Hines Tripp, Wang Catherine, Duttlinger Christine, Thompson Jay, Watford Kevin, Motley Benjamin, Wheeler Greg
Department of Neurosurgery, University of Kentucky.
Department of Neurosurgery, Lexington Veterans Affairs Medical Center, Lexington, Kentucky, United States.
Surg Neurol Int. 2021 Jul 6;12:323. doi: 10.25259/SNI_339_2021. eCollection 2021.
Thoracic arachnoid webs are a rare entity and can be challenging to diagnose with sometimes subtle radiographic findings. Arachnoid webs can cause severe cord compression with associated syrinx and resulting myelopathy, weakness, sensory loss, and bowel/bladder dysfunction. There have been a little over 60 cases total reported in the literature with only one systematic review. The cases presented here have unique features including rapid onset of symptoms, symptomatic syrinx extending into the cervical spine, and intraoperative syrinx drainage, all of which are quite rare in the current published literature for arachnoid webs.
Here, we present two patients, a 73-year-old man and 58-year-old man presenting with different symptoms and timing of symptom progression but both with "scalpel sign" and associated syrinx present on their MRIs. Each patient underwent a laminectomy with resection of arachnoid web with complete resolution of symptoms in the first case and significant improvement in the second case. Postoperative imaging in both cases showed almost complete resolution of the syrinx.
Early clinical evaluation and workup followed by early surgical treatment can lead to dramatic improvement in outcomes after surgery. For patients that are symptomatic from an associated syrinx, a midline myelotomy to facilitate drainage can be considered to be done concomitantly with the arachnoid web resection.
胸段蛛网膜网是一种罕见的病变，有时影像学表现不明显，诊断具有挑战性。蛛网膜网可导致严重的脊髓压迫，并伴有空洞形成，进而引起脊髓病、肌无力、感觉丧失以及肠道/膀胱功能障碍。文献中总共报道了60多例病例，仅有一篇系统综述。本文介绍的病例具有独特特征，包括症状迅速出现、有症状的空洞延伸至颈椎以及术中进行空洞引流，所有这些在目前已发表的关于蛛网膜网的文献中都相当罕见。
在此，我们介绍两名患者，一名73岁男性和一名58岁男性，他们表现出不同的症状和症状进展时间，但MRI上均有“手术刀征”及相关空洞。每名患者均接受了椎板切除术及蛛网膜网切除术，第一例患者症状完全缓解，第二例患者症状显著改善。两例患者术后影像学检查显示空洞几乎完全消失。
早期临床评估和检查，随后进行早期手术治疗，可使术后效果显著改善。对于因相关空洞出现症状的患者，可考虑在切除蛛网膜网的同时进行中线脊髓切开术以利于引流。
