Himes Benjamin T, Kerezoudis Panagiotis, Rajjoub Kenan R, Shepherd Daniel S, Bydon Mohamad
a Department of Neurologic Surgery , Mayo Clinic , Rochester , MN , USA.
b Mayo Clinic Neuro-Informatics Laboratory , Rochester , MN , USA.
Int J Neurosci. 2019 Apr;129(4):397-400. doi: 10.1080/00207454.2018.1538140. Epub 2018 Nov 28.
Spinal arachnoid cysts are a known cause of spinal cord compression. When symptomatic, treatment of choice entails laminectomies over the length of the cyst in order to achieve complete cyst removal and fenestration.
A 60-year-old woman presented with a one-year history of progressive pain between the shoulder blades, exacerbated by sitting up or standing, and relieved by lying supine. MRI imaging revealed a T3-T7 dorsal intradural arachnoid cyst. Due to extant spinal deformity and medical comorbidity, the decision was made to proceed with selective laminoplasties at the superior and inferior limits of the cyst.
After the dura was opened to reveal the margins, the cyst was sharply fenestrated and drained. Irrigation was passed through the cyst to ensure open communication, and a lumbar drain catheter was passed from the inferior to superior margin. The catheter was removed before closure. Postoperatively, MRI of the thoracic spine revealed decompression of the spinal cord and the patient noticed improvement in her symptoms. At 7-month follow-up, the patient remained free of symptoms and MRI demonstrated near-complete resolution of the cyst.
Although open exposure and complete resection are considered the treatment of choice for spinal arachnoid cysts, cyst fenestration through selective bony windows at the margins of the cyst represents a viable, less invasive alternative approach to effective cyst decompression, and can be considered in patients in whom a full exposure would be prohibitive.
脊髓蛛网膜囊肿是脊髓受压的已知原因。出现症状时，首选治疗方法是在囊肿全长范围内进行椎板切除术，以实现囊肿的完全切除和开窗引流。
一名60岁女性，有一年来逐渐加重的肩胛骨间疼痛病史，坐起或站立时疼痛加剧，仰卧时缓解。磁共振成像（MRI）显示T3 - T7节段硬脊膜内蛛网膜囊肿。由于存在脊柱畸形和内科合并症，决定在囊肿的上下限进行选择性椎板成形术。
打开硬脊膜暴露囊肿边缘后，将囊肿锐性开窗并引流。通过囊肿进行冲洗以确保通畅引流，并从囊肿下缘向上缘置入一根腰大池引流导管。关闭切口前拔除导管。术后，胸椎MRI显示脊髓减压，患者症状有所改善。在7个月的随访中，患者无症状，MRI显示囊肿几乎完全消退。
虽然开放暴露和完全切除被认为是脊髓蛛网膜囊肿的首选治疗方法，但通过在囊肿边缘选择性骨窗进行囊肿开窗引流是一种可行的、侵入性较小的有效囊肿减压替代方法，对于无法进行完全暴露的患者可以考虑采用。
