1
|
Jain S, Sun I, Pang BC, Lim SL, Low SW. Diagnostic dilemma in acute neurological presentation of spinal arachnoid cysts: A case report. Front Surg 2023; 10:1092345. [PMID: 37465064 PMCID: PMC10350562 DOI: 10.3389/fsurg.2023.1092345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/29/2023] [Indexed: 07/20/2023] Open
Abstract
Background Spinal arachnoid cysts are relatively uncommon, cerebrospinal fluid-filled sacs formed by arachnoid membranes that can be either idiopathic or acquired. The neurological presentation of these cysts is varied. Advances in imaging techniques have allowed an improved characterization of these entities and excluded other possible causes of clinical manifestation. Their presentation remains varied, ranging from pain to progressive neurological deficits. Here, we present two cases of patients with thoracic arachnoid cysts that posed a diagnostic dilemma at initial presentation because of their acute neurological deficit, and their eventual recovery after surgical intervention. Case description The first case is of a patient with end-stage renal failure, which prevented the administration of contrast during the workup. The differential diagnosis ranged from intradural abscess to arachnoid cyst. The second patient presented with non-remitting back pain that progressed to an acute neurological deficit. Both patients recovered well after decompression of the cyst. Conclusion The decision to intervene is still patient-dependent and based on the extent of neurological deterioration at the time of presentation due to the relatively benign nature and lack of understanding of the temporal presentation of neurological symptoms, which are rapidly and almost completely reversed after surgery. However, further studies need to be done to understand the acute presentation of these cysts, which are apparently long-standing.
Collapse
Affiliation(s)
- Swati Jain
- Division of Neurosurgery, University Surgical Cluster, National University Health System (NUHS), Singapore, Singapore
| | - Ira Sun
- Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Boon Chuan Pang
- Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Su Lone Lim
- Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Shiong Wen Low
- Division of Neurosurgery, Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| |
Collapse
|
2
|
Baig Mirza A, Bartram J, Sinha S, Gebreyohanes A, Boardman T, Vastani A, Dyson E, Lavrador JP, Russo V, Choi D, Vasan AK, Grahovac G. Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres. Acta Neurochir (Wien) 2022; 164:1217-1228. [PMID: 34705099 DOI: 10.1007/s00701-021-05027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC). METHODS Cases were identified from electronic records of two major neurosurgical centres in London over the last 10 years (October 2009-October 2019) that have been surgically treated in both institutions. Clinical findings, surgical technique, and recurrence by procedure were statistically analysed. Statistical analysis was performed with STATA 13.1 Software. RESULTS A total of 42 patients with SIAC were identified for this study with a mean age at the time of surgery of 53.6 years and a male:female ratio of 8:13. There were 31 patients with primary SIACs and 11 with secondary SIACs. The most common presenting symptom was paraesthesia (n = 27). The most common location of the cyst was in the thoracic region (n = 33). Syrinx was present in 26.2% of SIACs (n = 11). Resection was associated with significantly better postoperative pain compared to other surgical techniques (p = 0.01), significantly poorer postoperative urinary function (p = 0.029), and lower rates of sensory recovery in patients who presented preoperatively with sensory deficit (p = 0.041). No significant difference was seen in symptomatic outcomes between patients with primary and secondary SIACs. CONCLUSION Resection and drainage are both effective methods of managing SIACs. In this observational study, resection was associated with significantly reduced pain postoperatively when compared with drainage, however also with significantly less improvement in postoperative urinary function. Therefore, resection should be the gold standard management option for SIACs, with drainage as an option where resection is unsafe, and drainage should also be considered in patients presenting with urinary dysfunction.
Collapse
|
3
|
Takahata M, Watanabe T, Endo T, Ogawa Y, Miura S, Iwasaki N. Pulsating Spinal Arachnoid Cyst as a Hidden Aggravating Factor for Thoracic Spondylotic Myelopathy: A Report of 3 Cases. JBJS Case Connect 2022; 12:01709767-202206000-00033. [PMID: 35594560 DOI: 10.2106/jbjs.cc.22.00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE We report 3 cases of thoracic myelopathy caused by vertebral osteophytes and coexisting intradural spinal arachnoid cyst (SAC), which was difficult to diagnose on preoperative magnetic resonance imaging. Intraoperative ultrasound sonography revealed spinal cord impingement because of osteophytes and a pulsating intradural SAC. Repeated pincer compression on the spinal cord seemed to be associated with their paraparetic symptoms. CONCLUSION In treating patients presenting with unexplained progressive myelopathy with small ossified lesion in the thoracic spine, close attention should be paid to a coexisting SAC as a hidden aggravating factor for thoracic myelopathy.
Collapse
Affiliation(s)
- Masahiko Takahata
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | | | | | | | | |
Collapse
|
4
|
Pham N, Ebinu JO, Karnati T, Hacein-Bey L. Neuroimaging findings and pathophysiology of dorsal spinal arachnoid webs: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2142. [PMID: 35855021 PMCID: PMC9245846 DOI: 10.3171/case2142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinal arachnoid webs are uncommon and difficult to diagnose, especially because causative intradural transverse bands of arachnoid tissue are radiographically occult. Left untreated, arachnoid webs may cause progressive, debilitating, and permanent neurological dysfunction. Conversely, more than 90% of patients may experience rapid neurological recovery after resection, even with a prolonged duration of presenting symptoms. Indirect imaging signs such as spinal cord indentation and compression with cerebrospinal fluid (CSF) flow alteration provide crucial diagnostic clues that are critical in guiding appropriate management of such patients. OBSERVATIONS The authors reported a patient with no significant medical history who presented with back pain, progressive lower extremity weakness, gait ataxia, and bowel and bladder incontinence. They discussed multimodality imaging for determining the presence of arachnoid webs, including magnetic resonance imaging, phase-contrast CSF flow study, computed tomography myelography, and intraoperative ultrasound. They also discussed the detailed anatomy of the spinal subarachnoid space and a plausible pathophysiological mechanism for dorsal arachnoid webs. LESSONS The authors report on a patient who underwent comprehensive imaging evaluation detailing the arachnoid web and whose subsequent anatomical localization and surgical treatment resulted in a full neurological recovery.
