Hernández-León O, Pérez-Nogueira F R, Corrales N
Servicio de Neurocirugíal, Hospital Universitario Abel Santamaría Cuadrado, Pinar del Río, Cuba.
Neurocirugia (Astur). 2011 Jun;22(3):267-70.
Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases.
The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma.
Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.
硬脊膜外蛛网膜囊肿是一种罕见的病变，与脊柱创伤、手术有关，较少与先天性异常有关。其临床表现与其他压迫性脊髓病变相似。磁共振技术有助于正确诊断这种病理情况并确定其解剖位置。患者的病史对于确定病因至关重要。在大多数情况下，手术是首选治疗方法。
患者为一名35岁男性，有两年前穿透性脊柱创伤病史。当时，他在D2-D3水平遭受单侧脊髓横断伤，伴有相应的布朗-塞卡尔综合征。在背部皮肤水平发现一个小伤口，顺利缝合。起初，他通过康复治疗和维生素改善了右下肢运动功能。在良好恢复两年后，他因六个月来的神经功能恶化来到我院。体格检查发现痉挛性截瘫。进行磁共振检查显示在D3-D4水平有一个囊性硬膜外肿物压迫脊髓。手术减压治疗切除了囊肿，并确定了一处硬膜撕裂，成功进行了缝合。结果良好，恢复了脊柱创伤后最初的运动功能。
创伤后硬膜外蛛网膜囊肿的手术治疗能够发现并闭合脑膜撕裂，对这类病变非常有效。
