1
|
Sawaya J, Savla P, Minasian T. Extradural spinal cyst in a pediatric patient: A case report. Surg Neurol Int 2024; 15:123. [PMID: 38741998 PMCID: PMC11090601 DOI: 10.25259/sni_27_2024] [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] [Received: 01/10/2024] [Accepted: 03/22/2024] [Indexed: 05/16/2024] Open
Abstract
Background Spinal extradural arachnoid cysts comprise <1% of all spinal lesions and are rare findings in pediatric patients. The pathogenesis of spinal extradural arachnoid cysts is not well known but is thought to most commonly be due to congenital dural defects. Other origins include trauma, inflammation, or infection, such as arachnoiditis. Spinal magnetic resonance imaging is the gold standard for diagnosis, showing a fluid-filled space dorsal to the spinal cord with signal intensity akin to cerebrospinal fluid (CSF) and often the site of dural defect with CSF leak. While most spinal extradural arachnoid cysts are asymptomatic, large cysts can compress the spinal cord or nerve roots, leading to myelopathy, radiculopathy, or focal pain symptoms. In such cases, surgical management is indicated. Case Description Here, we present a case of a 15-year-old female who presented with lower back pain radiating to her bilateral posterior thighs and knees, with imaging indicating a thoracolumbar spinal extradural arachnoid cyst. After failed conservative treatment, surgical intervention in the form of laminectomy, fenestration of the arachnoid cyst, and repair of the dural defect was required, resolving the patient's symptoms with no recurrence of the cyst. Conclusion Complete resolution of pain in our patient following surgical management of spinal arachnoid cyst suggests that treatment of the arachnoid cyst can be achieved through minimal exposure to the site of the CSF leak to fenestrate the cyst and repair the leak.
Collapse
Affiliation(s)
- Jessica Sawaya
- School of Medicine, Loma Linda University, Loma Linda, United States
| | - Paras Savla
- Department of Neurosurgery, Riverside University Health System, Moreno Valley, United States
| | - Tanya Minasian
- Department of Neurosurgery, Loma Linda University Children’s Hospital, Loma Linda, United States
| |
Collapse
|
2
|
Messerer R, Aldugman M, Morgado A, Barrey C. Spinal extradural arachnoid cysts: a rare entity and review of the literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:872-880. [PMID: 38063861 DOI: 10.1007/s00586-023-08057-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/30/2023] [Accepted: 11/18/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE Spinal extradural arachnoid cysts (SEDC) are rare primary spinal lesions, accounting for less than 1% of all spinal epidural lesions. The literature contains only case reports of this pathology, and treatment remains controversial due to its rarity. Major reported SEDC cases are caused by leaking out of cerebrospinal fluid through a dural defect in the thecal sac forming an extradural cyst. Other reports describe non-communicating SEDC cases where the dural defect was not identified. We report a literature review on SEDC and the case of a 53 year‑old female who presented with type IA extradural cyst with subarachnoid space communication. METHODS Literature review, preoperative imaging and surgical technique. RESULTS The extradural cyst was excised completely and the dural defect was repaired. After surgical decompression, neurological symptoms gradually recovered. CONCLUSIONS The extradural arachnoid cyst is an uncommon entity. Preoperative imaging is one of the determining elements in orienting the therapeutic management of the SEDCs. The choice of the surgical technique must be the least invasive in order to avoid postoperative complications. Subtotal or complete excision of the cyst, followed by obliteration of the communication stalk and repair of the dural defect is the gold standard treatment.
Collapse
Affiliation(s)
- Rostom Messerer
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.
- Department of Neurosurgery, Annecy Genevois Hospital, Epagny Metz-Tessy, France.
| | - Mohammed Aldugman
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Alexis Morgado
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Cédric Barrey
- Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
3
|
Tian Y, Chen Y, Chen L, Meng X, Fu M, Shi X, Lin Y. How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome. BMC Surg 2023; 23:184. [PMID: 37386402 DOI: 10.1186/s12893-023-02013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis. METHODS A stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital's Department of Neurosurgery between January 2017 and January 2022. RESULTS All patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported. CONCLUSIONS The use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.