Collapse
Affiliation(s)
- Nancy Pham
- Department of Radiology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California; and
| | | | | | - Lotfi Hacein-Bey
- Radiology, University of California, Davis, School of Medicine, Sacramento, California
| |
Collapse
|
5
|
Herrera Herrera I, Garrido Morro I, Guzmán de Villoria Lebiedziejewski J, Ordoñez González C, Rovira À. Enfoque clínico-radiológico de la mielopatía no traumática. RADIOLOGIA 2020; 62:464-480. [DOI: 10.1016/j.rx.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 11/16/2022]
|
6
|
Smith CJ, Guevar J. Spinal subarachnoid diverticula in dogs: A review. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:1162-1169. [PMID: 33149353 PMCID: PMC7560765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Spinal subarachnoid diverticula are fluid dilations of the subarachnoid space that can cause a compressive myelopathy in dogs. These diverticula are usually associated with high motion areas in the cervical and caudal thoracic spine. The definitive etiopathogenesis has not been determined but likely involves congenital or acquired causes. Pugs, French bulldogs, and Rottweilers are overrepresented breeds. Clinical signs typically include ataxia, paresis, and upper motor neuron urinary and/or fecal incontinence; pain is a less common feature. Diagnosis is based on advanced imaging, with magnetic resonance imaging now being favored given the additional detail of the spinal cord parenchyma that can be obtained. Outcomes are better with surgical intervention than with medical therapies, though there is a lack of long-term data. No superior surgical technique has been identified, and questions remain on the significance of addressing leptomeningeal adhesions at the time of surgery. Clinical signs can recur, though not always due to recurrence of diverticulum formation, and pugs may be less likely to have a successful long-term outcome.
Collapse
Affiliation(s)
- Casey J Smith
- Department of Medical Sciences, University of Madison-Wisconsin School of Veterinary Medicine, 2015 Linden Drive, Madison, Wisconsin 53706, USA (Smith); Division of Clinical Neurology Vetsuisse-Faculty, University of Bern, Bern, Switzerland (Guevar)
| | - Julien Guevar
- Department of Medical Sciences, University of Madison-Wisconsin School of Veterinary Medicine, 2015 Linden Drive, Madison, Wisconsin 53706, USA (Smith); Division of Clinical Neurology Vetsuisse-Faculty, University of Bern, Bern, Switzerland (Guevar)
| |
Collapse
|
7
|
Herrera Herrera I, Garrido Morro I, Guzmán de Villoria Lebiedziejewski J, Ordoñez González C, Rovira À. Clinical-radiological approach to nontraumatic myelopathy. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
8
|
Schmutzer M, Tonn JC, Zausinger S. Spinal intradural extramedullary arachnoid cysts in adults-operative therapy and clinical outcome. Acta Neurochir (Wien) 2020; 162:691-702. [PMID: 31813001 DOI: 10.1007/s00701-019-04156-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spinal arachnoid cysts (SAC) are rare mostly idiopathic intradural lesions with compression of the spinal cord and clinical signs of radiculo- and/or myelopathy. We retrospectively analyzed radiological and clinical characteristics of patients with surgical treatment of SAC including a subgroup evaluation of long-term outcome and QoL. METHOD Patients with SAC treated between 1993 and 2017 were evaluated. Craniocaudal (c.c.) and anteroposterior (a.p) cyst diameters were measured pre- and post-OP. McCormick and Odom score for myelopathy, general outcome and QoL (SF-36, EORTC-QLQ30) were recorded. RESULTS A total of 72 patients (female:male = 1.9:1) were analyzed with mean FU of 44.8 ± 60 months (long-term data from 25 patients with FU 78.2 ± 63.9 months). All had surgery due to solitary cysts: 10 cervical (13.9%), 45 thoracic (62.5%), and 17 lumbosacral (23.6%), the majority (79.2%) located dorsally. Main symptoms were gait disturbance (80%), dysesthesia (64%) and paresis (80%). Patients had (hemi-)laminectomy with cyst fenestration in 48 (66.7%) and complete resection in 18 cases (25.0%). Four cases (5.5%) were treated by cystoperitoneal shunt, 2 by marsupialization (2.8%). In total, 11 revisions were necessary in 9/72 (12.5%) patients (one patient underwent 3 revisions). Two patients were reoperated for wound revision/epidural hematoma (each n = 1). Seven patients needed additional cyst wall resection after 1.5-31.0 months due to insufficient cyst shrinking and persistent clinical symptoms after first surgery; most of the cysts were multiple septated and of post-hemorrhagic origin. The mean c.c. size decreased from 5.2 ± 3.7 cm pre-OP to 2.7 ± 3.9 cm (p < 0.05); the a.p. diameter decreased from 1.0 ± 0.5 cm to 0.3 ± 0.3 cm (p < 0.0001) without significant differences between fenestration and resection. McCormick and Odom scores revealed improved symptoms, particularly of gait disturbance, sensory deficits, and general performance. Long-term FU displayed satisfying QoL performance without differences of fenestration or resection. CONCLUSION SAC mostly affect women and are predominantly located in the thoracic spine, becoming apparent with clinical myelopathy. For cysts without intracystic septae and compartments, both fenestration and resection of the cyst wall provided significant reduction of cyst size and clinical improvement.
