Spinal cavernous disease, as the name implies, is a chronic progressive degenerative disease of the spinal cord in which a cavity is formed in the spinal cord. It is a chronic progressive degenerative disease of the spinal cord. The disease progresses very slowly, and patients do not notice it for years or decades, and it does not attract the attention of specialists as much as multi-morbidities and common diseases. As a result, many patients are easily misdiagnosed.
More than 70% of spinal cord cavitation is caused by congenital posterior occipital dysplasia, and about 30% of patients suffer from inflammatory diseases such as tuberculosis, bacterial meningitis and trauma that lead to insufficient blood supply to the spinal cord, degeneration and atrophy of spinal cord nerve cells, and the gradual formation of spinal cord cavitation. In addition, some tumors in the spinal cord can also develop this condition.
The age of onset of the disease is usually between 20 and 30 years old, occasionally it can start in childhood, and from the current clinical observation, there is also a certain number of adults aged 40 to 50 years old.
What symptoms should be highly alerted to spinal cord cavitation?
Most of them have the same numbness as Ms. Li, i.e., pain-temperature and tactile sensory disorders, especially the loss or disappearance of temperature sensation.
Some people show pain and numbness in the head, neck, shoulders and upper extremities, cold, ankylosis, tingling and other sensations, while others show symptoms such as cyanosis of the extremities (blue fingertips), excessive or little sweating, dry skin and deformed nails. As the disease progresses, it may also gradually affect the upper arm, shoulder and some intercostal muscles, causing paralysis. The rate of disability is high in advanced stages of spinal cavernous disease, and respiratory dysfunction may also occur in severe cases.
However, there are several issues that need clarification and scientific understanding.
1. Understanding subungual herniation of the cerebellum?
Above: Imaging, schematic diagram and pathological specimen interpret this disease in three aspects. The red dotted line shows the herniated tonsils. The ventral medulla oblongata is compressed, which affects the patient’s neck movement and is life-threatening.
2. Must the spinal cord be cavernous? Is it true that the heavier the inferior herniation the heavier the cavity?
Figure: The cerebellar tonsils are herniated down to the level of cervical 1 but there is no cavity.
The above figure shows that the submural herniation of the cerebellum is not serious, but the cavity is large, and the spinal cord is compressed to a thin layer, and the patient’s clinical manifestations are very heavy.
3. What is the possible combination of other diseases in spinal cord cavitation?
Above: This deformity is combined with cervical spondylosis. The yellow dotted line shows a herniated cervical 6-7 disc, so the patient has numbness of the fingers, which is easily confused with cervical spondylosis.
Upper picture: The visible lower herniated tonsils are not severe, but the patient has severe cervical degeneration, in addition the spinal cord cavity is the result of several years of atrophy, therefore the patient’s main conflict, not the lower herniated tonsils of the cerebellum.
The above picture shows Chiari malformation, a teratoma with a combined spinal cone. Because it is a malformation, it is often combined with other malformations, especially in pediatric patients who can be combined with spinal cord spinal bulge, hydrocephalus and other malformations.
4.Why do some patients fail in surgery?
Above: The patient has subungual herniation of the cerebellum with spinal cord cavitation, but the main cause of the patient is the anterior compression so the operation cannot be performed from the posterior route, and if the operation may be aggravated, so it is most important to operate from the anterior route.
At present, the treatment of spinal cord hernia in the academic neurosurgical community both at home and abroad tends to be surgical.
The purpose of surgery.
1.Decompression of the bony and atlanto-occipital fascia and dura mater to release the compression of the medulla oblongata and superior cervical medulla;
2. To explore the median foramen of the fourth ventricle and restore cerebrospinal fluid access. Currently, there is a trend towards minimally invasive treatment of spinal cord cavities.