Harreld J H, Mohammed N, Goldsberry G, Li X, Li Y, Boop F, Patay Z
From the Departments of Radiological Sciences (J.H.H., Z.P.).
Department of Imaging Diagnostic (N.M.), Institute of Paediatric, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
AJNR Am J Neuroradiol. 2015 May;36(5):993-9. doi: 10.3174/ajnr.A4221. Epub 2015 Jan 22.
Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection.
Retrospective review of postoperative spine MRI in 243 children (5.5 ± 4.6 years of age) from our clinical data base postresection of posterior fossa tumors from October 1994 to August 2010 yielded 37 (6.0 ± 4.8 years of age) subjects positive for postoperative intraspinal subdural collections. Their extent and signal properties were recorded for postoperative (37/37), preoperative (15/37), and follow-up spine (35/37) MRI. Risk factors were compared with age-matched internal controls (n = 37, 5.9 ± 4.5 years of age). Associations of histology, hydrocephalus and cerebellar tonsillar herniation, and postoperative intracranial subdural collections with postoperative intraspinal subdural collections were assessed by the Fisher exact test or χ(2) test. The association between preoperative tumor volume and postoperative intraspinal subdural collections was assessed by the Wilcoxon rank sum test.
The overall incidence of postoperative intraspinal subdural collections was 37/243 (15.2%), greatest ≤7 days postoperatively (36%); 97% were seen 0-41 days postoperatively (12.9 ± 11.0 days). They were T2 hyperintense and isointense to CSF on T1WI, homogeneously enhanced, and resolved on follow-up MR imaging (35/35). None were symptomatic. They were associated with intracranial subdural collections (P = .0011) and preoperative tonsillar herniation (P = .0228).
Postoperative intraspinal subdural collections are infrequent and clinically silent, resolve spontaneously, and have a distinctive appearance. Preoperative tonsillar herniation appears to be a predisposing factor. In this series, repeat MR imaging by 4 weeks documented improvement or resolution of these collections in 88%.
后颅窝肿瘤切除术后儿童脊髓硬膜下积液可能会暂时妨碍通过磁共振成像（MR）或脑脊液分析进行转移检测，从而可能影响治疗。我们调查了后颅窝肿瘤切除术后这些积液的发生率、影像学和临床特征、诱发因素以及病程。
回顾性分析1994年10月至2010年8月我院临床数据库中243例（5.5±4.6岁）后颅窝肿瘤切除术后儿童的脊柱MRI，发现37例（6.0±4.8岁）术后脊髓硬膜下积液阳性患者。记录其术后（37/37）、术前（15/37）和随访脊柱（35/37）MRI的范围和信号特征。将危险因素与年龄匹配的内部对照（n = 37，5.9±4.5岁）进行比较。通过Fisher精确检验或χ²检验评估组织学、脑积水和小脑扁桃体疝以及术后颅内硬膜下积液与术后脊髓硬膜下积液的相关性。通过Wilcoxon秩和检验评估术前肿瘤体积与术后脊髓硬膜下积液的相关性。
术后脊髓硬膜下积液的总体发生率为37/243（15.2%），术后≤7天发生率最高（36%）；97%在术后0 - 41天出现（12.9±11.0天）。它们在T2加权像上呈高信号，在T1加权像上与脑脊液等信号，均匀强化，随访MR成像时消失（35/35）。均无症状。它们与颅内硬膜下积液（P = 0.0011）和术前扁桃体疝（P = 0.0228）相关。
术后脊髓硬膜下积液不常见，临床上无症状，可自发消退，且有独特表现。术前扁桃体疝似乎是一个诱发因素。在本系列中，4周时重复MR成像显示88%的这些积液有所改善或消退。
