CAJ | 학술논문

目的研究显微镜下切除囊壁及关闭硬膜缺损的手术效果,及减少神经组织及脊柱结构损伤的方法.方法回顾分析1996-2007年经显微手术治疗的11例椎管内硬膜外脊膜囊肿的资料.临床表现为下肢力弱、下肢麻木、腰痛伴根性痛及排尿无力.脊柱X线片检奁示椎弓根间距加大,MRI显爪硬膜外囊性病变,呈长T1长12的脑脊液信号.采用椎板切除术或半椎板切除术,显微镜下行囊壁切除及修补硬膜缺损,使用术中肌电监测以减少对神经根的损伤.结果病人下肢无力及排尿功能障碍逐渐恢复,4例病人根性痛症状明显改善,1例中度改善,术后出现新的神经功能缺失.结论硬膜外脊膜囊肿可由蛛嗍膜疝入硬膜缺损造成,瓣膜机制使囊肿增大.关闭硬膜缺损和切除囊壁的显微手术是有效的、首选治疗方法.注意将手术造成的脊柱稳定性改变及神经组织损伤降到最低程度.
목적 연구현미경하절제낭벽급관폐경막결손적수술효과,급감소신경조직급척주결구손상적방법.방법 회고분석1996-2007년경현미수술치료적11례추관내경막외척막낭종적자료.림상표현위하지력약、하지마목、요통반근성통급배뇨무력.척주X선편검렴시추궁근간거가대,MRI현조경막외낭성병변,정장T1장12적뇌척액신호.채용추판절제술혹반추판절제술,현미경하행낭벽절제급수보경막결손,사용술중기전감측이감소대신경근적손상.결과 병인하지무력급배뇨공능장애축점회복,4례병인근성통증상명현개선,1례중도개선,술후출현신적신경공능결실.결론 경막외척막낭종가유주삭막산입경막결손조성,판막궤제사낭종증대.관폐경막결손화절제낭벽적현미수술시유효적、수선치료방법.주의장수술조성적척주은정성개변급신경조직손상강도최저정도.
Objective To study the efficacy of microsurgical cyst resection and closure of the dural defect,while minimizing functional damage to neural tissues and spinal structure. Methods We retrospectively reviewed the records of 11 patients with intraspinal extradura] meningeal cysts who were treated microsurgically between 1996 and 2007. The patients presented lower extremity weakness,numbness,low back pain with radiacular radiation,and urinary dysfunction. Vertebral roentogenograms revealed an enlarged interpedicular space. Magnetic resonance (MR) imaging demonstrated extradural cystic lesions which were hypointense in Tl-weighted images and hyperintense in T2-weighted images mimicking the signal of CSF. We performed laminectomies or hemilaminectomies with microsurgical cyst resection and closure of the dural defect,using intraoperative electromyography to minimize damage to the nerve roots. Results The patients with motor deficits and bladder dysfunction recovered gradually. In 4 out of 5 patients the preoperative radicular pain improved markedly. No new postoperative neurological deficits were observed. Conclusions Spinal extradural cysts can be caused by anrachnoid herniation through dural defect. A valve mechanism promotes cyst progression. Microsurgical cyst resection and closure of the dural defect is effective and optimal therapeutic strategy. It is important to minimize the surgical damage to spinal stability and neural tissues.