现。在囊肿压迫导致脊髓软化的病例中，术后效果相当差。