Collapse
Affiliation(s)
- Yu Tian
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China
| | - Yong Chen
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Long Chen
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Xianghong Meng
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Mengmeng Fu
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China
| | - Xin Shi
- Department of Neurosurgery, Clinical Medical Academy Centre, Shenzhen University General Hospital, Shenzhen University, Shenzhen University, 1098 Xueyuan Avenue, Nanshan District, Shenzhen, 518000, Guangdong, China.
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Taijiang District, Fuzhou, 350005, Fujian, China.
| |
Collapse
|
4
|
Huang H, Wei M, Zhou Q, Peng R, Ding X, Xi J. Spinal extradural arachnoid cysts: A novel formation mechanism and dural defect location technology. Heliyon 2023; 9:e12969. [PMID: 36820184 PMCID: PMC9938496 DOI: 10.1016/j.heliyon.2023.e12969] [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] [Received: 06/28/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose The formation mechanism of spinal extradural arachnoid cysts (SEACs) remains unclear. There are several hypotheses for the formation of SEACs, but none of them can fully explain its pathological findings and surgical procedures. In this study, we retrospectively analyzed the cases of SEACs, aiming to clarify the formation mechanism of SEACs. In addition, we summarize a concise method for locating dural defects preoperatively and formulate a putative explanation of this method. Methods The clinical data of 14 patients with SEACs underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed. Results Fourteen patients were identified during the study period. The cysts all spanned the T12/L1 segment, and dural defects were also located at the T12/L1 level (2 cases not recorded) as well as the middle or the upper-middle level of the cysts. Nine cases were treated with total cyst excision, 2 cases were treated with dural defect closure only, and 3 cases were treated with total cyst excision and dural defect closure. Histopathological examination demonstrated that the cyst wall contained both the arachnoid epithelial and compact fibrous connective tissue. The symptoms were relieved in all patients, and no recurrence was observed. Conclusions According to intraoperative and pathological findings, the dural outer layer cyst (DOLC) is a more reasonable hypothesis about SEACs formation. When CT myelography or cinematic MRI cannot determine the location of the dural defect preoperatively, it can be located according to the middle level of the SEACs with high accuracy.
Collapse
Affiliation(s)
- He Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wei
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Quanwei Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Renjun Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiping Ding
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Corresponding author. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
| |
Collapse
|
5
|
How to locate the dural defect in a spinal extradural meningeal cyst: a literature review. Chin Neurosurg J 2022; 8:27. [PMID: 36045421 PMCID: PMC9429336 DOI: 10.1186/s41016-022-00291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
Spinal extradural meningeal cysts (SEMCs) are rare lesions of the spinal canal. Although closure of the dural defect can achieve satisfactory therapeutic effects, locating the fistula is difficult. This review summarizes the methods for locating the fistula of SEMCs and the distribution and features of fistula sites. This was a non-systematic literature review of studies on SEMCs. We searched PubMed for English-language articles to summarize the methods of locating the defect. The search words were “epidural arachnoid cyst,” “dural cyst,” “epidural cyst,” and “epidural meningeal cyst.” For the defect location component of the study, case reports, studies with a sample size less than four, controversial ventral dural dissection(s), and undocumented fistula location reports were excluded. Our review showed that radiography and computed tomography (CT) may show changes in the bony structure of the spine, with the largest segment of change indicating the fistula site. Occasionally, magnetic resonance imaging (MRI) can show a cerebrospinal fluid (CSF) flow void at the fistula site. The middle segment of the cyst on sagittal MRI, the largest cyst area, and cyst laterality in the axial view indicate the fistula location. Myelography can show the fistula location in the area of the enhanced cyst and subarachnoid stenosis. Digital subtraction or delayed CT can be used to observe the location of the initial cyst filling. Cine MRI and time-spatial labeling inversion pulse techniques can be used to observe CSF flow. Steady-state image construction interference sequence MRI has a high spatial resolution. Neuroendoscopy, MRI myelography, and ultrasound fistula detection can be performed intraoperatively. Moreover, the fistula was located most often in the T12–L1 segment. Identifying the fistula location is difficult and requires a combination of multiple examinations and experience for comprehensive judgment.
Collapse
|
6
|
Jian Q, Song G, Liu Z, Duan W, Guan J, Jian F, Chen Z. Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center. Neurospine 2022; 19:188-201. [PMID: 34990537 PMCID: PMC8987550 DOI: 10.14245/ns.2142526.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).
