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1CASEDISCUSSION
精选ppt2Vocabularyhypoalgesia[haɪpəʊæl‘dʒi:sɪə]痛觉减退Hypoesthesia[haɪpəʊs‘θi:zɪə]感觉迟钝Myodynamia[maɪɒdaɪ‘næmjə]肌力analsphincter[ˈsfɪŋktə]肛门括约肌congenitaldysplasia[disˈpleiziə]先天性发育不良spinabifida[ˌspaɪnəˈbɪfɪdə]脊柱裂精选ppt3CASE1Patient:female,34yearsoldWithwaist
pain
andtherightlowerextremity
radicularpainfor6months.Therewasnofever,noheadache,nosurgery,nohistoryoftraumaExamination:hypoesthesiaatthefrontofthethigh,BilateralLowerlimbsmyodynamiaIV,muscletension(-),BilateralBabinskisign(-)Laboratorytests(-)精选ppt4CT精选ppt5T1WIT2WISTIR精选ppt6CE-T1WI精选ppt7CASE2Patient:male,32yearsoldNeckandshoulder
and
bilateralupperlimbs
painwith
limbsnumbnessandweakness
formorethan6years,Thesymptomswereaggravating
withlimitedmobility
for10days.Therewasnofever,noheadache,nosurgery,nohistoryoftraumaExamination:passiveposture,neckmovementwasrestricted.doubleupperlimbsapparenthypoalgesia,bilateralupperlimbsmyodynamiaII;theleftlowerlimbmyodynamiaI,therightlowerlimbmyodynamiaII.muscletension(-).BilateralHoffmannsign(+),Babinskisyndrome(+),Rectaltouch:theanalsphinctercontractionweakness,analreflex(-)Laboratorytests(-)精选ppt8CT精选ppt9T1WIT2WICE-T1精选ppt10T2WICE-T1WI精选ppt11PLEASEGIVEYOUROPINION
精选ppt12手术记录case1精选ppt13手术记录case2精选ppt14Intraspinalneurentericcysts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Ⅳ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)精选ppt15NeurentericcystsMRIofthoracolumbarjunctionwithintradural/extramedullaryneurentericcystatT11.(a)MidsagittalMRIdemonstratesisointenselesion(arrow)onT1-weightedand(b)hyperintensesignal(arrow)onT2-weighted精选ppt16CauseItspathogenesis
isnotclear.
Itgeneralconsidered
asacongenital
diseaserelatedwithendodermdevelopmentdisorders.
Duringembryonicdevelopmentperiod,partoftheendodermaltissueswasabnormal
posteriordisplacementandembedded
intheneuraltube.Heterotopicrestsofepitheliumofgastrointestinaltissueleadtoeventualformationofcompressivecysticlesionsofthepediatricandadultspine.精选ppt17PathologicalmechanismOnly
containingendodermalcomponents,
similar
withthedigestivetract
epithelium.
Form
thecystwallepithelialcells
canbesinglelayer
flat,
cubic,
columnarepithelium,pseudostratifiedcolumnarepithelium
to
stratifiedsquamousepithelium,alsocanhave
mucousgland,
serousgland,
muscle
andfat.Sometimescontainciliaand
mucussecreting
gobletcells.精选ppt18Epidemiologyaccountfor0.7-1.3%ofspinalaxistumors.Mostlyoccursinchildrenandadolescents11days---40yearsMalepredilection:proportionofmentowomenas(2-3):1mostoccuredinthe
subduralextramedullary90%,afewinthe
epidural
orintramedullary.
neckorupper
thoracicweremostinvolved,
lumbarandsacral
rare.
Oftenaccompaniedwith
congenitalspinedeformities(likespina
bifida)精选ppt19ImagingfindingsMRIshowedaroundor
ovalcyst
lesion,
withsmoothedges,thelongaxisdirectionthesameasthespinalcord.butalsocanbe
irregularinshape.
Cyst
resultingin
significant
compressionofthespinalcord,cyst
wallisthinand
uniform.T1WI
shows
mainly
low/equal/slightlyhigherthanCSFT2WI
showshigh/iso
signal
toCSF,
usuallyhomogeniousSignal
strengthdependsonthe
cyst
contents,
more
protein
constituentsor
intracystichemorrhage,
T1WIshowedhighsignal
or
lowT2WIsignal"Spinalcord
embedded
syndrome"Noenhancement精选ppt20DiagnosisThefollowing
characteristics
shouldbehighlysuspected:
(1)inmaleadolescents;(2)partialnerverootpainorspinalcordcompression
symptomsasthemainclinicalmanifestations,remission
andexacerbationofalternating;(3)theMRIdisplaycysticlesionsinthecervicalorthoracic
intraspinalsubduralextramedullary,cystsignalsimilar
withCSF,withthincystwall,noenhancementeffect;with
"Spinalcord
embedded
syndrome"(4)X-rayplainradiographyandCTdisplayothercongenitalmalformations精选ppt21TreatmentSurgicaltreatment,particularlytotalresectionwithrarerecurrencepartialresection’srecurrencerateashighas37%JesseJ.Savageetal.Neurentericcystsofthespine.JCraniovertebrJunctionSpine.2010Jan-Jun;1(1):58–63.精选ppt22Differentialdiagnosis(1)蛛网膜囊肿:arachnoid
cyst:(2)皮样和表皮样囊肿:dermoidandepidermoidcyst(3)囊性神经鞘瘤:cysticschwannoma(4)血管母细胞瘤:hemangioblastoma:(5)脂肪瘤:lipoma精选ppt23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。精选ppt24表皮样囊肿M/35years:epidermoidcyst多位于腰骶部髓外硬膜下,信号多不均匀,大多数无强化,精选ppt25皮样囊肿F/35y:dermoidcyst精选ppt26囊性神经鞘瘤囊性神经鞘瘤:一般沿神经根走
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