Andrews John P, Chan Andrew K, Mummaneni Praveen V
Oper Neurosurg (Hagerstown). 2021 Jan 13;20(2):E143. doi: 10.1093/ons/opaa327.
Arachnoid webs of the spine are a relatively rare entity with unique radiological findings, most notably the scalpel-sign on sagittal magnetic resonance imaging (MRI).1-4 To date there have been no videographic descriptions of the surgical treatment for this clinical entity. We present the case of a patient with progressive myelopathy and MRI showing a cervical and thoracic syrinx with a sharp transition point at the level of the T5 vertebral body. On computed tomography myelogram, there was preserved cerebrospinal fluid (CSF) in the ventral subarachnoid space-this space is often interrupted in ventral cord herniation, and preserved in dorsal arachnoid webs.5 A laminectomy with intradural excision of arachnoid web was offered and the patient consented for the procedure. Preoperatively, a fiducial screw was placed at T5. A T4-6 laminectomy was performed. A clearly compressive arachnoid web was encountered on exposure. Bands were dissected under an operating microscope, restoring normal CSF flow. Ventral dural defect was ruled out by passing a delicot beneath the cord and withdrawing it on the contralateral side. The patient did well and has shown improvement in myelopathic symptoms at 1- and 3-mo follow-up. Arachnoid webs of the spine can be treated effectively with a prudent, stepwise approach, and careful microsurgical technique. The neurosurgeon should consult closely with their neuroradiology colleagues to rule out other entities prior to the operation, such as ventral cord herniations, which can mimic dorsal arachnoid webs radiologically and clinically. We have received informed consent of the patient to submit this video.
脊柱蛛网膜网是一种相对罕见的疾病，具有独特的放射学表现，最显著的是矢状面磁共振成像（MRI）上的手术刀征。1-4 迄今为止，尚无关于该临床疾病手术治疗的视频描述。我们报告一例进行性脊髓病患者，MRI显示颈段和胸段脊髓空洞症，在T5椎体水平有一个锐利的过渡点。在计算机断层扫描脊髓造影中，腹侧蛛网膜下腔脑脊液（CSF）保留——该间隙在腹侧脊髓疝中常中断，而在背侧蛛网膜网中保留。5 我们建议进行椎板切除术并硬膜内切除蛛网膜网，患者同意了该手术。术前，在T5放置了一个基准螺钉。进行了T4-6椎板切除术。暴露时发现一个明显压迫性的蛛网膜网。在手术显微镜下分离束带，恢复正常的脑脊液流动。通过在脊髓下方穿过一根细导管并在对侧抽出，排除了腹侧硬膜缺损。患者情况良好，在1个月和3个月的随访中脊髓病症状有所改善。脊柱蛛网膜网可以通过谨慎、逐步的方法和仔细的显微外科技术进行有效治疗。神经外科医生在手术前应与其神经放射学同事密切协商，以排除其他疾病，如腹侧脊髓疝，其在放射学和临床上可模仿背侧蛛网膜网。我们已获得患者的知情同意以提交此视频。
