Zuev A A, Epifanov D S
Pirogov National Medical Surgical Center, Nizhnyaya Pervomayskaya Str., 70, Moscow, Russia, 105203.
Zh Vopr Neirokhir Im N N Burdenko. 2018;82(2):71-80. doi: 10.17116/oftalma201882271-80.
To date, only 12 cases of ossifying arachnoiditis with concomitant syringomyelia have been reported in the world literature. In this article, we presented our experience of treating three patients with syringomyelia associated with ossifying arachnoiditis.
based on the literature data and our own experience, we tried to define the most optimal treatment approach for this disease.
We analyzed the data of 15 patients (12 cases reported in the literature and 3 our own cases). The diagnosis was established on the basis of complaints, medical history, patient examination, MRI and CT of the spinal cord, and intraoperative data. Progression of syringomyelia was evaluated by comparison of the neurological status and calculation of the Vaquero index before and after surgery; the Domenicucci classification was used to evaluate the severity of ossifying arachnoiditis. Surgical treatment included several stages: decompressive laminectomy, elimination of spinal cord fixation, excision of ossifying arachnoiditis, shunting of the syrinx, and repair of the dura mater.
An analysis of the patient data reported in the literature (12 cases) and those in our series (3) revealed that in the early postoperative period, 7 (46.7%) of these 15 patients had improvements, 5 (33.3%) patients had no changes, and 3 (20%) patients experienced a worsening. At present, there is no clear algorithm for diagnosing and treating this disease.
Further investigation of the problem may facilitate an earlier diagnosis of the disease and provide more effective medical care.
迄今为止，世界文献中仅报道了12例伴有脊髓空洞症的骨化性蛛网膜炎病例。在本文中，我们介绍了治疗3例与骨化性蛛网膜炎相关的脊髓空洞症患者的经验。
基于文献数据和我们自己的经验，我们试图确定这种疾病的最佳治疗方法。
我们分析了15例患者的数据（文献报道的12例和我们自己的3例）。诊断基于患者的主诉、病史、体格检查、脊髓的MRI和CT以及术中数据。通过比较手术前后的神经状态和计算瓦克罗指数来评估脊髓空洞症的进展；采用多米尼库奇分类法评估骨化性蛛网膜炎的严重程度。手术治疗包括几个阶段：减压性椎板切除术、解除脊髓固定、切除骨化性蛛网膜炎、脊髓空洞分流术以及硬脑膜修复术。
对文献报道的患者数据（12例）和我们系列中的患者数据（3例）进行分析发现，在术后早期，这15例患者中有7例（46.7%）病情改善，5例（33.3%）患者无变化，3例（20%）患者病情恶化。目前，对于这种疾病尚无明确的诊断和治疗算法。
对该问题的进一步研究可能有助于更早地诊断该疾病并提供更有效的医疗护理。
