Background

Arachnoid web (AW) is a rare but probably underestimated cause of spinal cord injury that is complex to diagnose due to subtle MRI findings and similarities to other better-known diseases such as arachnoid cyst (AC) or transdural spinal cord herniation (TSCH). Increased recognition of AW is mandatory since delay in diagnosis can lead to potentially serious neurological sequelae.

Case presentations

We report two additional cases of AW for didactic purposes, with special emphasis on the distinctive MRI and intraoperative findings. Both patients presented with progressively worsening neurological symptoms, including proprioceptive ataxia, motor weakness, numbness and neuropathic pain. The diagnosis of AW was suspected on the basis of specific MRI criteria, especially the so-called “scalpel sign”. Formal confirmation of the diagnosis was obtained in two patients that were managed surgically. Postoperative follow-up demonstrated significant functional recovery.

Discussion

There is a need for better recognition of AW by the medical community. Careful analysis of MRI semiology is crucial for the distinction between AW, AC and TSCH. Prompt and accurate diagnosis is mandatory to conserve functional prognosis, since appropriate surgical treatment with AW resection is curative, halting or even resolving the neurological symptoms.

中文翻译：

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脊髓蛛网膜网：两例临床、放射学、手术和病理相关的教学报告

背景

蛛网膜网 (AW) 是一种罕见但可能被低估的脊髓损伤原因，由于 MRI 的细微发现以及与其他众所周知的疾病（如蛛网膜囊肿 (AC) 或经硬膜脊髓疝 (TSCH)）的相似性，诊断起来很复杂。必须加强对 AW 的识别，因为延误诊断会导致潜在的严重神经系统后遗症。

案例展示

我们出于教学目的报告了另外两个 AW 病例，特别强调了独特的 MRI 和术中发现。两名患者均出现逐渐恶化的神经系统症状，包括本体感觉性共济失调、运动无力、麻木和神经性疼痛。根据特定的 MRI 标准，尤其是所谓的“手术刀征”，怀疑 AW 的诊断。两名接受手术治疗的患者获得了正式的诊断确认。术后随访显示显着的功能恢复。

讨论

医学界需要更好地认识 AW。仔细分析 MRI 符号学对于区分 AW、AC 和 TSCH 至关重要。及时准确的诊断对于保持功能性预后是必不可少的，因为适当的 AW 切除手术治疗可以治愈、停止甚至解决神经系统症状。