Collapse
|
9
|
Li Z, Chen YA, Chow D, Talbott J, Glastonbury C, Shah V. Practical applications of CISS MRI in spine imaging. Eur J Radiol Open 2019; 6:231-242. [PMID: 31304197 PMCID: PMC6603258 DOI: 10.1016/j.ejro.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/21/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
Conventional spin echo imaging is limited by low spatial resolution and CSF pulsation artifact. CISS MRI enables submillimeter spatial resolution and myelographic contrast. Inherent flow compensation of the CISS technique reduces CSF pulsation artifact. CISS improves the delineation of a wide variety of spinal pathologies.
Routine magnetic resonance imaging evaluation of the spine is often limited by low spatial resolution and artifacts resulting from cerebrospinal fluid pulsation. Balanced steady-state free precession sequences can supplement routine spin echo sequences and provide exquisite anatomic detail and high cerebrospinal fluid-to-soft tissue contrast, adding significant diagnostic value to the evaluation of a wide variety of spine disorders.
Collapse
Affiliation(s)
- Zhixi Li
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Yingming Amy Chen
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Daniel Chow
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Christine Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| | - Vinil Shah
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628, USA
| |
Collapse
|
10
|
Watanabe A, Nakanishi K, Kataoka K. Intradural spinal arachnoid cyst contributing to sudden paraparesis. Surg Neurol Int 2019; 10:102. [PMID: 31528440 PMCID: PMC6744768 DOI: 10.25259/sni-246-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Spinal arachnoid cysts are cystic lesions filled with cerebrospinal fluid that contributes to neurological deficits depending on their size/location within the spinal canal. Here, we report a patient with a spinal subarachnoid cyst who suddenly developed paraparesis. CASE Description: A 37-year-old female with a thoracic spinal arachnoid cyst at the T7 level suddenly developed lower abdominal pain followed by immediate paraparesis. Two weeks following the onset of symptoms, she underwent a T6-T8 laminectomy; this included with full cyst excision. By the 4th postoperative week, her signs/symptoms fully resolved. Conclusions: A 37-year-old female with a T7 thoracic spinal subarachnoid cyst who presented with acute paraparesis regained normal function 2 weeks following a T6-T8 laminectomy.
Collapse
Affiliation(s)
- Akira Watanabe
- Departments of Neurosurgery, Nara Hospital, Kindai University, Ikoma, Nara, Japan
| | - Kinya Nakanishi
- Departments of Neurosurgery, Yuaikai Hospital, Suminoe-ku, Osaka, Osaka-fu, Japan
| | - Kazuo Kataoka
- Departments of Neurosurgery, Nara Hospital, Kindai University, Ikoma, Nara, Japan
| |
Collapse
|
11
|
Kaloostian SW, Vartanian TK, Ordookhanian C, Vartanian T, Kaloostian PE. Recurrent Caterpillar-like Arachnoid Cysts Following Initial Resection: A Unique Presentation of a Disorder Where the Limits of Modern Medicine Are Reached. Cureus 2019; 11:e3946. [PMID: 30937244 PMCID: PMC6433457 DOI: 10.7759/cureus.3946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Of the many emergent neurological cases presenting to the emergency department (ED) and operating room (OR) for resection, arachnoid cysts are amongst one of the rarer pathologies. The proper resection of arachnoid cysts has substantially decreased the risk of recurrence. Current medicinal and surgical approaches have been refined over the years and prove to be successful for many patients. Where current practices begin to fail is during the treatment of complex and rare cases, such as the one presented in this manuscript. The commonly accepted surgical practices that were utilized to aid in the management of our patient, who initially presented with a simple arachnoid cyst, unexpectedly resulted in the further development of additional arachnoid cysts, a very rare occurrence, and a complication that should be discussed amongst all specialists in the hope of identifying more focused, novel, and less-invasive approaches to cyst removal and recurrence prevention.
Collapse
Affiliation(s)
| | - Tara K Vartanian
- Internal Medicine, White Memorial Medical Center, Los Angeles, USA
| | | | - Talia Vartanian
- Physical Medicine and Rehabilitation, University of Southern California, Pomona, USA
| | | |
Collapse
|
12
|
Lavi ES, Pal A, Bleicher D, Kang K, Sidani C. MR Imaging of the Spine: Urgent and Emergent Indications. Semin Ultrasound CT MR 2018; 39:551-569. [DOI: 10.1053/j.sult.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
13
|
Diyora B, Bhende B, Dhall G, Patil A, Nayak N. Ventral Craniovertebral Junction Arachnoid Cyst in an Elderly Patient-A Case Report of a Unique Occurrence at Extremes of Age. World Neurosurg 2018; 122:577-582. [PMID: 30472283 DOI: 10.1016/j.wneu.2018.11.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Craniovertebral junction arachnoid cysts are uncommon. Among those reported, ventrally located arachnoid cysts at the extremes of age have been even rarer. We report a successfully managed case of a ventrally placed arachnoid cyst in an 88-year-old man using an unconventional surgical approach. CASE DESCRIPTION An 88-year-old man presented to us with complaints of tingling and numbness in both upper and lower limbs. He had a weak handgrip on both sides. Spinal magnetic resonance imaging (MRI) showed a non-contrast-enhancing cystic lesion over the anterior lip of the foreman magnum that had displaced the cervicomedullary junction posteriorly. The lesion was homogenously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI. The lesion was excised using a posterior approach. The cyst contents were drained, followed by complete wall excision. Complete improvement in clinical symptoms and an absence of neurological deficits were noted in the patient. CONCLUSION Arachnoid cysts are congenital lesions and can present at the extremes of age. Ventrally placed small symptomatic arachnoid cysts can be managed successfully through the posterior approach, especially in the elderly population.
