Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Department of Clinical Neuroscience, University of Cambridge, Cambridge, United Kingdom.
World Neurosurg. 2018 Jan;109:e81-e87. doi: 10.1016/j.wneu.2017.09.107. Epub 2017 Sep 23.
Arachnoid webs are rare intradural lesions that can cause direct spinal cord compression or alteration of the cerebrospinal fluid flow with syringomyelia. Surgery has been historically performed through wide-open laminectomies. The aim of this study is to prove the feasibility of minimally invasive techniques for the excision of arachnoid webs.
A retrospective review of two cases of minimally invasive excision of thoracic arachnoid webs was performed. Surgery was undertaken through expandable tubular retractors.
Complete excision was achieved through the described approach, with minimal bony removal and soft tissue disruption. There were no intraoperative or perioperative complications. Both patients were mobilized early and discharged home within 24 hours after surgery. Postoperative imaging showed good re-expansion of the spinal cord, with no evidence of residual compression or tethering.
For symptomatic arachnoid webs, surgery remains the only definitive treatment. In expert hands, the excision of arachnoid webs can be achieved with tubular retractors and minimally invasive techniques.
蛛网膜粘连是一种罕见的硬脊膜内病变，可导致脊髓直接受压或脑脊液流动改变并发脊髓空洞症。传统上，这些病变是通过广泛的椎板切除术进行治疗的。本研究旨在证明微创技术切除蛛网膜粘连的可行性。
回顾性分析了 2 例经微创扩张管状牵开器切除胸段蛛网膜粘连的病例。
通过描述的方法实现了完全切除，骨切除和软组织损伤最小。术中及围手术期无并发症。术后影像学检查显示脊髓良好的再膨胀，无残留压迫或牵拉伤。
对于有症状的蛛网膜粘连，手术仍然是唯一的根治性治疗方法。在有经验的医生手中，蛛网膜粘连的切除可以通过管状牵开器和微创技术来实现。
