Klekamp J, Batzdorf U, Samii M, Bothe H W
Medical School of Hannover, Nordstadt Hospital, Germany.
J Neurosurg. 1997 Feb;86(2):233-40. doi: 10.3171/jns.1997.86.2.0233.
The authors conducted a retrospective study of 107 patients treated for syringomyelia associated with arachnoid scarring between 1976 and 1995 at the Departments of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, and the University of California in Los Angeles, California. Twenty-nine patients have not been surgically treated to date because of their stable neurological status. Seventy-eight patients with progressive neurological deficits underwent a total of 121 surgical procedures and were followed for a mean period of 32 (+/- 37) months. All patients demonstrated arachnoid scarring at a level close to the syrinx. In 52 patients the arachnoid scarring was related to spinal trauma, whereas 55 had no history of trauma and developed arachnoid scarring was a result of an inflammatory reaction. Of these, 15 patients had undergone intradural surgery, eight had suffered from spinal meningitis, three had undergone peridural anesthesia, and one each presented with a history of osteomyelitis, spondylodiscitis, and subarachnoid hemorrhage. No obvious cause for the inflammatory reaction resulting in arachnoid scarring could be ascertained for the remaining 26 patients. The postoperative neurological outcome correlated with the severity of arachnoid pathology and the type of surgery performed. Shunting of the syrinx to the subarachnoid, pleural, or peritoneal cavity was associated with recurrence rates of 92% and 100% for focal and extensive scarring, respectively. Successful long-term management of the syrinx required microsurgical dissection of the arachnoid scar and decompression of the subarachnoid space with a fascia lata graft. This operation stabilized the preoperative progressive neurological course in 83% of patients with a focal arachnoid scar. For patients with extensive arachnoid scarring over multiple spinal levels or after previous surgery, clinical stabilization was achieved in only 17% with this technique.
作者对1976年至1995年间在德国汉诺威市诺德施塔特医院神经外科以及加利福尼亚大学洛杉矶分校神经外科接受治疗的107例与蛛网膜瘢痕相关的脊髓空洞症患者进行了一项回顾性研究。29例患者由于神经状态稳定，至今未接受手术治疗。78例有进行性神经功能缺损的患者共接受了121次外科手术，并接受了平均32（±37）个月的随访。所有患者均在靠近脊髓空洞的水平出现蛛网膜瘢痕。52例患者的蛛网膜瘢痕与脊柱创伤有关，而55例无创伤史，蛛网膜瘢痕是炎症反应的结果。其中，15例患者接受了硬脊膜内手术，8例患有脊髓膜炎，3例接受了硬膜外麻醉，1例分别有骨髓炎、脊椎间盘炎和蛛网膜下腔出血病史。其余26例患者无法确定导致蛛网膜瘢痕的炎症反应的明显原因。术后神经功能结果与蛛网膜病变的严重程度和所进行的手术类型相关。将脊髓空洞分流至蛛网膜下腔、胸膜腔或腹膜腔时，局灶性和广泛性瘢痕的复发率分别为92%和100%。脊髓空洞的成功长期治疗需要对蛛网膜瘢痕进行显微手术解剖并用阔筋膜移植对蛛网膜下腔进行减压。该手术使83%有局灶性蛛网膜瘢痕的患者术前进行性神经病程得以稳定。对于多个脊髓节段有广泛性蛛网膜瘢痕或曾接受过手术的患者，采用该技术仅17%实现了临床稳定。