Collapse
Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India.
| | - Bhagyashri Bhende
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Gagan Dhall
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Aditya Patil
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Naren Nayak
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| |
Collapse
|
14
|
Laing R, Timofeev I, Colasanti R, Dean A, Di Rienzo A. Cord Splitting Access to Ventral Intradural Cysts of Cervicothoracic Junction and Thoracic Spine. World Neurosurg 2018; 122:e168-e175. [PMID: 30292666 DOI: 10.1016/j.wneu.2018.09.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Surgical treatment of ventrally located intradural cysts is difficult and controversial. Laminectomy with division of the denticulate ligaments and gentle cord mobilization remains the standard approach but risks further neurologic deterioration secondary to cord manipulation. Our purpose is to evaluate the safety and effectiveness of a midline cord-splitting approach as an alternative for treating ventral thoracic intradural cysts. METHODS We describe 2 patients who were treated for ventral intradural cysts causing progressive and severe myelopathy. Under general anesthesia and continuous neurophysiologic monitoring, laminectomy, durotomy, and cord splitting through a midline approach gave direct access to both lesions. Cyst drainage was supplemented by a cystopleural shunt in 1 case. RESULTS Cyst collapse and cord reexpansion were documented in both patients with a magnetic resonance imaging scan 1 week after surgery. In both cases there was a significant neurologic improvement, which was maintained 2 years postoperatively. Intraoperative monitoring recorded no loss of somatosensory or motor potentials during surgery. Follow-up magnetic resonance imaging scans 2 years postoperatively showed no evidence of cyst recurrence, and both patients remained neurologically improved and stable. CONCLUSIONS We have been able to drain 2 ventral intradural cysts using a cord-splitting technique. This has allowed safe access to purely ventrally located lesions, which were inaccessible dorsally or dorsolaterally. By using this method we have been able to avoid a more invasive ventral transthoracic approach necessitating vertebrectomy and reconstruction and risking serious complications.
Collapse
Affiliation(s)
- Rodney Laing
- Department of Neurosurgery, Addenbrooke's University Hospital, Cambridge, United Kingdom
| | - Ivan Timofeev
- Department of Neurosurgery, Addenbrooke's University Hospital, Cambridge, United Kingdom
| | - Roberto Colasanti
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrew Dean
- Department of Histopathology, Addenbrooke's University Hospital, Cambridge, United Kingdom
| | | |
Collapse
|
15
|
Umerani MS, Mostafa GA, Nada MAF, Darwish AAQ. Postepidural Spinal Intradural Arachnoid Cyst: A Rare Case Report. J Neurosci Rural Pract 2017; 8:677-679. [PMID: 29204040 PMCID: PMC5709903 DOI: 10.4103/jnrp.jnrp_335_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Compression of the neural structures in spine by an intradural arachnoid cyst is a rare entity. At times such a cyst is an incidental finding. Spinal epidural injection is one of the few rare etiological factors for its development. Symptomatic cysts can present with variable neurological manifestations depending on the spinal level involved. This includes back pain, lower limb weakness, and sphincteric dysfunction. If asymptomatic, they can be followed radiologically. Surgical decompression along with a histological diagnosis is reserved for cysts that are enlarging, symptomatic or the ones for whom the diagnosis is uncertain. Incomplete excision of cyst wall or simple fenestration and decompression mandates close follow-up, clinically and radiologically for further recurrences.
Collapse
Affiliation(s)
| | - Gabr Ahmed Mostafa
- Department of Clinical Neurosciences, King Fahd Military Medical Complex, Dhahran, KSA
| | - Mona A F Nada
- Department of Clinical Neurosciences, King Fahd Military Medical Complex, Dhahran, KSA
| | | |
Collapse
|
16
|
Brown-Séquard syndrome following intracranial subarachnoid hemorrhage-induced spinal arachnoid cyst. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
17
|
Clinical and Radiologic Outcomes After Fenestration and Partial Wall Excision of Idiopathic Intradural Spinal Arachnoid Cysts Presenting with Myelopathy. World Neurosurg 2017; 105:213-222. [PMID: 28578118 DOI: 10.1016/j.wneu.2017.05.136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intradural spinal arachnoid cysts (ISACs) with associated neurologic deficits are encountered infrequently. Various management strategies have been proposed with minimal data on comparative outcomes. OBJECTIVE We describe the clinical and radiologic presentation as well as the outcomes of 14 surgically managed patients who presented with an ISAC and associated myelopathy. METHODS We retrospectively reviewed the clinical course of consecutive patients presenting with neurologic deficits associated with idiopathic ISACs at our institution. The diagnoses were based on preoperative magnetic resonance imaging studies followed by intraoperative and histopathological confirmation. RESULTS A total of 14 consecutive patients with ISACs (1 cervicothoracic, 12 thoracic, and 1 thoracolumbar) and associated myelopathy were identified. Syringomyelia was noted in 8 patients. All ISACs were treated with cyst fenestration and partial wall resection through a posterior approach. Preoperative neurologic symptoms were noted to be stable or improved in all patients starting at 6-week postoperative follow-up. The median (interquartile range) preoperative mJOA score was 13 (12.0-14.8), whereas the postoperative median score at a mean follow-up of 22 months (range 6-50 months) was 16 (14.0-17.0), which represents a median improvement (ΔmJOA) of 2.0 (1.3-3.0) (P < 0.001). Comparison of ΔmJOA scores between cases without and with associated syrinxes did not reveal a significant difference (P = 0.23). Postoperative magnetic resonance imaging scans revealed spinal cord re-expansion at the level of the ISAC in all cases and either complete or partial syrinx resolution in 7 of 8 cases. CONCLUSIONS Early treatment with fenestration and partial wall resection allows for cord decompression, syrinx resolution, and gradual resolution of myelopathic symptoms in most cases.
