Objective: To summarize the characteristics of sacral cysts containing fila terminale and to explore the surgical treatment methods.
Methods: The clinical features, imaging characteristics and surgical methods of 21 cases of sacral cysts containing fila terminale from July 2010 to March 2017 were reviewed and analyzed. Lumbosacral and perineal pain, weakness of the lower limbs and bladder and bowel dysfunction were the common clinical symptoms. MRI showed that the cysts located in the sacral canal. The lower T1 and higher T2 signals were found on MRI. There were fila terminale within the cysts which tethered the spinal cord. No enhancement was visible within the lesion. The key steps of operation included the resection of the cyst wall, the cutting off of the fila terminale, the release of the tethered cord and the reconstruction of the cisterna terminalis.
Results: The total and subtotal resections of cyst walls were achieved in 14 and 7 cases, respectively. The fila terminales were separated and cut off in all the cases, and the tethered cords were released completely. The reconstructions of the cisterna terminalis were accomplished in all the cases. There was no new-onset dysfunction except for 7 cases of mild numbness around anus postoperatively. Pathological examinations confirmed that the cyst wall was fibrous connective tissue, and hyperplasia of fibrous tissue and/or adipose tissue was found within the thickened fila terminale. The lumbosacral and perineal pain disappeared. The weakness of the lower extremities and the bladder and bowel dysfunction gradually improved. The period of follow-up ranged from 3 months to 7 years (average: 2.25 years). The spinal function of all the patients restored to McCormick grade Ⅰ. Only 1 case encountered recurrence of cyst.
Conclusion: The sacral cysts containing fila terminale are rare. The common symptoms include lumbosacral and perineal pain and symptoms of tethered cord. MRI is helpful to the diagnosis, which shows the signal of cerebrospinal fluid and the fila terminale in the cyst as well as tlow-placed conus medullaris. Microsurgery should remove the cyst wall, cut off the fila terminale, release the tethered cord and reconstruct the cisterna terminalis.
目的: 总结内含终丝的骶管囊肿的特点,探讨其手术治疗方法。
方法: 回顾分析2010年7月至2017年3月收治的21例内含终丝的骶管囊肿患者的临床特点、影像学特征和手术方法。临床症状以腰骶部及会阴区疼痛、双下肢无力和二便功能障碍为主。磁共振成像表现为骶管内长T1、长T2囊性信号,囊内可见终丝信号,增强扫描无强化,均合并脊髓低位。手术包括囊壁切除、终丝切断、脊髓拴系松解和终池重建等主要步骤。
结果: 囊壁全切除14例,次全切除7例。21例均将终丝分离切除,彻底松解拴系,并全部完成终池重建。术后除7例有轻度肛周麻木感外,无其他新发神经功能障碍。病理检查证实囊壁和终丝符合脊膜囊肿和终丝结构。术后患者腰骶部及会阴区疼痛消失、双下肢无力及大小便功能障碍逐渐恢复。视觉模拟疼痛评分从术前(5.24±1.41)分降到术后的(2.01±1.33)分;运动障碍者手术后肌力提高1~2级;括约肌障碍者日本骨科协会(Japanese Orthopaedic Association,JOA)评分从(2.09±0.99)分上升到(2.78±0.52)分。随访3个月至7年,平均2.25年,所有患者脊髓功能达到McCormick分级Ⅰ级,仅1例囊肿复发。
结论: 内含终丝的骶管囊肿罕见,以腰骶部及会阴区疼痛和脊髓拴系症状为主要表现。磁共振成像有助于该病的诊断,表现为囊肿内脑脊液信号和终丝结构,伴有脊髓圆锥低位。手术应在显微镜下切除囊壁,切断终丝并松解脊髓拴系和重建终池。
Keywords: Electromyography; Fila terminale; Microsurgery; Sacral cyst; Tethered cord syndrome.