Department of Neurology and Neurophysiology, Institute of Experimental Neurology, IRCCS San Raffaele, Via Olgettina 58, Milan, Italy.
Spine (Phila Pa 1976). 2010 Apr 15;35(8):E322-4. doi: 10.1097/BRS.0b013e3181c8a40a.
A case report of a unique anterior intradural spinal arachnoid cyst (ISAC) associated with syringomyelia.
To discuss the surgical treatment and follow-up of anterior ISACs associated with syringomyelia.
Fenestration is commonly performed in arachnoid cysts with a large craniocaudal extension and in arachnoid cysts associated with syringomyelia. Particularly, excision of dorsal arachnoid cysts, without a shunting operation for the syrinx, achieves excellent results. However, anterior arachnoid cysts are different from dorsal cysts in having a greater craniocaudal extension and showing intracystic fibrous septae.
A 55-year-old man presented a small syringomyelic cavity at C1/C2 level and a giant anterior extramedullary intradural cystic cavity spreading from C1 to T11. A posterior laminectomy at C3 level was performed, and generous fenestration of the cyst was followed by the positioning of a cyst-subarachnoid shunt.
After surgery, transitory relief was soon followed by a progressive worsening of symptoms. A specific kinematic-magnetic resonance imaging (K-MRI) was then carried out, showing a regular sisto-diastolic modulation of flow and normal shunt function. To define the real fluid dynamics within the cyst, the patient underwent a computed tomography-myelography (CT-M). Only a small quantity of contrast was found inside the pouch, confirming the clinical diagnosis of a poor communication within the shunt and the failure of previous surgery.
This is the most extensive anterior ISAC associated with syringomyelia reported in literature until now. The treatment of extensive intradural extramedullary arachnoid cysts, especially for those located ventral to the spine and associated with syringomyelia, is still a matter of debate. In our case, fenestration and insertion of a cyst-subarachnoid shunt alone were not sufficient to restore normal CSF dynamics. In addition, we show that K-MRI may not be a proper method for postoperative follow-up of these lesions.
一例独特的脊髓前方硬脊膜蛛网膜囊肿（ISAC）合并脊髓空洞症的病例报告。
讨论与脊髓空洞症相关的前方 ISAC 的手术治疗和随访。
蛛网膜囊肿有较大的颅尾延伸时通常行开窗术，蛛网膜囊肿合并脊髓空洞症时也常行开窗术。特别是，切除背侧蛛网膜囊肿，而不对脊髓空洞进行分流手术，可以取得很好的效果。然而，前方蛛网膜囊肿与背侧囊肿不同，其颅尾延伸更大，并显示出囊内纤维隔。
一名 55 岁男性表现为 C1/C2 水平的小脊髓空洞腔和从 C1 延伸到 T11 的巨大前方髓外硬脊膜内囊性腔。在 C3 水平行后路椎板切除术，对囊肿进行充分开窗，并放置囊肿蛛网膜下腔分流管。
手术后，症状很快得到短暂缓解，但随后逐渐恶化。随后进行了特定的动力学磁共振成像（K-MRI）检查，显示出正常的收缩期和舒张期的流动调制以及正常的分流功能。为了确定囊肿内的真实流体动力学，患者进行了计算机断层脊髓造影（CT-M）检查。仅在囊中发现少量造影剂，证实了分流器内沟通不良和先前手术失败的临床诊断。
这是目前文献中报道的最广泛的与脊髓空洞症相关的前方 ISAC。广泛的硬脊膜外髓内蛛网膜囊肿的治疗，特别是位于脊柱腹侧并与脊髓空洞症相关的囊肿，仍然存在争议。在我们的病例中，单纯开窗和插入囊肿蛛网膜下腔分流管不足以恢复正常的 CSF 动力学。此外，我们表明 K-MRI 可能不是这些病变术后随访的适当方法。
