Mallucci C L, Stacey R J, Miles J B, Williams B
Midlands Centre for Neurology and Neurosurgery, Smethwick, UK.
Br J Neurosurg. 1997 Aug;11(4):306-9. doi: 10.1080/02688699746087.
Syringomyelia is the condition in which longitudinal cavities are found within the spinal cord. The use of drainage procedures has been widely practised with good short term results. However, the long-term results in some large series have been less favourable. There are many associated conditions and in most forms a blockage to the normal flow of CSF, either at the foramen magnum or in the spinal canal, can be identified. Most surgeons would now direct their efforts to the establishment of normal CSF flow rather than a shunting procedure. In a certain group of patients, even with the advent of sophisticated MRI, no associated abnormality or CSF block is easily identified. This type of syringomyelia is often termed idiopathic. We report 10 patients with symptomatic syringomyelia without readily recognized predisposing factors. In eight patients preoperative myelography revealed a block to the flow of contrast compatible with subarachnoid obstruction. Eight patients underwent laminectomy and division of the obstructing arachnoid webs. Five experienced good improvement and three only moderate improvement. Two of the patients underwent syrinx shunting procedures only, which resulted in a worsening of their symptoms. At operation one patient was found to have an arachnoid cyst. We believe that patients with idiopathic symptomatic syringomyelia may need myelography to identify such arachnoid abnormalities. Subsequent surgery should be directed at the establishment of normal CSF flow by laminectomy and excision of the offending lesion.
脊髓空洞症是指在脊髓内发现纵向空洞的病症。引流手术已被广泛应用，短期效果良好。然而，一些大型系列研究的长期结果却不尽人意。脊髓空洞症存在许多相关病症，并且在大多数类型中，可以确定在枕骨大孔或椎管处存在脑脊液正常流动的阻塞。现在大多数外科医生会将精力集中在建立正常的脑脊液流动上，而不是进行分流手术。在某一组患者中，即使有先进的磁共振成像（MRI），也不容易识别出相关异常或脑脊液阻塞。这种类型的脊髓空洞症通常被称为特发性。我们报告了10例有症状的脊髓空洞症患者，他们没有容易识别的诱发因素。8例患者术前脊髓造影显示造影剂流动受阻，符合蛛网膜下腔梗阻。8例患者接受了椎板切除术和阻塞性蛛网膜网的分离。5例患者症状明显改善，3例仅中度改善。2例患者仅接受了空洞分流手术，结果症状恶化。手术中发现1例患者有蛛网膜囊肿。我们认为，特发性有症状的脊髓空洞症患者可能需要脊髓造影来识别此类蛛网膜异常。后续手术应通过椎板切除术和切除病变来建立正常的脑脊液流动。