Methods The authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up.
Results Thirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84%±26.63%.
Conclusion Most fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.
Collapse
Affiliation(s)
- Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
7
|
Zhang P, Liu H, Sun Z, Guo Y, Wang G, Wang JJ. Ultrafine Flexible endoscope visualization to assist in the removal of a huge spinal extradural arachnoid cyst: a case report and literature review. World Neurosurg 2021; 159:130-133. [PMID: 34973437 DOI: 10.1016/j.wneu.2021.12.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Peihai Zhang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China.
| | - Huiting Liu
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Zhenxin Sun
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Yi Guo
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Guihuai Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - James Jin Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| |
Collapse
|
8
|
Shi L, Su Y, Yan T, Wang H, Wang K, Liu L. Early microsurgery on thoracolumbar spinal extradural arachnoid cysts: Analysis of a series of 41 patients. J Clin Neurosci 2021; 94:257-265. [PMID: 34863448 DOI: 10.1016/j.jocn.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We designed this study to share our management experiences on spinal extradural arachnoid cysts (SEACs) to add more to the body of evidence for their treatment. METHODS We retrospectively reviewed 41 patients who underwent microsurgery for thoracolumbar SEACs at our hospital from June 2009 to June 2019. All clinical data, including medical history, clinical features, imaging manifestation, operative findings, and prognosis, were extracted from medical records and databases. Perioperative differences of the Visual Analogue Scale (VAS), the Oswestry disability index (ODI) score, and postoperative Odom's criteria were used to assess the surgical outcome. RESULTS The most common and very first clinical symptom in the 41 patients was pain (VAS = 2.82 ± 0.89), and the mean ODI value was 61.7 ± 8.9%. Imaging revealed that the cystic lesions in the thoracolumbar spine involved an average of 2.85 segments. Of the 41 patients, 39 underwent total cyst excisions, and 36 had their dural defect repaired by one of three methods. The mean postoperative follow-up time was 52.3 months. Postoperatively, one case developed kyphoscoliosis and two cases experienced a recurrence. The majority of patients showed excellent outcomes according to Odom's criteria, the postoperative VAS (0.80 ± 1.08), and the ODI (15.4 ± 9.3%). CONCLUSIONS Themost commonclinicalsymptoms of thoracolumbar SEACs included progressive discomfort and pain around the involved spinal segments. Early surgical intervention relieved the patients from their symptoms. Microsurgery was recommended to resect the complete cyst and to repair the dural defect, but resection of the complete cyst is more necessary than just repairment of the dural defect for providing promising outcomes.
Collapse
Affiliation(s)
- Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China.
| | - Yibin Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China
| | - Tao Yan
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China
| | - Hanbin Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China
| | - Keda Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China
| | - Longqi Liu
- Department of Neurosurgery, Beijing Jishuitan Hospital, The Fourth Medical College of Peking University, No. 31 East Street Xinjiekou, Xicheng District, Beijing 100035, China
| |
Collapse
|
9
|
Ouyang T, Meng W, Wang L, Li M, Hong T, Zhang N. A Single Vertebral Surgical Approach for Spinal Extradural Meningeal Cysts Spanning Multiple Vertebral Segments by Auxiliary Neuroendoscope. World Neurosurg 2021; 158:e975-e983. [PMID: 34871804 DOI: 10.1016/j.wneu.2021.11.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal extradural meningeal cysts (SEMCs) are rare lesions, especially those spanning multiple vertebral segments, and the surgical strategy has remained controversial. In the present study, we have described the outcomes of 4 patients with SEMCs treated with dural defect repair alone assisted by neuroendoscopy. METHODS From January 2018 to January 2020, 4 patients with SEMCs spanning multiple vertebral segments had undergone single-vertebral laminectomy or hemilaminectomy. RESULTS The SEMCs in all 4 patients had spanned multiple vertebral segments, from T11 to L2. Using magnetic resonance imaging, the location of the dural defect was predicted correctly for 3 patients. Single-vertebral laminectomy was used in 2 patients and single-vertebral hemilaminectomy in 2 patients. Intraoperatively, the entire cyst, including the upper pole, lower pole, and middle segment of the cyst, was explored using neuroendoscopy. In each patient, only 1 dural defect was found, which had been located in the middle segment of the cyst (T12-L1). All cyst dural defects had been sutured under a microscope. In all cases, the cyst wall was not removed. Postoperatively, the symptoms for all the patients had improved significantly, and subsequent magnetic resonance imaging studies showed obvious cyst regression. During the follow-up period of 15-44 months, no recurrence was observed. CONCLUSIONS For SEMCs spanning multiple vertebral segments, dural defect repair without cyst wall resection through single-vertebral hemilaminectomy or laminectomy can be effective. Intraoperative neuroendoscopy can assist, not only in finding the dural defect, but also in avoiding the omission of multiple dural defects as much as possible.
