Abstract：
BACKGROUND: Spinal bronchogenic cysts are rare nonneoplastic congenital variants of neurenteric cysts. The natural history and surgical management of these lesions are poorly understood.
METHODS: A 25-year-old male presented with progressive back pain and bilateral lower limb sciatica of 6 months\' duration. He had undergone subtotal resection of an intramedullary bronchogenic conus medullaris cyst 5 years prior. Magnetic resonance imaging revealed a recurrent bilobed intramedullary and extramedullary conus medullaris cystic lesion. The authors resected the lesion via a posterior approach with the aid of intraoperative neuromonitoring. Gross total resection was precluded by the tightly adherent nature of the cyst and the fact that stimulation of a residual intramedullary portion of the lesion evoked external anal sphincter responses.
CONCLUSIONS: This is the first reported case of a bilobed intramedullary and extramedullary bronchogenic cyst of the conus medullaris. This unique case lends insight into the poorly defined embryogenesis of bronchogenic cysts by favoring the split notochord syndrome theory rather than the ectopic ectoderm proposal. The importance of neuromonitoring when resecting these tightly adherent lesions is demonstrated. Finally, although the secretory nature of these lesions portends a tendency for cyst reaccumulation, it is imperative to recognize that this is usually a slow process.
METHODS: A 25-year-old male presented with progressive back pain and bilateral lower limb sciatica of 6 months\' duration. He had undergone subtotal resection of an intramedullary bronchogenic conus medullaris cyst 5 years prior. Magnetic resonance imaging revealed a recurrent bilobed intramedullary and extramedullary conus medullaris cystic lesion. The authors resected the lesion via a posterior approach with the aid of intraoperative neuromonitoring. Gross total resection was precluded by the tightly adherent nature of the cyst and the fact that stimulation of a residual intramedullary portion of the lesion evoked external anal sphincter responses.
CONCLUSIONS: This is the first reported case of a bilobed intramedullary and extramedullary bronchogenic cyst of the conus medullaris. This unique case lends insight into the poorly defined embryogenesis of bronchogenic cysts by favoring the split notochord syndrome theory rather than the ectopic ectoderm proposal. The importance of neuromonitoring when resecting these tightly adherent lesions is demonstrated. Finally, although the secretory nature of these lesions portends a tendency for cyst reaccumulation, it is imperative to recognize that this is usually a slow process.
摘要：
背景：脊髓支气管囊肿是罕见的神经囊肿的非肿瘤性先天性变异。对这些病变的自然史和手术治疗知之甚少。
方法：一名25岁男性，表现为进行性背痛和持续6个月的双侧下肢坐骨神经痛。5年前，他接受了髓内支气管圆锥髓质囊肿的次全切除术。磁共振成像显示复发性双叶髓内和髓外圆锥髓质囊性病变。作者在术中神经监测的帮助下通过后路切除了病变。由于囊肿的紧密粘附性以及对病变残余髓内部分的刺激引起肛门外括约肌反应，因此无法进行总切除。
结论：这是首例报道的双叶髓内和髓外支气管囊肿。这个独特的案例通过支持分裂的脊索综合征理论而不是异位的外胚层建议，使人们能够深入了解支气管囊肿的定义不清的胚胎发生。证明了在切除这些紧密粘附的病变时进行神经监测的重要性。最后,尽管这些病变的分泌性质预示着囊肿再积聚的趋势，必须认识到这通常是一个缓慢的过程。
方法：一名25岁男性，表现为进行性背痛和持续6个月的双侧下肢坐骨神经痛。5年前，他接受了髓内支气管圆锥髓质囊肿的次全切除术。磁共振成像显示复发性双叶髓内和髓外圆锥髓质囊性病变。作者在术中神经监测的帮助下通过后路切除了病变。由于囊肿的紧密粘附性以及对病变残余髓内部分的刺激引起肛门外括约肌反应，因此无法进行总切除。
结论：这是首例报道的双叶髓内和髓外支气管囊肿。这个独特的案例通过支持分裂的脊索综合征理论而不是异位的外胚层建议，使人们能够深入了解支气管囊肿的定义不清的胚胎发生。证明了在切除这些紧密粘附的病变时进行神经监测的重要性。最后,尽管这些病变的分泌性质预示着囊肿再积聚的趋势，必须认识到这通常是一个缓慢的过程。
