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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (2): 303-308. doi: 10.19723/j.issn.1671-167X.2025.02.013

• 论著 • 上一篇    下一篇

任意维度重建磁共振对骶管囊肿进行精准分型对于指导微创手术和康复的意义

孙建军1,2,*(), 马千权1, 尹晓亮1, 杨辰龙1, 张嘉1, 陈素华1, 吴超1, 谢京城1, 韩芸峰1, 林国中1, 司雨1, 杨军1, 邬海博3, 赵强3   

  1. 1. 北京大学第三医院神经外科，北京 100191
    2. 首都医科大学附属北京友谊医院神经外科，北京 100050
    3. 北京大学第三医院放射科，北京 100191
  • 收稿日期:2022-01-18 出版日期:2025-04-18 发布日期:2025-04-12
  • 通讯作者: 孙建军 E-mail:sunjianjun@bjmu.edu.cn
  • 基金资助:
    北京大学第三医院创新转化基金(Y74496-05)

Significance of precise classification of sacral meningeal cysts by multiple dimensions radiographic reconstruction MRI in guiding operative strategy and rehabilitation

Jianjun SUN1,2,*(), Qianquan MA1, Xiaoliang YIN1, Chenlong YANG1, Jia ZHANG1, Suhua CHEN1, Chao WU1, Jingcheng XIE1, Yunfeng HAN1, Guozhong LIN1, Yu SI1, Jun YANG1, Haibo WU3, Qiang ZHAO3   

  1. 1. Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    3. Department of Radiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-01-18 Online:2025-04-18 Published:2025-04-12
  • Contact: Jianjun SUN E-mail:sunjianjun@bjmu.edu.cn
  • Supported by:
    the Innovation Transfer Fund of Peking University Third Hospital(Y74496-05)

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摘要：

目的: 运用任意维度重建磁共振对骶管囊肿进行精准分型, 有效指导患者的微创手术和术后个性化康复。方法: 2021年3—12月, 应用任意维度重建磁共振评估骶管囊肿患者的围手术期状况, 根据神经根或漏口轨迹重建出囊肿内神经根走行和囊肿漏口情况, 对骶管囊肿进行精准分型并精准设计手术切口和骶管后壁骨窗范围。于显微镜下验证术前分型的准确性, 指导对应术式治疗不同类型的骶管囊肿。术后复查神经根水肿情况、术腔是否有积液等, 制定患者个性化的康复方案, 便于患者顺利康复。结果: 92例骶管囊肿患者中, 58例(63.0%)为内含神经根囊肿, 29例(31.5%)为内无神经根囊肿, 5例(5.4%)为混合型骶管囊肿。58例内含神经根囊肿的患者中, 手术显微镜下复核影像临床分型的准确度可达96.6% (56/58), 只有2例较大的单发囊肿、神经根在囊肿上极闪现被误认为内无神经根型。29例内无神经根的骶管囊肿患者中, 显微镜下复核影像的准确度达100%。对12例复发骶管囊肿内部的神经根和漏口情况的判断准确度达到100%。术后1个月发现迟发性术腔积液2例, 予以艾灸、泡澡等康复治疗, 患者术后4~6个月积液消失。结论: 任意维度重建磁共振在术前可准确判断骶管囊肿的临床分型, 指导手术精准执行, 并个性化改善患者的康复效果。

关键词: 骶管囊肿, 临床分型, 脊神经根, 磁共振成像, 图像重建

Abstract:

Objective: To precise classify sacral meningeal cysts, effective guide minimally invasive neurosurgery and postoperative personalized rehabilitation by multiple dimensions radiographic reconstruction MRI. Methods: From March to December 2021, based on the original 3D-fast imaging employing steadystate acquisition (FIESTA) scanning sequence, 92 patients with sacral meningeal cysts were pre-operatively evaluated by multiple dimensional reconstruction MRI. The shape of nerve root and the leakage of cyst were reconstructed according to the direction of nerve root or leakage track showed on original MRI scans. Sacral canal cysts were accurately classified as including nerve root and without nerve root, so as to accurately design the incision of skin and formulate corresponding open range of the posterior wall of the sacral canal. Under the microscope intraoperation, the shape of the nerve roots inside cysts or leakage track of the cysts without nerve roots were verified and explored. After the reinforcement and shaping operation, several reexaminations of multiple dimensional reconstruction MRI were performed to understand the deformation of the nerve root and hydrops in the operation cavity, so as to formulate a persona-lized rehabilitation plan for the patients. Results: Among the 92 patients with sacral mengingeal cyst, 58 (63.0%) cysts with nerve root cyst, 29 (31.5%) cysts without nerve root cyst, and 5 (5.4%) cysts with mixed sacral canal cyst. In 58 patients with nerve root cysts, the accuracy of preoperative clinical classification on MRI image reached 96.6% (56/58) through confirmation by operating microscope. Only 2 cases of large single cyst with nerve root on the head of cyst were mistaken for without nerve root type. In 29 patients with sacral cyst without nerve root, the accuracy of preoperative image reached 100% through confirmation by operating microscope. The accuracy of judging the internal nerve root and leakage of 12 cases with recurrent sacral cyst was also 100%. Two cases of delayed postoperative hydrops were found one month after operation. After rehabilitation treatment by moxibustion and bathing, the hydrops disappeared 4-6 months after operation. Conclusion: Multiple dimensional reconstruction MRI can precisely make clinical classification of sacral meningeal cysts before operation, guide minimally invasive neurosurgery effectively, and improve the rehabilitation effect.

Key words: Sacral meningeal cysts, Clinical classification, Spinal nerve roots, Magnetic resonance imaging, Image reconstruction

中图分类号: 

  • R739.42

表1

92例骶管囊肿患者的一般资料"

Classification of sacral cysts Gender Age/years, ${\bar x}$±s Numbers of cysts Maximum diameter of cyst/cm,
${\bar x}$±s
Male
(n=27, 29.3%)		 Female
(n=65, 70.6%)
With nerve root fiber 18 (31.0%) 40 (69.0%) 40.0±15.1 137 4.0±5.9
Without nerve root fiber 8 (27.6%) 21 (72.4%) 41.0±12.5 30 5.0±2.0
Mixture type 1 (20.0%) 4 (80.0%) 46.0±14.5 14 (8+6)* 3.0±1.2

图1

内含神经根囊肿的不同类型"

图2

内无神经根型骶管囊肿的各种类型"

表2

5例骶管囊肿合并骶前囊肿患者的一般资料"

Items Gender Maximum diameter of cyst/cm
Sacral canal Presacral
With nerve root fiber
  Case 1 Male 4.4 6.2
  Case 2 Female 5.5 8.6
Without nerve root fiber
  Case 1 Male 4.0 8.0
  Case 2 Female 3.6 14.0
  Case 3 Female 2.5 1.0

图3

骶管囊肿合并骶前囊肿的典型病例"

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ISSN 1671-167X
CN 11-4691/R
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