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脊髓局灶性粘连性蛛网膜炎：影像学诊断与手术治疗

Focal adhesive arachnoiditis of the spinal cord: Imaging diagnosis and surgical resolution.

作者信息

Morisako Hiroki, Takami Toshihiro, Yamagata Toru, Chokyu Isao, Tsuyuguchi Naohiro, Ohata Kenji

机构信息

Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

出版信息

J Craniovertebr Junction Spine. 2010 Jul;1(2):100-6. doi: 10.4103/0974-8237.77673.

DOI:10.4103/0974-8237.77673
PMID:21572630
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3075825/
Abstract

BACKGROUND

Although adhesive arachnoiditis of the spinal cord can cause progressive symptoms associated with syringomyelia or myelomalacia, its surgical resolution based on the imaging diagnosis is not well characterized. This study aims to describe the use of imaging for the diagnosis of focal adhesive arachnoiditis of the spinal cord and its surgical resolution using microsurgical arachnoidolysis.

MATERIALS AND METHODS

Four consecutive patients with symptomatic syringomyelia or myelomalacia caused by focal adhesive arachnoiditis underwent microsurgical arachnoidolysis. Comprehensive imaging evaluation using constructive interference in steady-state (CISS) magnetic resonance imaging (MRI) or myelographic MR imaging using true fast imaging with steady-state precession (TrueFISP) sequences was included before surgery to determine the surgical indication.

RESULTS

In all four patients a focal adhesion was identified at the cervical or thoracic level of the spinal cord, a consequence of infection or trauma. Three patients showed modest or minor improvement in neurological function, and one patient was unchanged after surgery. The syringomyelia or myelomalacia resolved after surgery and no recurrence was noted within the follow-up period, which ranged from 5 months to 30 months.

CONCLUSIONS

MRI diagnosis of focal adhesive arachnoiditis is critical to determine the surgical indication. Microsurgical arachnoidolysis appears to be a straightforward method for stabilizing the progressive symptoms, though the procedure is technically demanding.

摘要

背景

尽管脊髓粘连性蛛网膜炎可导致与脊髓空洞症或脊髓软化相关的进行性症状，但其基于影像学诊断的手术治疗方法尚未得到充分描述。本研究旨在描述影像学在诊断脊髓局灶性粘连性蛛网膜炎中的应用，以及使用显微外科蛛网膜松解术进行手术治疗的情况。

材料与方法

4例因局灶性粘连性蛛网膜炎导致有症状的脊髓空洞症或脊髓软化的患者接受了显微外科蛛网膜松解术。术前采用稳态构成干扰（CISS）磁共振成像（MRI）或使用稳态进动快速成像（TrueFISP）序列的脊髓造影MRI进行全面的影像学评估，以确定手术指征。

结果

所有4例患者均在脊髓颈段或胸段发现局灶性粘连，这是感染或创伤的结果。3例患者神经功能有中度或轻度改善，1例患者术后无变化。脊髓空洞症或脊髓软化在术后得到缓解，在5个月至30个月的随访期内未发现复发。

结论

MRI对局灶性粘连性蛛网膜炎的诊断对于确定手术指征至关重要。显微外科蛛网膜松解术似乎是稳定进行性症状的一种直接方法，尽管该手术对技术要求较高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/d4187799a513/JCVJS-1-100-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/cfe06b991965/JCVJS-1-100-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/d45506c72eee/JCVJS-1-100-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/3d516ea52cca/JCVJS-1-100-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/c88b10a70cd0/JCVJS-1-100-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/d4187799a513/JCVJS-1-100-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/cfe06b991965/JCVJS-1-100-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/d45506c72eee/JCVJS-1-100-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/3d516ea52cca/JCVJS-1-100-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/c88b10a70cd0/JCVJS-1-100-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d383/3075825/d4187799a513/JCVJS-1-100-g008.jpg

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