Symptomatic Spinal Epidural Varices Presenting With Nerve Impingement: Report of Two Cases and Review of the Literature
Symptomatic Spinal Epidural Varices Presenting With Nerve Impingement: Report of Two Cases and Review of the Literature
复制标题
症状性脊髓硬膜外静脉曲张伴神经压迫：二例报告及文献复习
DOI：
10.1097/01.brs.0000090500.10184.7a
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发表时间：
2003
期刊：
影响因子：
3
通讯作者：
C. Low
中科院分区：
文献类型：
--
作者：
Chin;P. Thng;F. Thoo;C. Low
研究设计.两例有症状的硬膜外静脉曲张的情况下，提出和文献回顾这个实体。Objective.提高对这种罕见疾病的认识，以解释术前磁共振成像扫描，并评估手术治疗的结果。背景以神经根病变为表现的症状性硬膜外静脉曲张极为罕见，且在术前评估时常漏诊。这种情况通常伪装成一个突出的髓核。诊断通常只能在术中进行。材料和方法。病例1是一名40岁男性，右下肢下腰痛伴神经根病急性加重。磁共振成像显示旁中央椎间盘脱垂。术中发现硬膜外静脉充血压迫L5神经根，无椎间孔狭窄。进行了静脉切除术。第二个病例是一名50岁的男性，既往接受过脊柱内固定，因左下肢神经根病急性发作而入院。术中发现硬膜外静脉曲张压迫L4神经根。在术前磁共振成像扫描中发现硬膜外静脉曲张的特征。两名患者均报告术后症状消退。结果第1例患者行切除术，第2例患者行凝固消融术。两名患者在随访时症状缓解，神经功能恢复。结论我们的经验和文献表明，切除或消融硬膜外静脉曲张后，神经系统症状的解决往往可以实现良好的结果。
Study Design. Two cases of symptomatic epidural varices are presented and the literature was reviewed on this entity. Objective. To raise awareness of this rare condition in the interpretation of preoperative magnetic resonance imaging scans and to assess the results of surgical treatment. Background. Symptomatic epidural varices presenting with radiculopathy are extremely rare, and the diagnosis is often missed in the preoperative evaluation. This condition commonly masquerades as a herniated nucleus pulposus. Diagnosis is often only made intraoperatively. Materials and Methods. Case 1 is a 40-year-old man presenting with acute exacerbation of lower back pain associated with radiculopathy down his right lower limb. Magnetic resonance imaging showed a paracentral disc prolapse. At operation, a congested epidural vein impinging on the L5 nerve root was noted with no intervertebral foramens stenosis. Excision of the vein was performed. The second case, a 50-year-old man with previous spinal instrumentation, was admitted for acute onset of radiculopathy down his left lower limb. At operation, an epidural varix compressing on the L4 nerve root was noted. Retrospectively, features of epidural varices were noted in the preoperative magnetic resonance imaging scans. Both patients reported resolution of symptoms after surgery. Results. Excision was done for the first patient, and coagulative ablation was done in the second patient. Both patients had symptomatic relief and neurologic recovery on follow-up. Conclusion. Our experience and the literature demonstrated that a favorable outcome with resolution of neurologic symptoms can often be achieved after excision or ablation of the epidural varices.