Carr Matthew T, Bhimani Abhiraj D, Schupper Alexander J, Yang Anthony, Chen Mark, Vij Meenakshi, Doshi Amish, Choudhri Tanvir F, Ghatan Saadi, Houten John K, Jenkins Arthur L, Margetis Konstantinos, Steinberger Jeremy, Weiss Nirit, Roonprapunt Chan
Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
World Neurosurg. 2025 Jan;193:781-790. doi: 10.1016/j.wneu.2024.10.055. Epub 2024 Nov 12.
Thoracic dorsal arachnoid webs are intradural membranes that may cause obstruction of cerebrospinal fluid flow and spinal cord compression. Although well recognized, they are rare and there is a paucity of long-term data on their natural history and prognosis. We reviewed radiographic features, surgical indications, and pathologic specimens of patients diagnosed with focal thoracic dorsal arachnoid webs.
A radiology database and surgical case logs were queried for thoracic arachnoid webs at a single hospital system for a 10-year period. A retrospective chart review was performed on identified cases.
We identified 127 patients with dorsal thoracic arachnoid webs. Arachnoid webs were radiographically classified into 3 morphologic types: type 1 (54%) causing spinal cord deformity only, type 2 (32%) producing cord deformity with myelomalacia, and type 3 (14%) with cord deformity, myelomalacia, and syringomyelia. These arachnoid webs were commonly centered at the upper thoracic T4 segmental level. Forty-one cases (32%) required surgery, generally for thoracic myelopathy with gait instability (46%) and lower extremity numbness and pain (39%). In patients who underwent surgery, 79% experienced symptomatic improvement and 21% remained stable, after an average of 21 months follow-up evaluation. Surgical pathology revealed fibrous connective tissue (100%) with calcifications (26%) or inflammation (7%).
Most patients in a large series of patients with dorsal arachnoid webs did not undergo surgical intervention, but those with myelomalacia and syrinx experienced radiographic and clinical deterioration without surgery. Surgery to treat symptomatic arachnoid webs results in significant clinical improvement with low surgical morbidity.
胸段背侧蛛网膜网是硬脊膜内的膜性结构，可导致脑脊液流动受阻和脊髓受压。尽管已得到充分认识，但它们较为罕见，且关于其自然病史和预后的长期数据匮乏。我们回顾了诊断为局灶性胸段背侧蛛网膜网患者的影像学特征、手术指征和病理标本。
在一个单一医院系统的放射学数据库和手术病例记录中查询10年间的胸段蛛网膜网病例。对确诊病例进行回顾性病历审查。
我们识别出127例胸段背侧蛛网膜网患者。蛛网膜网在影像学上分为3种形态类型：1型（54%）仅导致脊髓畸形，2型（32%）导致脊髓畸形并伴有脊髓软化，3型（14%）导致脊髓畸形、脊髓软化和脊髓空洞症。这些蛛网膜网通常集中在胸段上部T4节段水平。41例（32%）患者需要手术，通常是因为胸段脊髓病伴有步态不稳（46%）和下肢麻木疼痛（39%）。在接受手术的患者中，平均随访21个月后，79%的患者症状改善，21%的患者病情稳定。手术病理显示为纤维结缔组织（100%），伴有钙化（26%）或炎症（7%）。
在一大系列胸段背侧蛛网膜网患者中，大多数患者未接受手术干预，但那些伴有脊髓软化和脊髓空洞症的患者在未手术的情况下出现影像学和临床恶化。治疗有症状的蛛网膜网的手术可显著改善临床症状，且手术并发症发生率低。
