手术治疗儿童硬脊膜囊末端囊肿样膨出的疗效

目的观察手术治疗儿童硬脊膜囊末端囊肿样膨出的疗效。方法2015年1月至2021年1月苏州大学附属儿童医院神经外科采用手术治疗11例儿童硬脊膜囊末端囊肿样膨出患者,其中8例行终丝离断+椎管内囊肿切除+硬脊膜囊末端缺损修补术,2例仅行终丝切断手术,1例行终丝离断+囊壁部分切除+囊腔脂肪填塞术。回顾性观察患儿术后的临床及影像学改善情况。结果11例患儿术后无一例发生感染及脑脊液漏等并发症。术后随访3个月至5年4个月(中位数为3年6个月),无一例患儿出现新发神经功能缺损症状;4例术前出现症状的患儿术后3例原有症状明显改善。术后3~6个月复查MRI,所有患儿均可见终丝离断;行硬膜囊远端瘘口修补的8例患儿,术后MRI显示骶管囊肿基本消失;行终丝离断+囊壁部分切除+囊腔脂肪填塞术的1例患儿,术后MRI显示囊肿为填塞脂肪组织代替。3例术前出现脊髓远端和终丝中央管极度扩张的患儿,术后MRI显示扩张明显改善。结论采用手术治疗儿童硬脊膜囊末端囊肿样膨出,手术安全;可改善患儿的临床症状和影像学情况。

Therapeutic outcomes of surgical treatment of dural terminal cystoid meningocele in children

Objective To investigate the therapeutic outcomes of surgical treatment of dural terminal cystoid meningocele(DTCM)in children.Methods From January 2015 to January 2021,11 children with DTCM underwent surgical treatment in the Department of Neurosurgery of the Children′s Hospital of Soochow University,of which 8 cases underwent cutting of the terminal filum+resection of intraspinal cyst+repair of terminal dural defect,2 cases only underwent cutting of the terminal filum,1 case underwent cutting of the terminal filum+partial resection of cyst wall+fat packing of cyst cavity.We retrospectively observed the clinical and imaging improvement of the children′s conditions.Results None of the children had complications such as infection and cerebrospinal fluid leakage after surgery.The postoperative follow-up period was 3 months to 5 years and 4 months(median:3 years and 6 months),and none of the patients developed new neurological symptoms.The original symptoms of 4 children with preoperative symptoms were significantly improved in 3 cases.Re-examination of MRI 3 to 6 months after surgery showed that all the children had cut terminal filum.In 8 patients who underwent repair of the terminal dural defect,postoperative MRI showed that the sacral cysts disappeared.In the patient who underwent cutting of the terminal filum+partial resection of cyst wall+fat packing of cystic cavity,postoperative MRI showed that the cyst was replaced by packed fat tissue.In 3 children with preoperative extreme dilation of the central canal of distal spinal cord and terminal filum,postoperative MRI showed that the dilation was significantly improved.Conclusion Surgical treatment of DTCM in children is safe,which can improve the clinical symptoms and imaging changes of the children to a certain extent.