脊髓硬膜囊肿的新型亚型分类及相应的手术策略--104 例病例报告。

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2024-12-01 DOI:10.1016/j.spinee.2024.08.005

Guangjian He BA , Xingsen Xue MA , Xin Chen BA , Xing Fang BA , Hongyan Zhang MA , Wanjiang Wu MA , Jiantao Shi MD , Rong Hu MD , Jiangkai Lin MD , Weihua Chu MD

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引用次数: 0

摘要

背景：目的：本研究提出了一种新的亚型分类系统和相应的手术策略，旨在加强对这一实体的理解并规范手术治疗：患者样本：自2015年1月至2021年12月，共有104名SDC患者接受了新型亚型分类和相应的手术策略。2012年1月至2014年12月接受常规手术的54例患者作为对照组进行初步验证：根据神经功能改善和疼痛缓解情况，结果分为四个等级：优、良、无变化和恶化。优和良的等级被认定为改善。还对随访磁共振成像和并发症进行了评估：根据硬脊膜缺损的共同致病因素，椎管内的硬脊膜相关囊肿统一称为 SDC。根据渗漏的形状和渗漏的流向，可将其进一步分为 1 型（无神经根）和 2 型（含神经根），以及另外四个亚型。1a 型 SDC 的裂缝状渗漏可直接缝合，而 1b 型的孔状渗漏则使用补片修复。2a 型的低流量漏点直接使用脂肪组织和纤维蛋白胶组合进行封堵，而 2b 型的高流量漏点则需要在封堵前缝合漏点末端以减弱脑脊液流动：随访时间平均为 23.8 个月。四个亚型分别有100%、88.9%、100%和97.3%的患者获得了极佳或良好的治疗效果。SDC的总体改善率为97.1%，明显高于传统手术组（85.2%，P=0.008）。磁共振成像随访显示，四种亚型的囊肿体积分别明显缩小了100%、100%、97.8%和97.3%。主要并发症包括假膜囊肿 4 例（3.8%）和伤口延迟愈合 5 例（4.8%）。并发症发生率也明显低于对照组（8.7% vs 24.1%，P=0.008）：结论：根据漏点和漏液的变化对 SDC 进行分型，可使手术策略更有针对性，有助于提高治疗效果和减少并发症。

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A novel subtype classification and corresponding surgical strategies for spinal dural cysts–a report of 104 cases

BACKGROUND

The nomenclature, classification, and surgical approaches for spinal dural cysts (SDCs) remain a subject of controversy.

PURPOSE

The present study proposes a novel subtype classification system and corresponding surgical strategies, with the aim of enhancing comprehension of this entity and standardizing surgical treatment.

STUDY DESIGN

A retrospective review.

PATIENT SAMPLE

A total of 104 patients with SDCs underwent novel subtype classification and corresponding surgical strategies from January 2015 to December 2021. Fifty-four patients who underwent conventional surgery from January 2012 to December 2014 as the control group for preliminary validation.

OUTCOME MEASURES

The outcomes are categorized into 4 levels: excellent, good, unchanged, and deteriorated, based on neurological improvement and pain relief. Grades of excellent and good were identified as improvements. Follow-up magnetic resonance imaging and complications were also evaluated.

METHODS

Based on the shared pathogenic factor of dural defects, the dural-associated cysts in the spinal canal are uniformly referred to as SDCs. They are further classified into Type 1 (no nerve roots) and Type 2 (containing nerve roots), with 4 additional subtypes based on the shape of the leak and the flow of leakage. The fissure-shaped leak of Type 1a SDCs is directly sutured, whereas the aperture-shaped leak of Type 1b is repaired using a patch. Low-flow leakage of Type 2a is directly sealed using a combination of adipose tissue and fibrin glue, whereas high-flow Type 2b necessitates suturing at the end of the leak to attenuate cerebrospinal fluid flow prior to sealing.

RESULTS

The follow-up period averaged 23.8 months. Excellent or good outcomes were achieved in 100%, 88.9%, 100%, and 97.3% for the 4 subtypes respectively. The overall improvement rate of SDCs was 97.1%, which was significantly higher than that of the conventional surgery group (85.2%, p=.008). MRI follow-up showed a significant reduction in cyst size of 100%, 100%, 97.8%, and 97.3% for the 4 subtypes, respectively. The primary complications included pseudomeningocele in 4 cases (3.8%) and delayed wound healing in 5 cases (4.8%). The complication rate was also significantly lower than that of the control group (8.7% vs 24.1%, p=.008).

CONCLUSIONS

Subtyping SDCs based on the variation of leaks and leakage can enable more targeted surgical strategies, which are helpful for improving treatment effectiveness and reducing complications.

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来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.