Ishi Yukitomo, Aoyama Takeshi, Kurisu Kota, Hida Kazutoshi, Houkin Kiyohiro
Department of Neurosurgery, Hokkaido University Hospital.
No Shinkei Geka. 2014 May;42(5):467-72.
An intradural arachnoid cyst is a relatively rare condition, occurring within the spinal subarachnoid space. We present the even-more rare case of an intradural arachnoid cyst associated with syringomyelia at the same spinal level. The patient was a 66-year-old man who presented with bilateral leg numbness and gait disturbance. Magnetic resonance imaging (MRI) revealed an intradural arachnoid cyst located dorsal to, and compressing, the thoracic spinal cord at the level of the 7th thoracic vertebra (Th 7). In addition, syringomyelia existed at the level of Th 8, slightly caudal to the intradural arachnoid cyst. We dissected the cyst but did not perform any surgical procedures for the syringomyelia. Post-operative MRI showed that the cyst had disappeared and the syringomyelia had spontaneously shrunk. The patient was discharged with improvement in his numbness and gait disturbance. There are a few case reports of intradural arachnoid cysts associated with syringomyelia, but recent evidence suggests that its occurrence is more common than previously thought. A combination of these two diseases is thought to be caused by blockage of cerebrospinal fluid (CSF) flow, which is also thought to cause adhesive arachnoiditis. For this reason, resection of the arachnoid cyst could improve the CSF flow and contribute to the shrinkage of syringomyelia. Furthermore, early treatment may correlate with improvement in radiological findings and neurological symptoms.
硬脊膜内蛛网膜囊肿是一种相对罕见的疾病，发生于脊髓蛛网膜下腔。我们报告一例更为罕见的同一脊髓节段硬脊膜内蛛网膜囊肿合并脊髓空洞症的病例。患者为一名66岁男性，表现为双侧腿部麻木和步态障碍。磁共振成像（MRI）显示在第7胸椎（Th 7）水平，硬脊膜内蛛网膜囊肿位于胸段脊髓背侧并对其造成压迫。此外，脊髓空洞症存在于Th 8水平，略低于硬脊膜内蛛网膜囊肿。我们切除了囊肿，但未对脊髓空洞症进行任何手术操作。术后MRI显示囊肿消失，脊髓空洞症自发缩小。患者出院时麻木和步态障碍有所改善。有一些硬脊膜内蛛网膜囊肿合并脊髓空洞症的病例报告，但最近的证据表明其发生率比以前认为的更为常见。这两种疾病的合并被认为是由脑脊液（CSF）流动受阻引起的，这也被认为会导致粘连性蛛网膜炎。因此，切除蛛网膜囊肿可以改善脑脊液流动并有助于脊髓空洞症的缩小。此外，早期治疗可能与影像学表现和神经症状的改善相关。
