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Thakur VV, Rangnekar RD, Aroor S, Kesavapisharady K, Abraham M. Conus medullaris intramedullary arachnoid cyst- case report and review of the literature. Surg Neurol Int 2021; 12:370. [PMID: 34513137 PMCID: PMC8422414 DOI: 10.25259/sni_525_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Spinal intramedullary cysts present a radiological dilemma. We present a rare case of a conus intramedullary arachnoid cyst and report on its differentiating features and management. Case Description: We report a case of a 30-month-old child who presented with decreased gluteal sensation and urinary dribbling for 6 months. Apart from some slowness in walking, the power was normal in all four limbs. Imaging showed a non-enhancing, T2-weighted hyperintense 12 × 8 mm conus intramedullary cyst without any edema. A T12-L1 laminotomy followed by marsupialization of the cyst was done. Histopathology was suggestive of an arachnoid cyst. The postoperative course was uneventful with improvement in muscle strength and achievement of regular milestones. We also present the pertinent review of the literature to date. Conclusion: Intramedullary arachnoid cysts are a rare entity and should form the differential diagnosis for cysts presenting in the conus medullaris. Simple decompressive options may suffice for symptomatic cases and radical excision may be avoided. A high index of suspicion is essential considering the subtle nature of presenting symptoms.
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Affiliation(s)
- Vishal Vishnu Thakur
- Department of Neurosurgery, Oscar Super Speciality Hospital, Rohtak, Haryana, India
| | | | - Shashank Aroor
- Department of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Krishnakumar Kesavapisharady
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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2
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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.
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Ichinose T, Miyashita K, Tanaka S, Oikawa N, Oishi M, Nambu I, Kinoshita M, Nakada M. Recurrent Spinal Intramedullary Arachnoid Cyst: Case Report and Literature Review. World Neurosurg 2020; 138:68-72. [PMID: 32142944 DOI: 10.1016/j.wneu.2020.02.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Symptomatic intramedullary arachnoid cysts are rarely observed lesions, particularly in the pediatric age group. Treatment includes cyst fenestration or resection of the cyst wall, and recurrence after surgery has never been reported. We report a rare case of a spinal intramedullary arachnoid cyst, which recurred after cyst fenestration and required reoperation after a certain period. CASE DESCRIPTION A 4-year-old boy presented to our hospital with tetraparesis and bladder and rectum disorder. A cystic intramedullary lesion in the cervical spinal cord was detected in preoperative imaging. An emergency fenestration of cyst was performed, and his symptoms were resolved immediately. One month after the operation, the symptoms and cyst recurred. The symptoms improved in the natural course without reoperation. However, the cyst increased in size and the symptoms recurred after 27 months from the first relapse and the cyst was removed urgently. The diagnosis was an arachnoid cyst. After the reoperation, the cyst has disappeared and not recurred. CONCLUSIONS To the best of our knowledge, this is the first report of recurrence of an intramedullary arachnoid cyst. This case indicates the importance of considering the resection of cyst wall as possible because of the probability of cyst recurrence after fenestration, while careful observation is the option in the short term, especially for children or high-risk cases.
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Affiliation(s)
- Toshiya Ichinose
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | | | - Shingo Tanaka
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Nozomu Oikawa
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Shaaban A, Abdelrahman A, Jarir RA, Al-Bozom I, Raza A. Thoracic Spinal Intramedullary Arachnoid Cyst Presented with Myelopathy with Marked Postoperative Improvement: A Case Report and Review of Literature. Asian J Neurosurg 2019; 14:981-984. [PMID: 31497146 PMCID: PMC6703067 DOI: 10.4103/ajns.ajns_72_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intramedullary spinal cord arachnoid cysts are rare. So, we present an interesting case of adult male presented with myelopathic symptoms and signs. Further investigations revealed a finding of thoracic intramedullary cystic lesion, found postoperatively to be an arachnoid cyst. Patient improved remarkably postoperative and during follow up period.