Collapse
|
18
|
Mishra RK, Pruthi N, Bharath RD, Malla BR. Role of intraoperative dynamic magnetic resonance myelogram in management of giant dorsolumbar spinal extradural arachnoid cyst: case report. J Neurosurg Spine 2017; 27:185-188. [PMID: 28574330 DOI: 10.3171/2017.2.spine16637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Giant dorsolumbar spinal arachnoid cysts are a complex, poorly understood, and difficult to manage clinical entity. Traditional CT myelography is technically difficult to use in these cases to detect the site of leakage preoperatively. The authors report a novel technique for detecting the site of the leak by using sequential, dynamic intraoperative MR myelography. To the authors' knowledge, there is no other similar report in the literature.
Collapse
Affiliation(s)
| | | | - Rose Dawn Bharath
- Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | |
Collapse
|
19
|
Mauler DA, De Decker S, De Risio L, Volk HA, Dennis R, Gielen I, Van der Vekens E, Goethals K, Van Ham L. Spinal Arachnoid Diverticula: Outcome in 96 Medically or Surgically Treated Dogs. J Vet Intern Med 2017; 31:849-853. [PMID: 28426173 PMCID: PMC5435043 DOI: 10.1111/jvim.14714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Little is reported about the role of medical management in the treatment of spinal arachnoid diverticula (SAD) in dogs. OBJECTIVES To describe the outcome of 96 dogs treated medically or surgically for SAD. ANIMALS Ninety-six dogs with SAD. METHODS Retrospective case series. Medical records were searched for spinal arachnoid diverticula and all dogs with information on treatment were included. Outcome was assessed with a standardized questionnaire. RESULTS Fifty dogs were managed medically and 46 dogs were treated surgically. Dogs that underwent surgery were significantly younger than dogs that received medical management. No other variables, related to clinical presentation, were significantly different between both groups of dogs. The median follow-up time was 16 months (1-90 months) in the medically treated and 23 months (1-94 months) in the surgically treated group. Of the 38 dogs treated surgically with available long-term follow-up, 82% (n = 31) improved, 3% (n = 1) remained stable and 16% (n = 6) deteriorated after surgery. Of the 37 dogs treated medically with available long-term follow-up, 30% (n = 11) improved, 30% (n = 11) remained stable, and 40% (n = 15) deteriorated. Surgical treatment was more often associated with clinical improvement compared to medical management (P = .0002). CONCLUSIONS AND CLINICAL IMPORTANCE The results of this study suggest that surgical treatment might be superior to medical treatment in the management of SAD in dogs. Further studies with standardized patient care are warranted.
Collapse
Affiliation(s)
- D A Mauler
- Veterinary Medical Teaching Hospital, College of Veterinary Medicine, University of Missouri, Columbia, MO
| | - S De Decker
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - L De Risio
- Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - H A Volk
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - R Dennis
- Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - I Gielen
- Department of Medical Imaging of Domestic Animals and Orthopedics of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - E Van der Vekens
- Department of Medical Imaging of Domestic Animals and Orthopedics of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - K Goethals
- Department of Comparative Physiology and Biostatistics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - L Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| |
Collapse
|
20
|
Uncommon Disorders Masquerading as Acute Flaccid Paralysis in Children. Indian J Pediatr 2017; 84:315-321. [PMID: 28000111 DOI: 10.1007/s12098-016-2276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
The syndrome of acute flaccid paralysis (AFP) is a common medical emergency in children. In the era of poliomyelitis eradication, the common causes of AFP include Guillain-Barré syndrome (GBS), transverse myelitis and traumatic neuritis. However, many common diseases can uncommonly present as AFP and some uncommon diseases may also masquerade like it. Uncommon causes of AFP seen at a tertiary care pediatric hospital are discussed along with relevant points in diagnosis and management. Also, common pitfalls in diagnosis of pediatric AFP and an approach to investigations are discussed.
Collapse
|
21
|
French H, Somasundaram A, Biggs M, Parkinson J, Allan R, Ball J, Little N. Idiopathic intradural dorsal thoracic arachnoid cysts: A case series and review of the literature. J Clin Neurosci 2017; 40:147-152. [PMID: 28318981 DOI: 10.1016/j.jocn.2017.02.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spinal intradural arachnoid cysts (SIAC) are cerebrospinal fluid (CSF) filled sacs formed by arachnoid membranes and may be either idiopathic or acquired. Idiopathic cysts represent a separate entity and their aetiology remains uncertain. By far the most difficult differential diagnosis is distinguishing between idiopathic anterior spinal cord herniation (IASCH) and dorsal thoracic intradural arachnoid cysts (TIAC), due to their similarity in radiological appearance. Cine-mode (SSFP) is emerging as a novel technique in the diagnosis and operative planning of SIAC. METHOD Retrospective analysis of patients with idiopathic TIACs that were surgically managed at Royal North Shore Hospital and North Shore Private Hospital between November 2000 and November 2015. RESULTS Ten patients were included in this study. Age ranged from 20 to 77years with a mean age of 60years and a female preponderance. The most common clinical features were progressive gait ataxia and lower limb myelopathy. Radicular pain tends to improve following surgery, however gait ataxia may not. DISCUSSION While there are circumstances in which the distinction between dorsal thoracic intradural arachnoid cysts and idiopathic anterior spinal cord herniation are radiologically obvious, in cases where the appearances are less clear, cine-mode SSFP MRI imaging can provide an invaluable tool to differentiate these pathologies and lead the clinician towards the correct diagnosis and management. The mainstay of surgical management for dorsal TIACs is laminectomy and cyst excision or fenestration. Surgery for gait ataxia should be aimed towards preventing deterioration, while maintaining the potential for symptomatic improvement, whereas surgery for radicular pain should be curative.
