椎管内肠源性囊肿ppt课件.pptx

CASE DISCUSSION 2014-12-252024/5/27 周一.1Vocabularyhypoalgesiahapldi:s痛觉减退Hypoesthesiahapsi:z感觉迟钝Myodynamiamadanmj肌力analsphinctersfkt肛门括约肌congenitaldysplasiadispleizi先天性发育不良spinabifidaspanbfd脊柱裂2024/5/27 周一.2CASE 1Patient:female,34yearsoldWithwaistpainandtherightlowerextremityradicularpainfor6months.Therewasnofever,noheadache,nosurgery,nohistoryoftraumaExamination:hypoesthesiaatthefrontofthethigh,BilateralLowerlimbsmyodynamiaIV,muscletension(-),BilateralBabinskisign(-)Laboratorytests(-)2024/5/27 周一.3CT2024/5/27 周一.4T1WI T2WI STIR2024/5/27 周一.5CE-T1WI2024/5/27 周一.6CASE 2Patient:male,32yearsoldNeckandshoulderandbilateralupperlimbspainwithlimbsnumbnessandweaknessformorethan6years,Thesymptomswereaggravatingwithlimitedmobilityfor10days.Therewasnofever,noheadache,nosurgery,nohistoryoftraumaExamination:passiveposture,neckmovementwasrestricted.doubleupperlimbsapparenthypoalgesia,bilateralupperlimbsmyodynamiaII;theleftlowerlimbmyodynamiaI,therightlowerlimbmyodynamiaII.muscletension(-).BilateralHoffmannsign(+),Babinskisyndrome(+),Rectaltouch:theanalsphinctercontractionweakness,analreflex(-)Laboratorytests(-)2024/5/27 周一.7CT2024/5/27 周一.8T1WI T2WI CE-T12024/5/27 周一.9 T2WI CE-T1WI2024/5/27 周一.10PLEASE GIVE YOUR OPINION2024/5/27 周一.11手术记录 case12024/5/27 周一.12手术记录 case22024/5/27 周一.13Intraspinal neurenteric cysts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）2024/5/27 周一.14Neurenteric cysts MRI of thoracolumbar junction with intradural/extramedullary neurenteric cyst at T11.(a)Midsagittal MRI demonstrates isointense lesion(arrow)on T1-weighted and(b)hyperintense signal(arrow)on T2-weighted2024/5/27 周一.15CauseItspathogenesisisnotclear.Itgeneralconsideredasacongenitaldiseaserelatedwithendodermdevelopmentdisorders.Duringembryonicdevelopmentperiod,partoftheendodermaltissueswasabnormalposteriordisplacementandembeddedintheneuraltube.Heterotopicrestsofepitheliumofgastrointestinaltissueleadtoeventualformationofcompressivecysticlesionsofthepediatricandadultspine.2024/5/27 周一.16Pathological mechanismOnlycontainingendodermalcomponents,similarwiththedigestivetractepithelium.Formthe cyst wall epithelial cellscan be singlelayerflat,cubic,columnarepithelium,pseudostratifiedcolumnarepitheliumtostratifiedsquamousepithelium,alsocanhavemucousgland,serous gland,muscleand fat.Sometimescontainciliaandmucussecretinggobletcells.2024/5/27 周一.17Epidemiologyaccountfor0.7-1.3%ofspinalaxistumors.Mostlyoccursinchildrenandadolescents11days-40yearsMalepredilection:proportionofmentowomenas(2-3):1mostoccuredinthesubduralextramedullary90%,afewintheepiduralorintramedullary.neckorupperthoracicweremostinvolved,lumbarandsacralrare.Oftenaccompaniedwithcongenitalspinedeformities(likespinabifida)2024/5/27 周一.18Imaging findingsMRIshowedaroundorovalcystlesion,withsmoothedges,thelongaxisdirectionthesameasthespinalcord.butalsocanbeirregularinshape.Cystresultinginsignificantcompressionofthespinalcord,cystwallisthinanduniform.T1WIshowsmainlylow/equal/slightlyhigherthanCSFT2WIshowshigh/isosignaltoCSF,usuallyhomogeniousSignalstrengthdependsonthecystcontents,moreproteinconstituentsorintracystichemorrhage,T1WIshowedhighsignalorlowT2WIsignalSpinalcordembeddedsyndromeNoenhancement2024/5/27 周一.19DiagnosisThefollowingcharacteristicsshouldbehighlysuspected:(1)inmaleadolescents;(2)partialnerverootpainorspinalcordcompressionsymptomsasthemainclinicalmanifestations,remissionandexacerbationofalternating;(3)theMRIdisplaycysticlesionsinthecervicalorthoracicintraspinalsubduralextramedullary,cystsignalsimilarwithCSF,withthincystwall,noenhancementeffect;withSpinalcordembeddedsyndrome(4)X-rayplainradiographyandCTdisplayothercongenitalmalformations2024/5/27 周一.20TreatmentSurgicaltreatment,particularlytotalresectionwithrarerecurrencepartialresectionsrecurrencerateashighas37%Jesse J.Savage etal.Neurenteric cysts of the spine.J Craniovertebr Junction Spine.2010 Jan-Jun;1(1):5863.2024/5/27 周一.21Differential diagnosis(1)蛛网膜囊肿:arachnoidcyst:(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:lipoma2024/5/27 周一.22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。2024/5/27 周一.23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,2024/5/27 周一.24皮样囊肿F/35y:dermoidcyst2024/5/27 周一.25囊性神经鞘瘤囊性神经鞘瘤:一般沿神经根走行分布,典型的肿瘤呈哑铃状,通过扩大的椎间孔向硬膜外生长。病变信号不均,增强扫描囊壁及实性部分明显强化。2024/5/27 周一.262024/5/27 周一.27血管母细胞瘤血管母细胞瘤:囊肿型血管母细胞瘤表现为髓内“囊肿壁结节”,壁结节明显强化,继发性脊髓空洞症及异常流空血管信号常见2024/5/27 周一.28脂肪瘤脂肪瘤:可发生于椎管内任何节段,T1WI和T2WI病灶均呈高信号,应用脂肪抑制序列后,病灶内的高信号明显被抑制。而蛋白含量高的肠源性囊肿信号强度不受脂肪抑制序列影响。2024/5/27 周一.292024/5/27 周一.30后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用2024/5/27 周一.31主要经营：网络软件设计、图文设计制作、发布广告等公司秉着以优质的服务对待每一位客户，做到让客户满意！2024/5/27 周一.32致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求2024/5/27 周一.33The user can demonstrate on a projector or computer,or print the presentation and make it into a film to be used in a wider field2024/5/27 周一.34