目的:皮样囊肿在脊髓肿瘤中并不常见,它们自发破裂进入syrinx腔的现象非常罕见。我们旨在分析影像学特征和病因,并提出了一些手术策略,这种不寻常的现象。
方法:我们回顾性分析了14例脊髓皮样囊肿破裂进入颈胸椎腔。有6例男性和8例女性,年龄21至46岁,从C1到L3的syrinx腔中有脂滴。皮样囊肿总是位于圆锥处。根据病人的投诉,临床表现,和成像结果,我们在一个阶段或多个阶段采用了肿瘤切除和/或syrinx腔抽吸术。
结果:3例患者由于有皮样囊肿切除史,仅进行了空洞抽吸手术。一期有8例患者进行了皮样囊肿切除术和注射器腔抽吸术。由于在9个月的随访中出现了新的症状,一名患者分两个阶段进行了手术。两名患者仅接受了肿瘤切除术,因为他们没有表现出由颈胸syrinx引起的类似症状或体征。轴向磁共振成像表明,脂滴总是不在中心,而是偏心的。本组随访期间临床疗效满意。
结论:脂滴充满脊髓空洞,并不完全局限于中央运河。根据主要投诉和相关标志,我们采取了不同的手术策略,取得了满意的临床效果。
OBJECTIVE: Dermoid cysts are uncommon in spinal cord tumors, and the phenomenon of their spontaneous rupture into the syrinx cavity is quite rare. We aimed to analyze the imaging characteristics and etiologies, and propose some surgical strategies, for this uncommon phenomenon.
METHODS: We retrospectively reviewed 14 cases with spinal dermoid cysts that ruptured into the cervical and thoracic syrinx cavity. There were six male and eight female cases, aged 21 to 46 years, who had lipid droplets in the syrinx cavity from C1 to L3. The dermoid cysts were always located at the conus. Based on patients\' complaints, clinical manifestations, and imaging results, we adopted tumor excision and/or syrinx cavity aspiration in one stage or multiple stages.
RESULTS: Three patients had only a syrinx cavity aspiration surgery due to a history of dermoid cyst excision. Eight patients had dermoid cyst resection and syrinx cavity aspiration in one stage. One patient was operated upon in two stages due to the development of new symptoms at nine months follow-up. Two patients underwent only tumor resection since they did not show similar symptoms or signs caused by the cervicothoracic syrinx. The axial magnetic resonance imaging indicated that the lipid droplets were always not at the center but were eccentric. The clinical effect was satisfactory during the follow-up period in this group.
CONCLUSIONS: The lipid droplets filled the spinal syrinx cavity, not entirely confined to the central canal. Based on the chief complaints and associated signs, we adopted different surgical strategies and had satisfactory clinical results.