Collapse
Affiliation(s)
| | | | | | - Jonathon Parkinson
- Royal North Shore Hospital, Australia; North Shore Private Hospital, Australia.
| | - Rodney Allan
- Royal Prince Alfred Hospital, Australia; North Shore Private Hospital, Australia.
| | - Jonathon Ball
- Royal North Shore Hospital, Australia; North Shore Private Hospital, Australia.
| | - Nicholas Little
- Royal North Shore Hospital, Australia; North Shore Private Hospital, Australia.
| |
Collapse
|
22
|
Klekamp J. A New Classification for Pathologies of Spinal Meninges—Part 2: Primary and Secondary Intradural Arachnoid Cysts. Neurosurgery 2017; 81:217-229. [DOI: 10.1093/neuros/nyx050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Spinal intradural arachnoid cysts are rare causes of radiculopathy or myelopathy. Treatment options include resection, fenestration, or cyst drainage.
OBJECTIVE: To classify intradural spinal arachnoid cysts and present results of their treatment.
METHODS: Among 1519 patients with spinal space occupying lesions, 130 patients demonstrated intradural arachnoid cysts. Neuroradiological and surgical features were reviewed and clinical data analyzed.
RESULTS: Twenty-one patients presented arachnoid cysts as a result of an inflammatory leptomeningeal reaction related to meningitis, subarachnoid hemorrhage, intrathecal injections, intradural surgery, or trauma, ie, secondary cysts. For the remaining 109 patients, no such history could be elucidated, ie, primary cysts. Forty-six percent of primary and 86% of secondary cysts were associated with syringomyelia. Patients presented after an average history of 53 ± 88 months. There were 122 thoracic and 7 lumbar cysts plus 1 cervical cyst. Fifty-nine patients with primary and 15 patients with secondary cysts underwent laminotomies with complete or partial cyst resection and duraplasty. Mean follow-up was 57 ± 52 months. In the first postoperative year, profound improvements for primary cysts were noted, in contrast to marginal changes for secondary cysts. Progression-free survival for 10 years following surgery was determined as 83% for primary compared to 15% for secondary cysts. Despite differences in clinical presentation, progression-free survival was almost identical for patients with or without syringomyelia.
CONCLUSIONS: Complete or partial resection leads to favorable short- and long-term results for primary arachnoid cysts. For secondary cysts, surgery can only provide clinical stabilization for a limited time due to the often extensive arachnoiditis.
Collapse
Affiliation(s)
- Jörg Klekamp
- Department of Neurosurgery, Christlich-es Krankenhaus Quakenbrück, Quaken-brück, Germany
| |
Collapse
|
23
|
Pillai MK. Dorsal cervical spinal arachnoid cyst (Type III) presenting with dorsal column dysfunction: A case report. J Spinal Cord Med 2017; 40:250-252. [PMID: 27827559 PMCID: PMC5430484 DOI: 10.1080/10790268.2016.1244987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Spinal arachnoid cysts are usually asymptomatic and discovered incidentally. Expansion of the cyst, whether acute, subacute or chronic, leads to neural compression resulting in radicuopathy and/or myelopathy. FINDINGS This case report is of a patient who presented primarily with posterior column dysfunction,subacute in onset and rapidly progressing. Images of the cervical spine showed a dorsal arachnoid cyst, causing significant cord compression and signal changes in the cord, with no scalloping of the vertebrae. CONCLUSION The author explains the mechanism of rapid expansion of an asymptomatic spinal arachnoid cyst, causing neural compression leading to fast progression of neurological deficits. The dorsal location of the cyst, explain the absence of radiculopathy, which is a common presenting feature of ventrally located intradural arachnoid cyst.
Collapse
Affiliation(s)
- Mahesh Krishna Pillai
- a Department of Neurosurgery , Sultan Qaboos University Hospital , Al Khaud , Muscat , Oman
| |
Collapse
|
24
|
Meren IL, Chavera JA, Alcott CJ, Barker AK, Jeffery ND. Shunt tube placement for amelioration of cerebrospinal fluid flow obstruction caused by spinal cord subarachnoid fibrosis in dogs. Vet Surg 2017; 46:289-296. [DOI: 10.1111/vsu.12622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 07/05/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ilyssa L. Meren
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences; Iowa State University; 1600 South 16th Street Ames Iowa
| | - Jessica A. Chavera
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences; Iowa State University; 1600 South 16th Street Ames Iowa
| | - Cody J. Alcott
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences; Iowa State University; 1600 South 16th Street Ames Iowa
| | - Andrew K. Barker
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences; Iowa State University; 1600 South 16th Street Ames Iowa
| | - Nick D. Jeffery
- Lloyd Veterinary Medical Center, Department of Veterinary Clinical Sciences; Iowa State University; 1600 South 16th Street Ames Iowa
| |
Collapse
|
25
|
Zhang D, Papavassiliou E. Spinal Intradural Arachnoid Webs Causing Spinal Cord Compression with Inconclusive Preoperative Imaging: A Report of 3 Cases and a Review of the Literature. World Neurosurg 2016; 99:251-258. [PMID: 27993741 DOI: 10.1016/j.wneu.2016.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Spinal arachnoid webs are a rare variant of spinal arachnoid cysts where 1 or multiple focal membranes of arachnoid tissue obstruct the subarachnoid space. Only 11 prior cases of arachnoid webs have been reported in the literature. We present a series of 3 consecutive cases of arachnoid webs from our institution and review the literature on this rare condition to provide recommendations for its management. METHODS Retrospective chart review was performed for 3 consecutive cases of intradural arachnoid webs causing spinal cord compression at our institution, with inconclusive preoperative imaging, treatment with surgical decompression, and resection. There were no external sources of funding. RESULTS Our cases occurred dorsally in the thoracic spine and were associated with syringomyelia. Preoperative magnetic resonance imaging, computed tomography myelography, and cine magnetic resonance imaging were inconclusive, and the definitive diagnosis was made with intraoperative ultrasound. Patients underwent laminectomies and resection of arachnoid webs. Unique from prior reports of arachnoid webs, the webs in the present cases were composed of multiple septated longitudinal membranes rather than a transverse band. All patients had improvement of presenting symptoms postoperatively. CONCLUSIONS Intradural arachnoid webs causing spinal cord compression are rare. Preoperative imaging may be inconclusive. Because of the septated longitudinal nature of the visualized membranes, we propose a 1-way valve mechanism of cerebrospinal fluid obstruction causing gradual cord compression and resultant syringomyelia.
