骶神经根周围囊肿的诊断及外科治疗

目的 探讨骶神经根周围囊肿的临床表现、影像学特点及外科治疗效果。方法 诊断22例骶管内神经根周围囊肿患者。对有明显症状的16例进行手术治疗。行病变部位后路椎板减压，13例囊肿切除，3例囊肿大部分切除，9例硬膜破裂神经根裸露采用胶原蛋白海绵覆盖。结果 MRI检查显示出椎管内神经根囊肿的形态，CT显示骶骨压迫性改变。16例切口均一期愈合，术后随访6个月～7年，平均2年9个月，患者术后腰骶疼痛、间歇跛行、骶神经症状均得到明显缓解，无感染病例，2例脑脊液漏1周内愈合。结论 骶管内神经周围囊肿临床上少见，容易误诊。MRI是最好的诊断方法，采用手术摘除囊肿和胶原蛋白海绵覆盖治疗，其治疗效果满意。

Diagnosis and surgical treatment of sacral nerve root cysts

Objective To study the characteristics of the image and clinical features of nerve root cyst in the sacral canal and effect of surgical treatment. Methods Twenty-two cases of sacral nerve root cyst were diagnosed. 16 patients with severe symptom received operations. The posterior laminectomy decompression was performed, of which 13 cases were undergone cysts resection, 3 subtotal resection. 9 cases of dural rupture were performed collagen sponge coverage for the exposed nerve roots. Results MRI showed the contour of the sacral canal nerve root cysts and CT showed the compression lesion of the sacrum. Sixteen cases got primary incision healing. All cases were followed up for 6 months to 7 years (average 2.6 years). All of the patients obtained alleviation of lower back pain, claudication and sacral nerve symptoms. No infection was found. Cerebrospinal fluid leaking occurred in 2 cases and healed in 1 week. Conclusion Sacral canal nerve root cyst is rare and very easy to be misdiagnosed. MRI is optimal in diagnosis of cyst in sacral canal. Satisfactory outcome can be obtained with surgical removal and the collagen sponge coverage.