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Affiliation(s)
- Ahmed Shaaban
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | | | - Raed Abu Jarir
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
| | - Issam Al-Bozom
- Department of Pathology, Hamad General Hospital, Doha, Qatar
| | - Ali Raza
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
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Panwar N, Purohit DK, Sharma S, Chopra S. Symptomatic Thoracic Intramedullary Arachnoid Cyst: "A Rare Entity" Report of Two Cases with Short Review of Literature. J Neurosci Rural Pract 2019; 10:306-311. [PMID: 31001022 PMCID: PMC6454973 DOI: 10.4103/jnrp.jnrp_246_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Spinal arachnoid cysts are uncommon benign lesions of spine axis and most commonly present as compressive myelopathy. Intramedullary arachnoid cyst is uncommonly seen, hence, not much discussed in literature. Due to rarity of this entity, many questions are yet to be answered and should be addressed properly, particularly related to etiopathogenesis, accustomed course, behavior, differential diagnosis, and the best treatment modality. We report the clinicopathological profile of thoracic intramedullary arachnoid cysts in two adult patients, and present a detailed review of available literature on the spinal intramedullary arachnoid cyst. Most of the literature concerning with intramedullary arachnoid cysts are in the form of case reports from pediatrics population. As far to the best of our knowledge, only a few cases excluding our two were found in both pediatrics and adult population.
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Affiliation(s)
- Naresh Panwar
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Somnath Sharma
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Sanjeev Chopra
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
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6
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Abstract
Arachnoid cysts in the spine are a rare entity with extradural occurrence being the commonest. Arachnoid cysts in intramedullary location are sparingly reported in elderly. We herein report a case of intramedullary arachnoid cyst in an adult female who presented with features of compressive myelopathy.
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Affiliation(s)
- Rajesh Alugolu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | - Vamshidhar Arradi
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
| | - B P Sahu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
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Novegno F, Umana G, Di Muro L, Fraioli B, Fraioli MF. Spinal intramedullary arachnoid cyst: case report and literature review. Spine J 2014; 14:e9-15. [PMID: 24262859 DOI: 10.1016/j.spinee.2013.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/21/2013] [Accepted: 10/31/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary arachnoid cysts are extremely rare; only 14 cases have been reported in the literature so far. PURPOSE We report on the case of a 31-year-old woman who presented with back pain and progressive paraparesis secondary to a dorsal intramedullary arachnoid cyst detected on magnetic resonance imaging (MRI): the surgical planning and clinico-radiological outcome are discussed along with a review of the relevant literature. STUDY DESIGN Case report and literature review. PATIENT SAMPLE One patient affected by intramedullary arachnoid cyst. OUTCOME MEASURES Magnetic resonance imaging and pathological findings from operative specimens were used to confirm the diagnosis. METHODS A 31-year-old woman presented with a 7-year history of back pain that had worsened 3 months before admission to our department; for this reason, the patient had undergone a spinal MRI revealing the presence of a 1-cm cystic intramedullary lesion at the level T11-T12, with no contrast enhancement. After 2 months, the patient presented with a worsening of clinical symptoms complaining of severe back pain radiating to the lower extremities associated with a progressive paraparesis, urinary incontinence, and abdominal pain. Referred to our department, at the time of admission the patient was bedridden because of the impossibility of maintaining a standing position. The patient underwent a T11-T12 laminectomy with fenestration of the cyst. RESULTS She experienced an immediate relief of pain symptoms, and by the seventh postoperative day she was able to stand without help and walk a few meters with assistance. By the sixth postoperative month, the patient had significantly improved, having gained the ability to walk alone without assistance with complete resolution of the bladder dysfunctions, with no cyst recurrence after approximately 2 years of follow-up. CONCLUSIONS Intramedullary arachnoid cysts should be considered in the differential diagnosis for intramedullary cystic lesions. A particular consideration deserves their occurrence in asymptomatic patients, who should be adequately informed on the possible natural evolution: when symptomatic, surgical therapy should be promptly offered, considering that a postoperative complete recovery is usually observed, regardless of the surgical technique.
