Eroshkin Aleksey, Romanukha Dmytro, Voitsekhovskyi Serhiy
Department of Neurosurgery, Central Hospital of Ministry of Internal Affairs of Ukraine (Central Police Hospital), Kyiv, Ukraine; and.
Bogomolets National Medical University, Kyiv, Ukraine.
J Neurosurg Case Lessons. 2021 Jan 11;1(2):CASE2050. doi: 10.3171/CASE2050.
Extensive spinal epidural abscesses (SEAs) occupying three or more spinal regions are rare. This study aimed to address the key dilemma of surgical treatment for holospinal epidural abscesses, i.e., to determine the required scope of surgery and minimize surgical trauma with adequate purulent drainage.
Two patients with extensive SEAs were treated at the Neurosurgery Department of the Central Hospital of Ministry of Internal Affairs of Ukraine from 2018 to 2020. Both patients had a neurological deficit and general inflammatory response syndrome. Spinal magnetic resonance examinations were performed, showing that the first and second patients had extensive SEAs at T11/S1 and C2/L1, respectively. Both underwent minimally invasive abscess drainage via intra- and translaminar access at the most caudal point using an epidural silicone catheter in the cranial direction along the entire length of the abscess.
To achieve the key goal of extensive SEA treatment, i.e., to prevent the development of a persistent neurological deficit, immediate effective spinal canal decompression should be performed. Access method and scope should meet the requirements of spinal canal decompression and purulent content aspiration to the greatest possible extent while inducing minimal trauma.
广泛的脊柱硬膜外脓肿（SEA）占据三个或更多脊柱节段的情况较为罕见。本研究旨在解决全脊柱硬膜外脓肿手术治疗的关键难题，即确定所需的手术范围，并在充分引流脓液的同时尽量减少手术创伤。
2018年至2020年期间，乌克兰内务部中央医院神经外科治疗了2例广泛SEA患者。两名患者均有神经功能缺损和全身炎症反应综合征。进行了脊柱磁共振检查，结果显示第一例和第二例患者分别在T11/S1和C2/L1节段存在广泛SEA。两人均通过在脓肿最尾端经椎板内外入路，使用硬膜外硅胶导管沿脓肿全长向头侧方向进行微创脓肿引流。
为实现广泛SEA治疗的关键目标，即预防持续性神经功能缺损的发生，应立即进行有效的椎管减压。入路方法和范围应在最大程度上满足椎管减压和吸出脓性内容物的要求，同时造成最小的创伤。
