Idiopathic Thoracic Intradural Spinal Arachnoid Cyst Associated with Syringomyelia: a Case Report and Literature Review

原發性脊髓蛛網膜囊腫及併發之脊髓空洞症－病例報告及文獻回顧

林柔妤(Jou Yu Lin) ； 鄧木火(Michael Mu Huo Teng) ； 劉復康(Fu-Kong Lieu) ； 陳思甫(Szu-Fu Chen)

《台灣復健醫學雜誌》 46卷2期 (2018/12) Pp. 107-112

https://doi.org/10.6315/TJPMR.201812_46(2).0007

摘要

We report an adult woman who presented with lower limb weakness and dysesthesia caused by a thoracic spinal arachnoid cyst associated with syringomyelia. Before the diagnosis was made by thoracic magnetic resonance imaging, she was diagnosed with lumbar spondylosis and underwent lumbar spinal surgery; however, her symptoms were not relieved. The patient received multilevel laminectomy and cyst resection after thoracic pathology was identified. An upper motor neuron lesion, although rare, should be considered a differential diagnosis when leg symptoms and signs develop. For patients with leg weakness and pain, we emphasize a detailed neurological examination to localize the lesion to a specific spinal region.

關鍵字

Arachnoid cyst ； syringomyelia ； spine ； drop foot

並列摘要

本文描述一名女性病患因胸椎脊髓蛛網膜囊腫及其伴隨之脊髓空洞症而導致下肢無力及感覺異常。此病患起初症狀為小腿感覺異常及垂足，經影像診斷為腰椎滑脫，故行腰薦椎椎板切除及融合術。術後症狀仍未改善且異常感覺延伸至上背部，才由胸椎磁振造影發現此蛛網膜囊腫及脊髓空洞症，並經病理切片確診。之後此病人行胸腰椎多節椎板切除併囊腫切除，術後持續復健。雖然小腿的症狀較少由上運動神經元病灶引起，但仍需列入鑑別診斷中。臨床上面對因腿部症狀而求診的病患，為找到真正的病灶，必須執行詳細的神經學檢查，方能開立更精確的影像學檢查、以及時解決病患的問題並避免不必要的手術。

並列關鍵字

脊髓蛛網膜囊腫（Arachnoid cyst） ； 脊髓空洞症（syringomyelia） ； 脊椎（spine） ； 垂足（drop foot）

參考文獻

1. Langston T. Holly, Ulrich Batzdorf. Syringomyelia associated with intradural arachnoid cysts. Journal of Neurosurgery: Spine 2006;5:111-116.

2. Petridis AK, Doukas A, Barth H, et al. Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case. European spine journal2010;19 Suppl 2:S124-129.

3. Klekamp J. A New Classification for Pathologies of Spinal Meninges—Part 2: Primary and Secondary Intradural Arachnoid Cysts. Neurosurgery 2017;81:217-229.

4. Nabors MW, Pait TG, Byrd EB, et al. Updated assessment and current classification of spinal meningeal cysts. Journal of neurosurgery 1988;68:366-377.

5. Wang MY, Levi ADO, Green BA. Intradural spinal arachnoid cysts in adults. Surgical Neurology 2003;60:49-55.