Collapse
Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | - Efstathios Papavassiliou
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Demir MK, Yılmaz B, Ekşi MŞ, Ozdamarlar U. Cervicothoracic intradural arachnoid cyst with scoliosis and brachial plexopathy. Spine J 2016; 16:e585-6. [PMID: 26882854 DOI: 10.1016/j.spinee.2016.01.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/17/2016] [Accepted: 01/28/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Mustafa Kemal Demir
- 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy-Bakırkoy, 34158, Istanbul, Turkey
| | - Baran Yılmaz
- Goztepe Medikal Park Hastanesi E5 Üzeri 23 Nisan Sok. No: 17 Merdivenköy Kadıköy, 34732, Istanbul, Turkey
| | - Murat Şakir Ekşi
- 500 Parnassus Avenue, MU320 West, San Francisco, CA 94143-0728, USA
| | - Umut Ozdamarlar
- Goztepe Medikal Park Hastanesi E5 Üzeri 23 Nisan Sok. No: 17 Merdivenköy Kadıköy, 34732, Istanbul, Turkey
| |
Collapse
|
27
|
Min WK, Kim JE. Extensive spinal intradural arachnoid cyst exhibiting a "double cord sign" on magnetic resonance imaging. J Orthop 2016; 13:110-4. [PMID: 27053833 DOI: 10.1016/j.jor.2015.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/27/2015] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective case study. OBJECTIVE To report on a case with an extensive intradural arachnoid cyst that caused left hemiparesis. SUMMARY OF BACKGROUND DATA Intradural arachnoid cysts are not common causes of spinal cord compression and myelopathy. Although arachnoid cysts of the spine have been occasionally reported, cases with extensive intradural arachnoid cysts associated with hemiparesis are rarely reported. METHOD The patient was a 43-year-old woman who had cervical myelopathy symptoms, including radiating pain and left limb hemiparesis with gait disturbance. Magnetic resonance imaging revealed an extensive intradural extramedullary multi-septated cyst from the C6-T12, exhibiting a double cord sign on the T2-weighted axial image of the spine. The mass blocked normal cerebrospinal fluid flow, which led to cord compression. Two stages of operations were planned because of the patient's health status. The patient underwent laminectomy and cyst wall resection on the level of the T5-T7, which had the most compressed lesion. From C6-T2, a right side unilateral laminectomy was performed to resolve the right limb's neurology after the first operation. RESULT Hypoesthesia and the radiating pain were improved immediately postoperatively; however, motor power at the C8-T1 level of the right unaffected side was impaired and included finger abduction and finger flexion, which decreased to 4/5. During the second operation, the arachnoid cyst was exposed by performing a right unilateral laminectomy. The patient's neurologic symptoms were improved without neurologic sequelae. CONCLUSION In the case of an extensive cyst that exhibits a double cord sign, an intradural arachnoid cyst should be suspected as a differential diagnosis. Without radical excision of all lesions, neurologic symptoms can be recovered by performing selective resection and CSF normalization can be achieved even at extensive levels.
Collapse
Affiliation(s)
- Woo-Kie Min
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| | - Ju-Eun Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, South Korea
| |
Collapse
|
28
|
Ros López B, Martín Gallego Á, Iglesias Moroño S. Quistes aracnoideos del sistema nervioso central. Algoritmos y recomendaciones generales de manejo. Neurocirugia (Astur) 2016; 27:67-74. [DOI: 10.1016/j.neucir.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/07/2015] [Indexed: 12/14/2022]
|
29
|
Nuances in Localization and Surgical Treatment of Syringomyelia Associated with Fenestrated and Webbed Intradural Spinal Arachnoid Cyst: A Retrospective Analysis. World Neurosurg 2016; 87:176-86. [DOI: 10.1016/j.wneu.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/22/2022]
|
30
|
|
31
|
Flegel T, Müller MK, Truar K, Löffler C, Oechtering G. Thoracolumbar spinal arachnoid diverticula in 5 pug dogs. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2013; 54:969-973. [PMID: 24155418 PMCID: PMC3781430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Clinical features, myelography, and computed tomography imaging findings as well as neurological outcome with and without surgery in 5 pug dogs with thoracolumbar arachnoid diverticula are described. Short-term prognosis after surgical therapy may not be as good as reported for other canine breeds, since immediate postsurgical deterioration is possible. Improvement of neurological deficits beyond the presurgical status may take several months.
