Zuev A A, Lebedev V B, Pedyash N V, Epifanov D S, Levin R S
Pirogov National Medical and Surgical Center, Moscow, Russia.
Petrovsky Russian Scientific Center of Surgery, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2017;81(3):39-47. doi: 10.17116/neiro201781339-47.
The prevalence of syringomyelia (SM) caused by adhesive arachnoiditis (AA) is 2 to 4 cases per 100000 population. Surgical treatment of this pathology usually includes implantation of shunts into the cyst cavity or opening and drainage of the cavity. In this case, SM continues to progress in 72-100% of patients. Unsatisfactory outcomes of this surgical approach necessitate searching for other treatment options.
To define the optimal amount of surgery for SM associated with AA and the criteria for assessment of surgery outcomes.
The authors treated 47 SM patients in the period from 2010 to 2015. Of these, 34 (72.3%) patients underwent surgery; a total of 40 operations were performed. The patients' age ranged from 18 to 64 years (mean, 43.5 years). Tethering of the spinal cord was eliminated in 25 patients; 9 patients underwent cyst shunting.
Among operated patients, 5 patients had grade 1 arachnopathy, 13 patients had grade 2 arachnopathy, 12 patients had grade 3 arachnopathy, and 4 patients had grade 4 arachnopathy. The minimal postoperative follow-up period was 11 months. After shunting, the condition improved in 8 of 9 patients; in 7 patients, the condition returned to the baseline level within the first postoperative year; in 6 (66.7%) of these patients, the disease continued to progress. After surgical release of spinal cord tethering, satisfactory long-term results were achieved in 13 (86.6%) patients with grade 1-2 arachnopathy. In 3 (50%) patients with grade 3 arachnopathy, the condition was stabilized. Among patients with grade 4 arachnopathy, progression of the disease was stopped in 1 patient; the condition worsened in 2 (50%) patients. Among all the operated patients, complications developed in 7 patients. There were no lethal outcomes.
In grade 1-2 arachnopathy, progression of SM after release of spinal cord tethering occurs only in 13.4% of patients. Therefore, release of spinal cord tethering is recommended for these patients. In grade 3-4 arachnopathy, the rate of relapse after this surgery is more than 80%. Therefore, given the simplicity and a lower risk of complications of cyst shunting, this procedure is advisable for these patients.
粘连性蛛网膜炎（AA）所致脊髓空洞症（SM）的患病率为每10万人中有2至4例。这种病变的手术治疗通常包括在囊肿腔内植入分流管或打开并引流囊肿。在这种情况下，72%至100%的患者脊髓空洞症会继续进展。这种手术方法的效果不理想，因此有必要寻找其他治疗方案。
确定与粘连性蛛网膜炎相关的脊髓空洞症的最佳手术量以及手术效果评估标准。
作者在2010年至2015年期间治疗了47例脊髓空洞症患者。其中，34例（72.3%）患者接受了手术；共进行了40次手术。患者年龄在18岁至64岁之间（平均43.5岁）。25例患者解除了脊髓栓系；9例患者进行了囊肿分流。
在接受手术的患者中，5例为1级蛛网病，13例为2级蛛网病，12例为3级蛛网病，4例为4级蛛网病。术后最短随访期为11个月。分流术后，9例患者中有8例病情改善；7例患者在术后第一年内病情恢复到基线水平；其中6例（66.7%）患者病情继续进展。在解除脊髓栓系手术后，1级至2级蛛网病的13例（86.6%）患者取得了满意的长期效果。3级蛛网病的3例（50%）患者病情稳定。在4级蛛网病患者中，1例患者病情停止进展；2例（50%）患者病情恶化。在所有接受手术的患者中，7例出现了并发症。无死亡病例。
在1级至2级蛛网病中，解除脊髓栓系后脊髓空洞症仅在13.4%的患者中进展。因此，建议对这些患者进行脊髓栓系松解术。在3级至4级蛛网病中，该手术后复发率超过80%。因此，鉴于囊肿分流术操作简单且并发症风险较低，该手术对这些患者是可取的。
