Spinal arachnoid cyst/meningeal cyst скачать в хорошем качестве

Spinal arachnoid cyst/meningeal cyst

This patient is a 26-year-old woman who comes in with a    chronic history of back pain. Her back pain has been present for at    least 2 years. She has pain both in the lumbar and upper thoracic area.   Pain also radiates into the shoulders at times. Her pain has also been   severe at times. She has had episodes of chest pain and also enough    severe pain that she has had difficulty moving due to the pain. In    addition, she reports numbness and tingling both in the upper    extremities distally and in the legs. These symptoms have been    persistent over time. On review of systems she also reports a headache.       Her past medical history includes depression, irritable bowel syndrome,   Crohn's disease and fibromyalgia.       PHYSICAL EXAMINATION: On examination the patient is overweight. She    does have good strength in her upper and lower extremities. I did not    note any spasticity or clonus in her legs.       IMAGING STUDIES: I reviewed this patient's MRI studies and myelogram of  the spine. These studies all suggest the presence of an arachnoid cyst  in the upper thoracic area extending over the upper four thoracic  levels. The cyst is located dorsal to the spinal cord and compresses    the spinal cord anteriorly. There is no signal change in the spinal    cord. The cervical canal is open and she does not have a Chiari    malformation.       I would concur that she does have evidence for an    arachnoid cyst in the upper thoracic area with compression of the    spinal cord. I would also concur that it is hard to know to what extent  her symptoms are related to this cyst and certainly possible the cyst could account for most of her symptoms, but is also possible they may be related to other causes. For this reason surgery on the cyst may or  may not completely correct her problems. We discussed the risks of  surgery in detail including risks that the surgery may not improve    things. At this point the patient is inclined to proceed with surgery,  which is scheduled next week, and I would concur with the surgical    plan.    We brought an intraoperative ultrasound machine and localized the arachnoid cyst. Cephalad edge was at T1 level, where CSF flow was clearly blocked by a "parachute" like membrane behind the cord. The cord was deviated ventrally due to the posterior arachnoid cyst. The caudal edge was around T4, where the cyst seemed to taper off. Dura was opened at midline and tacked up with multiple 4-0 Nurolon sutures. Thickened arachnoid was immediately noted. We then found cephalad edge of "parachute" and removed this in a piece. A small pial vessel, which was entering the cyst wall, was coagulated and cut. The rest of pial vessels were kept intact. The rest of the arachnoid cyst wall was carefully fenestrated to the normal cistern. The spinal cord pulsation appeared normal. I felt good decompression of cyst was achieved. We took video and multiple pictures with the microscope. Treatment Laminectomy with complete cyst wall resection If complete resection not possible Wide marsupialization of cyst, shunting, fenestration