Onishi Eijiro, Sakamoto Yushi, Mitsuzawa Sadaki, Sako Daiki, Yasuda Tadashi
Orthopedic Surgery, Kobe City Medical Center General Hospital, Kobe, JPN.
Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN.
Cureus. 2025 Mar 27;17(3):e81308. doi: 10.7759/cureus.81308. eCollection 2025 Mar.
Spinal arachnoid web (SAW) is a rare intradural lesion that can result in spinal cord compression and myelopathy. This report describes a case of SAW with atypical imaging findings and clinical manifestations in a 63-year-old male patient who presented with progressive lower limb paresthesia and left-dominant muscle weakness. The patient also exhibited temperature and pain sensory disturbances in the right leg. Magnetic resonance imaging (MRI) revealed spinal cord atrophy, intramedullary hyperintensity, and a dorsal flow void without the scalpel sign at the T7 level. Laminectomy and surgical resection of the SAW were performed. Intraoperative ultrasound revealed a SAW obstructing the flow of cerebrospinal fluid (CSF). The left and right sides of the posterior space were divided by the septum posticum, which moved pulsatile from side to side. Postoperative improvements in muscle strength, temperature, and pain sensation were observed; however, numbness and bladder dysfunction persisted. Diagnosing SAW is challenging in the absence of the scalpel sign; however, in cases of spinal cord atrophy and a dorsal CSF flow void on MRI, the presence of SAW should be considered. Brown-Sequard syndrome may result from asymmetric CSF pressure caused by the septum posticum.
脊髓蛛网膜网（SAW）是一种罕见的硬膜内病变，可导致脊髓压迫和脊髓病。本报告描述了一例63岁男性患者的SAW病例，该患者具有非典型的影像学表现和临床表现，表现为进行性下肢感觉异常和以左侧为主的肌肉无力。患者右腿还出现温度和疼痛感觉障碍。磁共振成像（MRI）显示脊髓萎缩、髓内高信号以及T7水平处无“手术刀征”的背侧血流空洞。进行了椎板切除术和SAW手术切除。术中超声显示SAW阻塞了脑脊液（CSF）流动。后间隙的左右两侧被后隔分开，后隔左右搏动移动。术后观察到肌肉力量、温度和疼痛感觉有所改善；然而，麻木和膀胱功能障碍仍然存在。在没有“手术刀征”的情况下诊断SAW具有挑战性；然而，在MRI显示脊髓萎缩和背侧CSF血流空洞的病例中，应考虑SAW的存在。后隔引起的不对称CSF压力可能导致布朗 - 色夸综合征。