Collapse
Affiliation(s)
- Taohui Ouyang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Meng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lichao Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meihua Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Hong
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Na Zhang
- Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| |
Collapse
|
10
|
Xu F, Jian F, Li L, Guan J, Chen Z. Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine. J Korean Neurosurg Soc 2021; 64:238-246. [PMID: 33715325 PMCID: PMC7969037 DOI: 10.3340/jkns.2020.0244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making.
Methods Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded.
Results Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up.
Conclusion SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.
Collapse
Affiliation(s)
- Feifan Xu
- Department of Neurosurgery, Peking University First Hospital, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
11
|
Congenital Spinal Cysts: An Update and Review of the Literature. World Neurosurg 2020; 145:480-491.e9. [PMID: 32822959 DOI: 10.1016/j.wneu.2020.08.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
Congenital spinal cysts are rare and encompass a wide variety of diseases including arachnoid, enterogenous, teratomatous, neurenteric, foregut, bronchogenic, epithelial, ependymal, dermoid, and epidermoid cysts. Here, we elucidate the epidemiology, pathology, pathogenesis, and diagnostic findings of the most common congenital spinal cysts, followed by a discussion of their presentation and treatment options. Differentiating the cause of each lesion is crucial for targeted clinical and surgical management for the patient. Our review describes how arachnoid cysts can be observed, fenestrated, percutaneously drained, or shunted; however, the primary goal for neurenteric, dermoid, and epidermoid cysts is removal. Further, we discuss how patient presentation is dependent on the rate of growth and location of compression on the spinal cord and nerve roots. However, although many of these lesions are discovered incidentally on imaging, the spectrum of possible symptoms include pain, weakness, ataxia, bladder incontinence, and progressive or acute neurologic deficits. We present and review the histology and imaging of a variety of cysts and discuss how although the goal of treatment is resection, the risks of surgery must be considered against the benefits of complete resection in each case.
Collapse
|
12
|
Guinn JMV, Mayer R, Auguste KI, Tihan T, Chou D. Extradural thoracic meningeal cyst without spinal dysraphism causing adulthood myelopathy: Case illustration and review of the literature. J Clin Neurosci 2020; 78:433-438. [PMID: 32600974 DOI: 10.1016/j.jocn.2020.05.039] [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: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
Extradural spinal meningeal cysts are rare lesions in the adult spine and are an uncommon cause of neurologic deficits. We present the case of an adult who presented with myelopathic symptoms related to a dorsally based extradural thoracic meningeal cyst in the absence of any defect in the posterior spinal elements and no history of spinal dysraphism or trauma. We also performed a review of the literature to evaluate the surgical techniques for extradural meningeal cysts. Most thoracic cysts are intradural arachnoid cysts, yet this lesion is an extradural meningeal cyst, not an intradural arachnoid cyst. Because of the rarity of this lesion, its anatomic characterization can be difficult to conceptualize. An artist's illustration helps illustrate the anatomic characteristics of this cyst and our surgical management.
Collapse
Affiliation(s)
- Jeremy M V Guinn
- Department of Neurological Surgery, University of California San Francisco, United States.
