一例胸段背侧蛛网膜网的神经外科治疗病例。
A case of neurosurgical treatment of thoracic dorsal arachnoid web.
作者信息
Tran Tri Duc Duy, Vo Phong Duc, Truong Tri Van, Ho Thi Duc
机构信息
Department of Neurosurgery, Hoan My ITO Dong Nai Hospital, Bien Hoa, Vietnam.
Department of Neurosurgery, Vinmec Central Park International Hospital, Hochiminh, Vietnam.
出版信息
Surg Neurol Int. 2023 Jun 16;14:210. doi: 10.25259/SNI_398_2023. eCollection 2023.
BACKGROUND
Dorsal arachnoid webs constitute abnormal formations of arachnoid that tend to occur in the upper thoracic spine and can lead to spinal cord displacement. Patients typically present with back pain, sensory disturbances, and weakness. It may also obstruct the cerebrospinal fluid (CSF) flow, leading to syringomyelia. In magnetic resonance (MR) studies, the "scalpel sign" is a classical finding, and it may also be accompanied by syringomyelia attributed to CSF flow. Definitive surgical resection is the mainstay of treatment.
CASE DESCRIPTION
A 31-year-old male presented with mild weakness in the right leg and diffuse lower extremity sensory changes. The MR showed the typical "scalpel sign" at the T7 level consistent with diagnosing a spinal arachnoid web. He underwent a T6-T8 laminotomy for lysis of the web and decompression of the thoracic cord. Postoperatively, his symptoms improved markedly.
CONCLUSION
Surgical resection is the treatment of choice when an arachnoid web is documented on an MR and correlates with the patient's clinical symptoms/signs.
背景
背侧蛛网膜网是蛛网膜的异常结构，倾向于发生在上胸椎，可导致脊髓移位。患者通常表现为背痛、感觉障碍和无力。它还可能阻塞脑脊液（CSF）流动，导致脊髓空洞症。在磁共振（MR）研究中，“手术刀征”是一个典型表现，也可能伴有因脑脊液流动导致的脊髓空洞症。明确的手术切除是主要治疗方法。
病例描述
一名31岁男性，出现右下肢轻度无力和下肢弥漫性感觉改变。磁共振成像显示T7水平有典型的“手术刀征”，符合诊断脊髓蛛网膜网。他接受了T6 - T8椎板切开术以松解网膜并减压胸段脊髓。术后，他的症状明显改善。
结论
当磁共振成像记录到蛛网膜网并与患者的临床症状/体征相关时，手术切除是首选治疗方法。
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