Department of Neurology, University of Missouri Columbia Medical Center, Columbia, Missouri, USA; Zeenat Qureshi Stroke Institute, St. Cloud, Minnesota, USA.
Department of Neurology, University of Missouri Columbia Medical Center, Columbia, Missouri, USA.
World Neurosurg. 2020 Oct;142:17-23. doi: 10.1016/j.wneu.2020.06.119. Epub 2020 Jun 24.
Spinal arachnoid webs are a rare anatomic entity manifesting as neuropathic back pain, compressive myelopathy, radiculopathy, and hydrocephalus. Typical treatments include hemilaminectomy or full laminectomy with durotomy and microsurgical resection, which can result in secondary scarring and recurrent blockage of cerebrospinal fluid (CSF) flow perpetuating the cycle.
A 66-year-old woman presented with progressively worsening gait and memory. Magnetic resonance imaging demonstrated an arachnoid web in the high thoracic region, causing CSF flow obstruction and hydrocephalus. A standard lumbar drainage catheter was introduced percutaneously into the lumbar thecal sac and advanced in a cephalad direction, across the arachnoid web, to the high thoracic region. The patient underwent continuous CSF drainage through this catheter for a total of 3 days, displaying measurable clinical improvement that persisted at the 3-month follow-up visit. Phase-contrast magnetic resonance imaging demonstrated interval reconstitution of dorsal synchronous CSF flow at the second thoracic vertebral level, both on day 3 and at the 3-month control imaging study.
This minimally invasive approach seems useful in achieving restoration of spinal fluid flow at the thoracic region when the underlying blockage results from an arachnoid web and leads to quantifiable clinical improvement.
蛛网膜 webs 是一种罕见的解剖实体，表现为神经性背痛、压迫性脊髓病、神经根病和脑积水。典型的治疗方法包括半椎板切除术或全椎板切除术伴硬脊膜切开和显微切除术，这可能导致继发性瘢痕形成和脑脊液（CSF）流动的反复阻塞，使循环持续存在。
一名 66 岁女性因步态和记忆力逐渐恶化而就诊。磁共振成像显示高胸段有蛛网膜 webs，导致 CSF 流动受阻和脑积水。一根标准的腰椎引流导管经皮插入腰椎蛛网膜下腔，并向头侧推进，穿过蛛网膜 webs 到达高胸段。患者通过该导管进行连续 CSF 引流，共 3 天，显示出可测量的临床改善，在 3 个月的随访中仍持续存在。相位对比磁共振成像显示在第 2 胸椎水平的背侧同步 CSF 流动在第 3 天和 3 个月的对照成像研究中均有间隔重建。
当蛛网膜 webs 导致的阻塞导致可量化的临床改善时，这种微创方法似乎可用于恢复胸段的脑脊液流动。