| | - Rory Mayer
- Department of Neurological Surgery, University of California San Francisco, United States
| | - Kurtis I Auguste
- Department of Neurological Surgery, University of California San Francisco, United States
| | - Tarik Tihan
- Department of Neuropathology, University of California San Francisco, United States
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, United States
| |
Collapse
|
13
|
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
|
14
|
Paredes I, Munarriz PM, Toldos O, Castaño-León AM, Panero I, Eiriz C, García-Pérez D, Pérez-Núñez A, Lagares A, Alen JAF. True Dural Spinal Epidural Cysts: Report of 5 Cases. World Neurosurg 2019; 135:87-95. [PMID: 31841718 DOI: 10.1016/j.wneu.2019.12.010] [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: 11/12/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal arachnoid cysts are a rare cause of compressive myelopathy. Spinal extradural arachnoid cysts (SEACs) are even rarer. METHODS We retrospectively reviewed the SEACs operated on in our hospital between 2015 and 2019, according to their clinical and radiologic findings, treatments performed, and outcomes. RESULTS We identified 5 cases (2 males and 3 females), ranging in age from 21 months to 78 years. Except for the pediatric case, all patients presented with pain and 3 had some grade of neurologic impairment. Preoperative magnetic resonance imaging showed multiloculated cyst in 4 cases, and the communication with the dura was properly identified in only 1 case. The patients were operated through a laminectomy or laminoplasty and total removal of the cyst, and the communication with the dura was identified and repaired in all cases. In all cases, the defect was near the exit of a nerve root, and rootlets were seen through it, producing a ball-like valve mechanism. Histology of the cyst wall showed true dura in every case. One patient needed a reoperation for evacuation of a fluid collection (related to the dural sealant). Following Odom's criteria, 3 patients had an excellent outcome and 2 had a fair outcome. CONCLUSIONS Total excision of a symptomatic SEAC through either laminectomy or laminoplasty is a safe and effective treatment option. Although isolated repair of the dural communication without cyst removal may seem appealing, we have found it very difficult to identify the point of communication preoperatively.
Collapse
Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Oscar Toldos
- Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Carla Eiriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Angel Pérez-Núñez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - José Antonio F Alen
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| |
Collapse
|
15
|
Luo R, Song Y, Liao Z, Yin H, Zhan S, Yang C. Severe Kyphoscoliosis Associated with Multiple Giant Intraspinal Epidural Cysts: A Case Report and Literature Review. World Neurosurg 2019; 125:129-135. [PMID: 30738941 DOI: 10.1016/j.wneu.2019.01.178] [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: 12/07/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Severe kyphoscoliosis associated with multiple giant spinal epidural arachnoid cysts (SEACs) is an extremely rare condition and remains a challenge in clinical practice. This study aimed to present a case of severe spinal deformity associated with multiple giant SEACs and to discuss strategies for the preoperative diagnosis and treatment. CASE DESCRIPTION A 22-year-old man with severe thoracolumbar kyphoscoliosis associated with multiple giant SEACs presented with progressive scoliosis, spastic paralysis, numbness, and abnormal gait. X-ray and magnetic resonance imaging revealed severe rigid kyphoscoliosis, extensive diffuse cystic space-occupying lesions, and diffuse spinal cord compression. After multidisciplinary consultation and discussion, the patient underwent a cyst-peritoneal shunting surgery followed by posterior vertebral column resection (PVCR) correction. The postoperative course was uneventful. Both kyphosis and scoliosis were significantly corrected, and muscle weakness of the lower extremities and sensory disturbance partially improved. At the 2-year follow-up visit, the patient could freely walk without the aid of crutches, but there were some residual neurologic deficits in both legs. A plain radiograph showed that bony fusion was achieved, and the correction was well maintained. CONCLUSIONS Cyst-peritoneal shunting surgery followed by PVCR, as in our case, could be an alternative surgical strategy for multiple giant SEACs associated with severe rigid kyphoscoliosis.
Collapse
Affiliation(s)
- Rongjin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Song
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwei Liao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huipeng Yin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengfeng Zhan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
16
|
Surgical Management of Spinal Arachnoid Cysts in Adults. World Neurosurg 2019; 122:e1146-e1152. [DOI: 10.1016/j.wneu.2018.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
|
17
|
Ying GY, Chang KS, Tang YJ, Cheng CY, Zhu YJ, Chen CM. Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery. BMC Surg 2019; 19:11. [PMID: 30665385 PMCID: PMC6341693 DOI: 10.1186/s12893-019-0475-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected. CASE PRESENTATION This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique. CONCLUSIONS The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.
