Koyanagi Izumi, Chiba Yasuhiro, Uemori Genki, Imamura Hiroyuki, Yoshino Masami, Aida Toshimitsu
Department of Neurosurgery, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Hokkaido, Japan; and.
Department of Neurosurgery, Moriyama Hospital, Asahikawa, Hokkaido, Japan.
J Neurosurg Case Lessons. 2021 Oct 18;2(16):CASE21426. doi: 10.3171/CASE21426.
Spinal adhesive arachnoid pathology is a rare cause of myelopathy. Because of rarity and variability, mechanisms of myelopathy are unknown. The authors retrospectively analyzed patients to understand pathophysiology and provide implications for surgical treatment.
Nineteen consecutive patients were studied. Thirteen patients had a secondary pathology due to etiological disorders such as spinal surgery or hemorrhagic events. They received arachnoid lysis (4 patients), syringo-subarachnoid (S-S) shunt (8 patients) with or without lysis, or anterior decompression. Three of them developed motor deterioration after lysis, and 6 patients needed further 8 surgeries. Another 6 patients had idiopathic pathology showing dorsal arachnoid cyst formation at the thoracic level that was surgically resected. With mean follow-up of 44.3 months, only 4 patients with the secondary pathology showed improved neurological grade, whereas all patients with idiopathic pathology showed improvement.
The idiopathic pathology was the localized dorsal arachnoid adhesion that responded to surgical treatment. The secondary pathology produced disturbed venous circulation of the spinal cord by extensive adhesions. Lysis of the thickened fibrous membrane with preservation of thin arachnoid over the spinal veins may provide safe decompression. S-S shunt was effective if the syrinx extended to the level of normal subarachnoid space.
脊髓粘连性蛛网膜病变是脊髓病的罕见病因。由于其罕见性和变异性，脊髓病的发病机制尚不清楚。作者对患者进行回顾性分析，以了解其病理生理学并为手术治疗提供启示。
对19例连续患者进行了研究。13例患者因脊髓手术或出血事件等病因性疾病存在继发性病变。他们接受了蛛网膜松解术（4例患者）、脊髓空洞-蛛网膜下腔（S-S）分流术（8例患者，伴或不伴松解术）或前路减压术。其中3例患者在松解术后出现运动功能恶化，6例患者需要进一步进行8次手术。另外6例患者患有特发性病变，表现为胸段背侧蛛网膜囊肿形成，均接受了手术切除。平均随访44.3个月，只有4例继发性病变患者的神经功能分级有所改善，而所有特发性病变患者均有改善。
特发性病变为局限性背侧蛛网膜粘连，对手术治疗有反应。继发性病变通过广泛粘连导致脊髓静脉循环障碍。在保留脊髓静脉上方薄蛛网膜的情况下，松解增厚的纤维膜可提供安全的减压。如果脊髓空洞延伸至正常蛛网膜下腔水平，S-S分流术是有效的。
