1Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
2Lab of Spinal Cord, Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China; and.
J Neurosurg Spine. 2024 Jun 7;41(3):407-415. doi: 10.3171/2024.3.SPINE231161. Print 2024 Sep 1.
Intraspinal cysts are uncommon, and the success rate of complete resection is still low for spinal neurenteric cysts (NCs). The aim of this study was to evaluate the efficacies of an anterior microscopic surgical approach in the treatment of ventral and ventrolateral subaxial cervical NCs (SCNCs).
Between 2019 and 2022, 9 patients with NCs of the subaxial spine underwent an anterior microsurgical approach. Their clinical presentations, radiological features, operative findings, and follow-up data were retrospectively reviewed and analyzed.
All spinal cysts were intradural and extramedullary in origin. Five patients were first-time cases while 4 patients with recurrence underwent revision surgery. The most common clinical manifestation was pain (77.78%). One patient was found to have a concomitant disorder of Klippel-Feil syndrome. Microscopically confirmed gross-total resection was achieved in 8 patients (88.89%) based on clinical comparisons between pre- and postoperative MRI and intraoperative video. One patient had symptom recurrence 1 year after subtotal resection, while there was no evidence of recurrence during follow-up for the other patients. Dense adhesions within the spinal cord were observed in 8 patients (88.89%) intraoperatively. Most importantly, the surgical outcome was significantly improved in all patients, and the mean (± SE) Japanese Orthopaedic Association score increased from 11.33 ± 0.91 preoperatively to 16.22 ± 0.32 postoperatively (p = 0.008).
An anterior surgical approach was proven to be both safe and effective in treating the ventral or ventrolateral SCNCs. The authors believe that an anterior microsurgical approach should be considered as a useful approach especially in patients with ventral recurrent SCNCs. Its clinical efficacy compared with a posterior approach in ventral spinal cyst may be better as most of the neurenteric cysts are ventrally or ventrolaterally located.
椎管内囊肿并不常见，而脊髓神经根肠囊肿（NCs）的完全切除成功率仍然较低。本研究旨在评估前路显微镜手术治疗下颈椎腹侧和腹外侧脊髓神经肠囊肿（SCNCs）的疗效。
2019 年至 2022 年间，9 例 SCNC 患者接受了前路显微手术治疗。回顾性分析其临床表现、影像学特征、手术结果和随访资料。
所有脊柱囊肿均起源于硬脊膜外髓内。5 例为首次发病，4 例复发患者行再次手术。最常见的临床表现是疼痛（77.78%）。1 例患者同时伴有 Klippel-Feil 综合征。根据术前和术后 MRI 及术中录像的临床比较，8 例患者（88.89%）实现了大体全切除。1 例患者在次全切除 1 年后出现症状复发，而其他患者在随访期间均未见复发。8 例患者（88.89%）术中发现脊髓内有致密粘连。最重要的是，所有患者的手术结果均明显改善，日本矫形协会评分（JOA）从术前的 11.33±0.91 分提高到术后的 16.22±0.32 分（p=0.008）。
前路手术治疗下颈椎腹侧和腹外侧 SCNCs 安全有效。作者认为，前路显微手术应作为治疗复发性腹侧 SCNCs 的一种有用方法，特别是对于此类患者。与后路相比，前路在治疗腹侧脊髓囊肿时可能更有效，因为大多数神经肠囊肿位于腹侧或腹外侧。