Collapse
Affiliation(s)
- Guang-Yu Ying
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Kai-Sheng Chang
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
| | - Ya-Juan Tang
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Chun-Yuan Cheng
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliate Hospital Zhejiang University School of Medicine, Zhejiang, China
| | - Chien-Min Chen
- Department of Neurosurgery, Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 500 Taiwan, Republic of China
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| |
Collapse
|
18
|
Lee SW, Foo A, Tan CL, Tan T, Lwin S, Yeo TT, Nga VD. Spinal Extradural Cyst: Case Report and Review of Literature. World Neurosurg 2018; 116:343-346. [DOI: 10.1016/j.wneu.2018.05.199] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/25/2018] [Accepted: 05/26/2018] [Indexed: 12/15/2022]
|
19
|
ARAÚJO JÚNIOR FRANCISCOALVESDE, BAYER DAFNELUANA, HASEGAWA HUGOAKIO, SILVA TALITARIBEIRODA, ZAMPONI JR. JOHNNI, YOKOO PATRICIA. THORACOLUMBAR EPIDURAL ARACHNOID CYST OF DIFFICULT CLINICAL MANAGEMENT: CASE REPORT. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181701177954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction: Among the primary lesions occupying the spinal space, only 1% corresponds to the epidural arachnoid cyst (EAC). This condition is usually asymptomatic, and identified accidentally in imaging tests. In symptomatic cases, total surgical resection is recommended. Objective: To describe a case of EAC refractory to clinical treatment. Methods: A 45-year-old woman had lumbar pain for six years and increased pain in the last months, with irradiation to the left lower limb (corresponding to L1). No other alterations found in the physical examination. Magnetic resonance imaging (MRI) of the spine revealed an intravertebral cystic lesion at T12-L1 level, in the left posterolateral position, causing enlargement of the foramen, and suggesting an epidural arachnoid cyst. Results: Due to failure of the initial clinical treatment, the patient underwent left T12-L1 hemilaminectomy, resection of the cyst and correction of dural failure. The patient progressed with effective pain control and MRI confirmed absence of residual lesion. Conclusion: EAC is more common in men (4:1) and may be congenital or acquired. The most common topography is thoracic (65%). Its clinical presentation is low back pain, lower limb pain and paresthesia. MRI is the method of choice for diagnosis and surgical intervention is restricted to cases that are symptomatic or refractory to clinical treatment, and the prognosis tends to be excellent. We conclude that, in addition to being a rare and commonly asymptomatic condition, an adequate therapeutic approach is essential for complete cure, avoiding intense pain and manifestations that bring about a drastic reduction of functional capacity. Level of evidence: IV. Type of study: Case series.
Collapse
|
20
|
Klekamp J. A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias. Neurosurgery 2017; 81:29-44. [DOI: 10.1093/neuros/nyx049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 01/30/2017] [Indexed: 12/19/2022] Open
Abstract
Abstract
BACKGROUND: The clinical significance of pathologies of the spinal dura is often unclear and their management controversial.
OBJECTIVE: To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results.
METHODS: Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed.
RESULTS: Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery.
CONCLUSION: The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively.
Collapse
Affiliation(s)
- Jörg Klekamp
- Department of Neurosurgery, Christliches Krankenhaus Quakenbrück, Quakenbr-ück, Germany
| |
Collapse
|
21
|
Jin B, Zhao JZ, Wang HB, Wang KD, Liu LQ, Su YB. Laminectomy by craniotome for huge spinal extradural arachnoid cyst: a case report. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0034-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
22
|
Abstract
To the authors' knowledge, most of intracranial arachnoid cyst located in middle cranial fossa and lateral fissure cistern. So, huge frontal-temporal lobe arachnoid cyst is rare. Symptoms of arachnoid cyst may be atypical, including headache, nausea, vomiting, epilepsy, poor memory, and so on. Of course, migraine related to weariness is a rare benign headache disorder. The authors reported a patient presenting with weariness migraine associated with large frontal-temporal lobe arachnoid cyst.
Collapse
|
23
|
Gu K, Kwon JW, Kim ES. Digital Subtraction Cystography for Detection of Communicating Holes of Spinal Extradural Arachnoid Cysts. Korean J Radiol 2016; 17:111-6. [PMID: 26798223 PMCID: PMC4720798 DOI: 10.3348/kjr.2016.17.1.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/31/2015] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. Materials and Methods Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. Results The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. Conclusion Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.
Collapse
Affiliation(s)
- Kyowon Gu
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.; Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| |
Collapse
|