1、CASE DISCUSSION 2019-12-25CASE DISCUSSION 2019-12Vocabularyhypoalgesia hapldi:s 痛覺減退Hypoesthesia hapsi:z 感覺遲鈍Myodynamia madanmj 肌力anal sphincter sfkt 肛門括約肌congenital dysplasia displeizi 先天性發(fā)育不良spina bifida span bfd 脊柱裂Vocabularyhypoalgesia hapCASE 1Patient: female, 34 years oldWith waistpain and the

2、 right lower extremityradicular pain for 6 months. There was no fever, no headache, no surgery, no history of traumaExamination: hypoesthesia at the front of the thigh, Bilateral Lower limbs myodynamia IV, muscle tension(-),Bilateral Babinski sign(-)Laboratory tests (-)CASE 1Patient: female, 34 year

3、CTCTT1WI T2WI STIRT1WI T2WI CE-T1WICE-T1WICASE 2Patient: male, 32years oldNeck and 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 trau

4、maExamination: passive posture, neck movement was restricted. double upper limbs 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 a

5、nal sphincter contraction weakness, anal reflex (-)Laboratory tests (-)CASE 2Patient: male, 32years CTCTT1WI T2WI CE-T1T1WI T2WI T2WI CE-T1WI T2WI PLEASE GIVE YOUR OPINIONPLEASE GIVE YOUR OPINION手術(shù)記錄 case1手術(shù)記錄 case1手術(shù)記錄 case2手術(shù)記錄 case2Intraspinal neurenteric cysts神經(jīng)腸囊腫上皮細(xì)胞的顯微照片。（a）囊腫壁：顯示單層柱狀和立方上皮細(xì)胞貼

6、附由型膠原組成的基底層（H和E，200）（b）柱狀上皮、立方上皮和分泌粘液的杯狀細(xì)胞，高倍鏡（H和E，1000）（C）假復(fù)層纖毛柱狀上皮的腸源性囊腫壁高倍鏡（H和E，1000）Intraspinal neurenteric cysts神Neurenteric cysts MRI of thoracolumbar junction with intradural/ extramedullary neurenteric cyst at T11. (a) Midsagittal MRI demonstrates isointense lesion (arrow) on T1-weighted and

7、 (b) hyperintense signal (arrow) on T2-weightedNeurenteric cysts MRI of thoraCauseIts pathogenesisis not clear.It general considered as a congenitaldisease related with endoderm development disorders.During embryonic development period, part of the endodermal tissues was abnormalposterior displaceme

8、nt 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. CauseIts pathogenesisis not cPathological mechanismOnlycontaining endodermal components,similarwith the digestive tr

9、actepithelium.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 cilia andmucus secretinggoblet cells.Pathological mechanis

10、mOnlyconEpidemiologyaccount for 0.7-1.3% of spinal axis tumors. Mostly occurs in children and adolescents11days-40yearsMale predilection: proportion of men to women as (2-3):1most occured in thesubdural extramedullary 90%, a few in theepiduralor intramedullary.neck or upperthoracic were most involve

11、d,lumbar and sacral rare.Often accompanied withcongenital spine deformities (like spinabifida)Epidemiologyaccount for 0.7-1.Imaging findingsMRI 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 ins

12、ignificantcompression of the spinal cord, cystwall is thin anduniform.T1WIshowsmainlylow /equal /slightly higher than CSFT2WIshows high/isosignalto CSF,usually homogeniousSignalstrength depends on thecystcontents, moreprotein constituents orintracystic hemorrhage,T1WI showed high signal orlow T2WI s

13、ignalSpinal cordembeddedsyndromeNo enhancementImaging findingsMRI showed a rDiagnosisThe 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 alt

14、ernating; (3) the MRI 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 malformationsDiagnosisT

15、he followingcharactTreatmentSurgical treatment, particularly total resection with rare recurrencepartial resections recurrence rate as high as 37%Jesse J. Savage etal. Neurenteric cysts of the spine. J Craniovertebr Junction Spine. 2019 Jan-Jun; 1(1): 5863.TreatmentSurgical treatment, pDifferential

16、diagnosis(1)蛛網(wǎng)膜囊腫: arachnoidcyst:(2)皮樣和表皮樣囊腫: dermoid and epidermoid cyst(3)囊性神經(jīng)鞘瘤:cystic schwannoma(4)血管母細(xì)胞瘤:hemangioblastoma:(5)脂肪瘤:lipomaDifferential diagnosis(1)蛛網(wǎng)膜囊腫蛛網(wǎng)膜囊腫蛛網(wǎng)膜囊腫:青年人多見,一般位于脊髓背側(cè)髓外硬膜下或硬膜外,信號強(qiáng)度在各序列上均與腦脊液一致,無強(qiáng)化。一般不合并其他先天性畸形。蛛網(wǎng)膜囊腫蛛網(wǎng)膜囊腫:青年人多見,一般位于脊髓背側(cè)髓外硬膜下表皮樣囊腫M/35years: epidermoid cyst 多位于腰骶部髓外硬膜下,信號多不均勻,大多數(shù)無強(qiáng)化,表皮樣囊腫M/35years: epidermoid cys皮樣囊腫F/35y: dermoid cyst皮樣囊腫F/35y: dermoid cyst囊性神經(jīng)鞘瘤囊性神經(jīng)鞘瘤:一般沿神經(jīng)根走行分布,典型的腫瘤呈啞鈴狀,通過擴(kuò)大的椎間孔向硬膜外生長。病變信號不均,增強(qiáng)掃描囊壁及