背景:继发性脊髓蛛网膜囊肿很少有报道,但对治疗提出了重大挑战。这些囊肿可能位于前部,头尾延伸很长,许多与蛛网膜炎有关。导致难以治疗的疾病。到目前为止,由于报告的稀缺性,该疾病的特征和最佳治疗策略仍不清楚.
目的:研究继发性脊髓蛛网膜囊肿与原发性脊髓蛛网膜囊肿的临床特征和最佳治疗方式。研究设计:系统评价患者样本:系统评价从80项研究和报告中确定了103例继发性病例;结果指标:分析了症状缓解情况和治疗反应持续时间。
方法:对PubMed数据库进行了电子文献检索,以研究1990年至2022年之间的继发性脊髓蛛网膜囊肿。非英语出版物,非人类研究,原发性囊肿的报告,不包括案例细节的研究,并排除无症状病例的研究.
结果:本系统综述包括103个次要病例。最常报道的病因是医源性因素,创伤,和蛛网膜下腔出血,占88的髓外硬膜内,11硬膜外,1硬膜内/硬膜外,1间硬脑膜,和1个髓内脊髓蛛网膜囊肿后,中位持续时间为30、12和9个月,分别。硬膜外囊肿更容易发生在背侧位置并影响胸段(平均囊肿长度:3.4段)。硬膜内囊肿表现出相对较高的腹侧/背侧比例(1:1.09,1.75:1和3.50:1的囊肿发生于医源性因素,创伤,和蛛网膜下腔出血,分别)和胸部分布,平均囊肿长度为4.3段(腹侧囊肿为5.1,背侧囊肿为3.5)。对于硬膜内囊肿,手术切除后的复发风险低于开窗术/袋式化后(12个月复发风险:21.43%vs.50.72%,对数秩检验:P=0.0248,Gehan-Breslow-Wilcoxon检验:P=0.0126)。在分流治疗的病例中,在中位随访12个月时,1例(1/8例)在外部分流后复发,2例(2/5例)在内部分流后复发.
结论:继发性脊髓蛛网膜囊肿,尤其是硬膜内囊肿,比原发性脊髓囊肿更罕见,更具有挑战性。虽然开窗术/有袋化是普遍采用的治疗方法,复发率高。对于不可切除的囊肿,分流程序,特别是分流到体腔中(例如,胸膜或腹膜腔)远离蛛网膜下腔,除了开窗术/marupialization之外,可能是一种治疗方法,然而,它的有效性需要更多的数据证实。
Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long rostral-caudal extensions and many are related to arachnoiditis, leading to difficult-to-treat disorders. Thus far, due to the scarcity of reports, the features of the disease and the optimal therapeutic strategies remain unclear.
To investigate clinical features and the optimal treatment modalities of secondary spinal arachnoid cysts compared with primary spinal arachnoid cysts.
Systematic review.
Systematic review identified 103 secondary cases from 80 studies and reports.
Condition of symptom relief and duration of treatment response were analyzed.
An electronic literature search of the PubMed database was conducted for studies on secondary spinal arachnoid cysts between 1990 and 2022. Non-English publications, nonhuman studies, reports of a primary cyst, studies not including case details, and studies of nonsymptomatic cases were excluded.
This systematic review included 103 secondary cases. The most commonly reported etiologies were iatrogenic factors, trauma, and subarachnoid hemorrhage, accounting for 88 intradural extramedullary, 11 extradural, one intradural/extradural, one interdural, and one intramedullary spinal arachnoid cyst after a median duration of 30, 12, and 9 months, respectively. Extradural cysts were more prone to occur at dorsal locations and affect thoracic segments (mean cyst length: 3.4 segments). Intradural cysts showed a relatively higher ventral/dorsal ratio (1:1.09, 1.75:1, and 3.50:1 for cysts occurring from iatrogenic factors, trauma, and subarachnoid hemorrhage, respectively) and thoracic distribution, with a mean cyst length of 4.3 segments (5.1 for ventral and 3.5 for dorsal cysts). For intradural cysts, recurrence risk was lower after surgical resection than after fenestration/marsupialization (12-month recurrence risk: 21.43% vs 50.72%, log-rank test: p=.0248, Gehan-Breslow-Wilcoxon test: p=.0126). In cases treated with shunting, one recurrence (1/8 cases) was noted after external shunting and two recurrences (2/5 cases) after internal shunting at a median follow up of 12 months.
Secondary spinal arachnoid cysts, particularly intradural cysts, are rarer and more challenging to treat than primary spinal cysts. Although fenestration/marsupialization is the commonly adopted treatment, the recurrence rate is high. For unresectable cysts, shunting procedures, particularly shunting into a body cavity (eg, pleural or peritoneal cavity) away from the subarachnoid space, could be a therapeutic alternative besides fenestration/marupialization, yet its efficacy requires confirmation by more data.