Department of Neurosurgery, Tokyo Women's Medical University, Yachiyo Medical Center, 477-96 Owada-Shinden, Yachiyo-shi, Chiba 276 8524, Japan.
J Clin Neurosci. 2011 Dec;18(12):1702-4. doi: 10.1016/j.jocn.2011.03.014. Epub 2011 Oct 22.
Spinal cord tethering and cerebrospinal fluid (CSF) flow disturbance are two major features in the pathophysiology of spinal adhesive arachnoiditis. We hypothesized that insufficient CSF supply to the surgically untethered spinal cord may be one of the causes of the typical post-operative recurrent extensive lesion. We report a patient with extensive spinal adhesive arachnoiditis, who was successfully treated using a novel surgical technique consisting of two procedures. First, microdissection of the thickened adherent arachnoid was performed to resolve spinal cord tethering. Next, a ventriculo-subarachnoid shunt was placed to provide sufficient flow of CSF. Clinical improvement was sustained for at least 22 months after surgery. The present surgical procedure may improve clinical outcome in patients with longitudinally extensive spinal adhesive arachnoiditis.
脊髓栓系和脑脊液（CSF）流动障碍是脊髓粘连性蛛网膜炎病理生理学的两个主要特征。我们假设，手术松解脊髓后 CSF 供应不足可能是典型术后复发性广泛病变的原因之一。我们报告了一例广泛脊髓粘连性蛛网膜炎患者，采用包括两个步骤的新手术技术成功治疗。首先，进行增厚的粘连蛛网膜的显微解剖以解除脊髓栓系。其次，放置脑室-蛛网膜下腔分流管以提供足够的 CSF 流动。手术后至少 22 个月，临床改善持续存在。目前的手术程序可能会改善纵向广泛脊髓粘连性蛛网膜炎患者的临床结果。
