The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy
The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy
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DOI：
10.1111/jon.12243
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发表时间：
2015-09-01
影响因子：
2.4
通讯作者：
Erbay, Sami H.
中科院分区：
文献类型：
--
作者：
Hakky, Michael M.;Justaniah, Almamoon I.;Erbay, Sami H.
蛛网膜囊肿和脑膜是胸椎脊髓病髓外病因的鉴别诊断考虑因素。在这个病例系列的7名患者，我们提出了压缩脑膜模仿背侧蛛网膜囊肿。目的：探讨后隔的影像学表现和临床病理特点，以提高影像学诊断水平，指导临床治疗。方法：对40 ~ 75岁上胸椎腹侧移位和脊髓背侧受压的患者，采用MRI检查，观察其影像学表现，并结合临床资料进行分析。进一步评估CT脊髓造影。主要指征是排除背侧蛛网膜囊肿。2例症状进展伴下肢无力者行脊髓减压术，所有病例经MSCT脊髓造影均排除占位性病变及脊髓疝。硬膜内背侧脑膜网和膜的可视化不一致。在2个操作的情况下，厚的聚结膜和高动力湍流CSF流严重压缩胸cord.CONCLUSIONDerangements的后隔可能会提出一个频谱的发现，应考虑在胸部脊髓病的鉴别。脊髓后缘变平是背侧髓外压迫性病变的可靠影像学线索。脐带压迫是由粘附膜和湍流CSF流的组合引起的。临床过程可能难以预测。定期影像学随访有助于确定预期治疗病例的结果稳定性。
BACKGROUNDArachnoid cysts and meningeal membranes are among the differential diagnostic considerations of extra-medullary causes of thoracic myelopathy. In this case series of 7 patients, we present compressive meningeal membranes mimicking dorsal arachnoid cyst. The propensity of the meningeal membranes for the dorsal aspect of upper thoracic spine may reflect derangements of the septum posticum.OBJECTIVETo provide the spectrum of imaging appearances and clinical presentations of pathology of the septum posticum to improve imaging utilization and to better guide treatment planning.METHODSSeven patients aged 40 to 75 with MRI findings of ventral displacement and dorsal cord compression in the upper thoracic spine were further evaluated with CT-myelograms. The primary indication was to exclude dorsal arachnoid cyst. Two patients with progressive symptoms and lower extremity weakness were operated for decompression.RESULTSCT-myelogram excluded space occupying lesions and cord herniation in all cases. Intradural dorsal meningeal webs and membranes were inconsistently visualized. In the 2 operated cases, thick coalescing membranes and hyperdynamic turbulent CSF flow were severely compressing the thoracic cord.CONCLUSIONDerangements of septum posticum may present a spectrum of findings that should be considered in the differential of thoracic myelopathy. Flattening of the posterior cord margin is a reliable imaging clue for a dorsal extra-medullary compressive lesion. Cord compression results from combination of adhesive membranes and turbulent CSF flow. The clinical course may be difficult to predict. Periodic imaging follow up can be helpful to confirm stability of findings in expectantly managed cases.