《椎管内肠源性囊肿》PPT课件.pptx

1、CASE DISCUSSION,2014-12-25,Vocabulary,hypoalgesia hapldi:s 痛觉减退 Hypoesthesia hapsi:z 感觉迟钝 Myodynamia madanmj 肌力 anal sphincter sfkt 肛门括约肌 congenital dysplasia displeizi 先天性发育不良 spina bifida span bfd 脊柱裂,CASE 1,Patient: female, 34 years old With waistpain and the right lower extremityradicular pain f

2、or 6 months. There was no fever, no headache, no surgery, no history of trauma Examination: hypoesthesia at the front of the thigh, Bilateral Lower limbs myodynamia IV, muscle tension(-),Bilateral Babinski sign(-) Laboratory tests (,CT,T1WI T2WI STIR,CE-T1WI,CASE 2,Patient: male, 32years old Neck an

3、d shoulderandbilateral upper limbspain withlimbs numbness and weaknessfor more than 6 years, The symptoms were aggravatingwith limited mobilityfor 10 days. There was no fever, no headache, no surgery, no history of trauma Examination: passive posture, neck movement was restricted. double upper limbs

4、 apparent hypoalgesia, bilateral upper limbs myodynamia II; the left lower limb myodynamia I, the right lower limb myodynamia II. muscle tension(-). Bilateral Hoffmann sign (+), Babinski syndrome (+), Rectal touch: the anal sphincter contraction weakness, anal reflex (-) Laboratory tests (,CT,T1WI T

5、2WI CE-T1,T2WI CE-T1WI,PLEASE GIVE YOUR OPINION,手术记录 case1,手术记录 case2,Intraspinal neurenteric cysts,神经肠囊肿上皮细胞的显微照片。 （a）囊肿壁：显示单层柱状和立方上皮细胞贴附由型胶原组成的基底层（H和E，200） （b）柱状上皮、立方上皮和分泌粘液的杯状细胞，高倍镜（H和E，1000） （C）假复层纤毛柱状上皮的肠源性囊肿壁高倍镜（H和E，1000,Neurenteric cysts,MRI of thoracolumbar junction with intradural/ extramed

6、ullary neurenteric cyst at T11. (a) Midsagittal MRI demonstrates isointense lesion (arrow) on T1-weighted and (b) hyperintense signal (arrow) on T2-weighted,Cause,Its pathogenesisis not clear.It general considered as a congenitaldisease related with endoderm development disorders. During embryonic d

7、evelopment period, part of the endodermal tissues was abnormalposterior displacement and embeddedin the neural tube. Heterotopic rests of epithelium of gastrointestinal tissue lead to eventual formation of compressive cystic lesions of the pediatric and adult spine,Pathological mechanism,Onlycontain

8、ing endodermal components,similarwith the digestive tractepithelium. Formthe cyst wall epithelial cellscan be single layerflat ,cubic,columnar epithelium, pseudostratified columnar epitheliumtostratified squamous epithelium, also can havemucous gland,serous gland,muscleand fat. Sometimes contain cil

9、ia andmucus secretinggoblet cells,Epidemiology,account for 0.7-1.3% of spinal axis tumors. Mostly occurs in children and adolescents 11days-40years Male predilection: proportion of men to women as (2-3):1 most occured in thesubdural extramedullary 90%, a few in theepiduralor intramedullary. neck or

10、upperthoracic were most involved,lumbar and sacral rare. Often accompanied withcongenital spine deformities (like spinabifida,Imaging findings,MRI showed a round oroval cystlesion,with smooth edges, the long axis direction the same as the spinal cord. but also can beirregular in shape. Cystresulting

11、 insignificantcompression of the spinal cord, cystwall is thin anduniform. T1WIshowsmainlylow /equal /slightly higher than CSF T2WIshows high/isosignalto CSF,usually homogenious Signalstrength depends on thecystcontents, moreprotein constituents orintracystic hemorrhage,T1WI showed high signal orlow

12、 T2WI signal Spinal cordembeddedsyndrome No enhancement,Diagnosis,The followingcharacteristicsshould be highly suspected: (1) in male adolescents; (2) partial nerve root pain or spinal cord compression symptoms as the main clinical manifestations, remission and exacerbation of alternating; (3) the M

13、RI display cystic lesions in the cervical or thoracic intraspinal subdural extramedullary, cyst signal similar with CSF, with thin cyst wall, no enhancement effect; with Spinal cordembeddedsyndrome (4) X-ray plain radiography and CT display other congenital malformations,Treatment,Surgical treatment

14、, particularly total resection with rare recurrence partial resections recurrence rate as high as 37,Jesse J. Savage etal. Neurenteric cysts of the spine. J Craniovertebr Junction Spine. 2010 Jan-Jun; 1(1): 5863,Differential diagnosis,1)蛛网膜囊肿: arachnoidcyst: (2)皮样和表皮样囊肿: dermoid and epidermoid cyst (3)囊性神经鞘瘤:cystic schwannoma (4)血管母细胞瘤:hemangioblastoma: (5)脂肪瘤:lipoma,蛛网膜囊肿,蛛网膜囊肿:青年人多见,一般位于脊髓背侧髓外硬膜下或硬膜外,信号强度在各序列上均与脑脊液一致,无强化。一般不合并其他先天性畸形,表皮样囊肿,M/35years: epidermoid cyst 多位于腰骶部髓外硬膜下,信号多不均匀,大多数无强化,皮样囊肿,F/35y: dermoid