Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuropsychiatr Dis Treat. 2014 Mar 19;10:499-506. doi: 10.2147/NDT.S52517. eCollection 2014.
Idiopathic spinal arachnoid cysts are rare cystic masses of the spinal canal generally classified as intra- or extradural, based on anatomical presentation. However, this system may not effectively indicate treatment.
To investigate the incidence, resection modality, and prognosis of spinal arachnoid cyst in a 15-year case series.
A retrospective study was conducted in 81 spinal arachnoid cyst patients (male:female 34:47, mean age 36.5 years, age range 6-66 years) classified using a novel five-category T1-weighted and T2-weighted magnetic resonance imaging (MRI) classification system (intramedullary, subdural extramedullary, subdural/epidural, intraspinal epidural, or intraspinal/extraspinal). Conservative treatment failed in all patients. They underwent spinal surgery between January 1995 and December 2010 and were followed up for 69 (range 3-187) months. Performance outcomes were assessed using the Fugl-Meyer (FM) scale 90 days after operation. Recurrences and deaths were recorded.
Subdural/epidural and intraspinal epidural cysts accounted for 66.7% (54 of 81) of patients, but exhibited relatively lower rates of postsurgical improvement using FM, with only 66.7% (36 of 54) of patients showing improvements. Excellent outcomes using the FM scale were reached in 100% (eight of eight) of intramedullary, intraspinal/extraspinal, and subdural extramedullary cyst patients, 86.7% (13 of 15) of subdural extramedullary cyst patients, and 66.7% (36 of 54) of epidural intraspinal cyst patients.
The proposed five-category multimodal MRI-based stratification system for spinal arachnoid cyst patients may more effectively allow clinicians to select the appropriate surgical intervention, and may help to predict outcomes.
特发性脊髓蛛网膜囊肿是一种罕见的椎管囊性肿块，一般根据解剖学表现分为硬脊膜内或硬脊膜外。然而，这种分类系统可能并不能有效地指导治疗。
通过对 15 年的病例系列研究，调查脊髓蛛网膜囊肿的发病率、切除方式和预后。
对 81 例脊髓蛛网膜囊肿患者（男/女 34/47，平均年龄 36.5 岁，年龄 6-66 岁）进行回顾性研究，采用一种新的基于 T1 加权和 T2 加权磁共振成像（MRI）的五分类系统（髓内、硬脊膜下髓外、硬脊膜下/硬膜外、脊髓硬膜外或脊髓/硬膜外）进行分类。所有患者均经保守治疗无效，于 1995 年 1 月至 2010 年 12 月行脊髓手术治疗，随访时间为 69（3-187）个月。术后 90 天采用 Fugl-Meyer（FM）量表评估运动功能。记录复发和死亡情况。
硬脊膜下/硬膜外和脊髓硬膜外囊肿占 81 例患者的 66.7%（54 例），但 FM 术后改善率相对较低，仅 66.7%（54 例中的 36 例）患者有改善。髓内、脊髓/硬膜外和硬脊膜下髓外囊肿患者的 FM 评分优良率为 100%（8/8），硬脊膜下髓外和脊髓硬膜外囊肿患者为 86.7%（13/15），脊髓硬膜外囊肿患者为 66.7%（54 例中的 36 例）。
提出的基于五分类多模态 MRI 的脊髓蛛网膜囊肿患者分层系统，可能更有效地帮助临床医生选择合适的手术干预措施，并有助于预测预后。