Collapse
Affiliation(s)
- Thomas Flegel
- Address all correspondence to Dr. Thomas Flegel; e-mail:
| | | | | | | | | |
Collapse
|
32
|
Evangelou P, Meixensberger J, Bernhard M, Hirsch W, Kiess W, Merkenschlager A, Nestler U, Preuss M. Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review. Childs Nerv Syst 2013; 29:657-64. [PMID: 23224408 DOI: 10.1007/s00381-012-1990-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare. PATIENTS AND METHODS We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts. RESULTS In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %). CONCLUSION Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.
Collapse
Affiliation(s)
- Petros Evangelou
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Reardon MA, Raghavan P, Carpenter-Bailey K, Mukherjee S, Smith JS, Matsumoto JA, Yen CP, Shaffrey ME, Lee RR, Shaffrey CI, Wintermark M. Dorsal thoracic arachnoid web and the "scalpel sign": a distinct clinical-radiologic entity. AJNR Am J Neuroradiol 2013; 34:1104-10. [PMID: 23348759 DOI: 10.3174/ajnr.a3432] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Arachnoid webs are intradural extramedullary bands of arachnoid tissue that can extend to the pial surface of the spinal cord, causing a focal dorsal indentation of the cord. These webs tend to occur in the upper thoracic spine and may produce a characteristic deformity of the cord that we term the "scalpel sign." We describe 14 patients whose imaging studies demonstrated the scalpel sign. Ten of 13 patients who underwent MR imaging demonstrated T2WI cord signal-intensity changes, and 7 of these patients also demonstrated syringomyelia adjacent to the level of indentation. Seven patients underwent surgery, with 5 demonstrating an arachnoid web as the cause of the dorsal indentation demonstrated on preoperative imaging. Although the webs themselves are rarely demonstrated on imaging, we propose that the scalpel sign is a reliable indicator of their presence and should prompt consideration of surgical lysis, which is potentially curative.
Collapse
Affiliation(s)
- M A Reardon
- Neuroradiology Division, Department of Radiology, Veterans Administration San Diego Healthcare System and University of California, San Diego, San Diego, California, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Klekamp J. Treatment of Syringomyelia Related to Nontraumatic Arachnoid Pathologies of the Spinal Canal. Neurosurgery 2012. [DOI: 10.1227/neu.0b013e31827fcc8f] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
BACKGROUND:
Disturbances of cerebrospinal fluid (CSF) flow are the commonest cause of syringomyelia. Spinal arachnopathies may lead to CSF flow obstructions but are difficult to diagnose. Consequently, associated syringomyelias are often categorized as idiopathic.
OBJECTIVE:
To present and analyze the diagnosis of and long-term outcomes in an observational study of patients with nontraumatic arachnopathies from 1991 to 2011.
METHODS:
A total of 288 patients (mean age, 47 ± 15 years; follow-up, 54 ± 46 months) were evaluated. Decompression with arachnolysis, untethering, and duraplasty for restoration of CSF flow was recommended to patients with neurological progression. Neurological examinations, magnetic resonance images, and follow-up data were evaluated. Individual symptoms were analyzed during the first postoperative year, and long-term outcomes were analyzed with Kaplan-Meier statistics to determine rates of progression-free survival.
RESULTS:
In total,189 patients either refused an operation or were managed conservatively for lack of progression. Among 79 unoperated patients with follow-up information available for up to 8 years, 2 patients deteriorated. Ninety-nine patients with progressive symptoms underwent 116 operations: 108 decompressions and 8 other surgeries. Three months postoperatively, 53% considered their status improved and 37% were unchanged. In the long term, surgery on arachnopathies limited to 2 spinal segments was followed by progression-free survival for 78% over 10 years, in contrast to 31% with extensive arachnopathies.
CONCLUSION:
Surgery on nontraumatic arachnopathies related to syringomyelia should be reserved for patients with progressive symptoms. Arachnolysis, untethering, and duraplasty provide good long-term results for focal arachnopathies. For extensive pathologies with a history of subarachnoid hemorrhage or meningitis, treatment remains a major challenge.
Collapse
Affiliation(s)
- Jörg Klekamp
- Christliches Krankenhaus, Department of Neurosurgery, Quakenbrück, Germany
| |
Collapse
|
35
|
Oxley W, Pink J. Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst. J Small Anim Pract 2011; 53:67-72. [PMID: 22122126 DOI: 10.1111/j.1748-5827.2011.01146.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management.
Collapse
Affiliation(s)
- W Oxley
- Willows Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH
| | | |
Collapse
|
36
|
Abstract
Spinal extradural arachnoid cysts (ACs) have an infrequent predilection for the sacrum. As with their counterparts in other regions of the spine, cysts in this location are mostly asymptomatic. Common presentations in symptomatic cases include pain in the low back or perineum, radiculopathy, and sphincteric dysfunction. The authors report a hitherto undescribed presentation in which the predominant symptoms are those related to an associated holocord syrinx. This 15-year-old boy presented with fluctuating, spastic paraparesis and a dissociated sensory loss in the trunk. Admission MR imaging of the spine showed an extradural AC from S-2 to S-4 and a holocord, nonenhancing syrinx. The patient underwent S-2 laminectomy, fenestration of the cyst, and partial excision of its wall. Intradural exploration revealed a normal-looking filum terminale and the absence of any dural communication with the cyst. At a follow-up visit 6 months after surgery, his motor and sensory deficits had resolved. Follow-up MR imaging showed complete resolution of the syrinx in the absence of the sacral AC. This is the first report of a sacral extradural AC causing holocord syringomyelia. Because conventional theories of syrinx formation were not helpful in elucidating this case, a hypothesis is postulated to explain the clinicoradiological oddity.
Collapse
Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
| | | | | |
Collapse
|
37
|
|