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Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy.
| | - Giuseppe Umana
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Licia Di Muro
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Bernardo Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Mario Francesco Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
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Rahimizadeh A, Soufiani H. Intramedullary arachnoid cyst in association with cervical spondylosis: case report. Spine J 2013; 13:e21-5. [PMID: 23932823 DOI: 10.1016/j.spinee.2013.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 11/19/2012] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently. PURPOSE Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis. STUDY DESIGN To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis. METHODS Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity. RESULT Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status. CONCLUSION Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Department of Neurosurgery, Pars Hospital, 83 Keshawarz Blvd, 14154 Tehran, Islamic Republic of Iran.
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Park KJ, Kang SH, Chae YS, Chung YG. Supratentorial Arachnoid Cyst Located in the Brain Parenchyma: Case Report. Neurosurgery 2011; 68:E258-62. [DOI: 10.1227/neu.0b013e3181ff355c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
abstract
BACKGROUND AND IMPORTANCE:
Arachnoid cysts have not been reported to be located within the brain parenchyma. We present a case of an arachnoid cyst that was contained entirely within the right frontal lobe devoid of communication with the subarachnoid space and ventricle.
CLINICAL PRESENTATION:
A 65-year-old woman presented with a 1-year history of progressive headache and nausea. Computed tomographic and magnetic resonance imagining scans showed a well-defined, nonenhancing mass measuring 5 × 5 × 3.5 cm in the right frontal lobe. The mass appeared to be contained entirely within the brain parenchyma. The patient underwent a right frontal craniotomy, at which time the cystic mass was identified in the brain parenchyma without any communication with the arachnoid space. The cyst contained a clear fluid, and its wall was excised. The fluid contents demonstrated a composition similar to that of normal cerebrospinal fluid. Histological and immunohistochemical examinations of the cyst wall were compatible with the diagnosis of an arachnoid cyst. Postoperatively, the symptoms of the patient resolved, and no recurrence was observed up to 6 months after removal.
CONCLUSION:
The present case showed an intraparenchymal arachnoid cyst arising in the frontal lobe. Although the etiology is not known, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.
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Affiliation(s)
- Kyung-Jae. Park
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Shin-Hyuk. Kang
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yang-Seok. Chae
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yong-Gu. Chung
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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10
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Medved F, Seiz M, Baur MO, Neumaier-Probst E, Tuettenberg J. Thoracic intramedullary arachnoid cyst in an infant. J Neurosurg Pediatr 2009; 3:132-6. [PMID: 19278313 DOI: 10.3171/2008.10.peds08202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic intramedullary arachnoid cysts are rare, especially in children; these lesions are rarely described as a cause of spinal cord compression in this age group. The authors report on an 18-month-old boy who experienced a sudden loss of his ability to stand and walk due to a paraparesis. Magnetic resonance imaging of the spine exhibited a cystic intramedullary lesion at the level of T5-6. A hemilaminectomy was performed, and after myelotomy the cystic lesion was decompressed by fenestration to the subarachnoid space. The histopathological examination verified the diagnosis of an arachnoid cyst. In the postoperative course the boy experienced complete resolution of the initial paraparesis.
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Affiliation(s)
- Fabian Medved
- Department of Neurosurgery, University Children's Hospital, and Department of Neuroradiology, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
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Intramedullary arachnoid cyst: 3-year follow up after bilateral dorsal root entry zone myelotomy. Acta Neurochir (Wien) 2008; 150:595-7; discussion 597. [PMID: 18458811 DOI: 10.1007/s00701-007-1501-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 12/12/2007] [Indexed: 10/22/2022]
Abstract
Spinal arachnoid cysts are relatively uncommon an intramedullary location is believed to be extremely rare. A 35 year old woman, admitted with progressive weakness in the lower limbs, was diagnosed as having a thoracic intramedullary arachnoid cyst. After bilateral dorsal root entry zone myelotomy procedures and wide fenestration was performed, there was a dramatic and immediate recovery. This is the first intramedullary arachnoid cyst reported to be treated by this approach and the long term outcome discussed.
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