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Afana HB, Kananeh SF, Duraisamy R, Farah A, Figueiredo N. Long-Term Recurrent Intramedullary Arachnoid Cyst: Case Report and Literature Review. Asian J Neurosurg 2023; 18:667-675. [PMID: 38152523 PMCID: PMC10749842 DOI: 10.1055/s-0043-1774380] [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: 12/29/2023] Open
Abstract
Objectives This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to an intramedullary arachnoid cyst (IMAC). For literature review, the authors used the phrase "intramedullary arachnoid cyst" in PubMed search engine. 23 articles describing cases with IMAC were included in this review, with a total of 26 patients. Materials and Methods We report a case with long term recurrant intramedullary arachnoid cyst and present a review on spinal intramedullary arachnoid cyst. Result IMAC is showing bimodal incidence and trending to occur below 10 years and after 30 years. However, rarely, it should be considered in the differential diagnosis of intramedullary cystic lesions. Authors suggest doing laminoplasty or fusion for the pediatric patients to prevent kyphoscoliosis deformity in the long run, but doing early surgery to gain better outcome. Resection of the cyst wall should be done as much as possible; if it could not be achieved, then marsupialization or cysto-subarachnoid shunt should be considered. Aspiration alone or fenestration is not enough to eradicate the cyst. Long-term and prospective studies are recommended to achieve the best treatment options. Conclusion Review supports early surgical treatment of symptomatic IMACs with resection of the cyst wall as much as possible.
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Affiliation(s)
- Hatem B. Afana
- Departments of Orthopaedic and Spine Surgery, King's College Hospital London, Dubai, UAE
| | - Salman F.M. Kananeh
- Internal Medicine, Capital Health Regional Medical Center, Trenton, New Jersey, United States
| | | | - Abdulkadir Farah
- Department of Radiology, Medcare Orthopaedic and Spine Hospital, Dubai, UAE
| | - Nicandro Figueiredo
- Departments of Orthopaedic and Spine Surgery, King's College Hospital London, Dubai, UAE
- Medical School, University of Cuiaba (UNIC), Cuiaba, MT, Brazil
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
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2
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Diyora B, Dhall G, Bhende B, More N, Mulla M, Vekaria M. Giant Craniospinal Intramedullary Arachnoid Cyst: A Rare Occurrence. Asian J Neurosurg 2022; 17:389-391. [PMID: 36120633 PMCID: PMC9473815 DOI: 10.1055/s-0042-1750813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, Lokmanya Tilak Municiple Medical College and Lokmanya Tilak Municiple General Hospital (LTMMC & LTMGH) Sion, Mumbai, Maharashtra, India
| | - Gagan Dhall
- Department of Neurosurgery, Lokmanya Tilak Municiple Medical College and Lokmanya Tilak Municiple General Hospital (LTMMC & LTMGH) Sion, Mumbai, Maharashtra, India
| | - Bhagyashri Bhende
- Department of Neurosurgery, Lokmanya Tilak Municiple Medical College and Lokmanya Tilak Municiple General Hospital (LTMMC & LTMGH) Sion, Mumbai, Maharashtra, India
| | - Nilesh More
- Department of Neurosurgery, Lokmanya Tilak Municiple Medical College and Lokmanya Tilak Municiple General Hospital (LTMMC & LTMGH) Sion, Mumbai, Maharashtra, India
| | - Mazharkhan Mulla
- Department of Neurosurgery, Lokmanya Tilak Municiple Medical College and Lokmanya Tilak Municiple General Hospital (LTMMC & LTMGH) Sion, Mumbai, Maharashtra, India
| | - Mayank Vekaria
- Department of Neurosurgery, Jaslok Hospital & Research Center, Mumbai, Maharashtra, India
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Djumanov K, Kariev G, Chmutin G, Antonov G, Chmutin E, Musa G, Maier A, Shumadalova A. Comparing Two Improved Techniques With the Traditional Surgical Techniques for Intra and Extramedullary Spinal Tumor Resection: A Report of 280 Cases. Front Surg 2022; 9:892470. [PMID: 35548191 PMCID: PMC9083194 DOI: 10.3389/fsurg.2022.892470] [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: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Spinal tumors remain a challenging problem in modern neurosurgery. The high rate of postoperative morbidity associated with intramedullary tumors makes the need for safer surgical techniques invaluable. This study analyses our experience with the treatment of spinal cord tumors and compares traditional management and a new different surgical approach to intramedullary tumors with an associated hydrosyringomyelia. Materials and Methods This retrospective study compared standard surgical techniques and 2 newer modified techniques for intra and extramedullary spinal tumors at the Neurosurgery center for spinal cord tumors of the Republic of Uzbekistan. Preoperative neurological status was recorded with the ASIA/ISNCSCI scale. Postoperative outcome was graded using the Nurrick score. Results Of the 280 cases, there were 220 (78.5%) extramedullary and 60 (21.5%) with intramedullary spinal tumors. The control and main group had 159 (56.8%) and 121 (43.2%) patients, respectively. Severe compression myelopathy (ASIA- A, B, C) was 217 (77.5%) patients i.e., ASIA A-39 (13.9%); B-74 (26.4%), and C-104 (37.1%). In 74 extramedullary tumors (33.6%) treated with the new method, good postoperative outcomes in 44 cases (59.5%) with OR = 1.9; 95% CI 1.1–3.3 (p < 0.05). Thirty-seven (61.7%) intramedullary tumors were treated with the newer modified technique. There was no difference with the standard method (p = 0.15). However, when comparing postoperative Nurick grade 1–2 with grade 3–4, the newer strategy was superior with improvement in 24 (65%) patients, OR = 3.46; 95% CI 1.2–10.3 (p < 0.05). Conclusion When compared with standard methods, the proposed newer modified strategy of surgical treatment of spinal cord tumors with the insertion of a syringosubarachnoid shunt in the presence of an associated hydrosyringomyelia is associated with better postoperative outcome (Nurick 1 and 2) in 64.8%.
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Affiliation(s)
- Kamaliddin Djumanov
- Republican Specialized Scientific and Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
| | - Gayrat Kariev
- Republican Specialized Scientific and Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan
- Department of Neurosurgery, Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - Gennady Chmutin
- Department of Nervous Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- Federal State Budgetary Institution of Medical Department of Moscow “Morozov Children's City Clinical Hospital of Medical Department of Moscow”, Moscow, Russia
| | - Gennady Antonov
- 3rd Central Military Clinical Hospital Named After A.A. Vishnevsky Under the Ministry of Defense of the Russian Federation, Krasnogorsk, Russia
| | - Egor Chmutin
- Department of Nervous Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Gerald Musa
- Department of Nervous Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
- *Correspondence: Gerald Musa
| | - Adam Maier
- Department of Nervous Diseases and Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, Russia
| | - Alina Shumadalova
- Department of General Chemistry, Bashkir State Medical University, Ufa, Russia
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Epstein NE. Review/Perspective On the Diagnosis and Surgical Management of Spinal Arachnoid Cysts. Surg Neurol Int 2022; 13:98. [PMID: 35399888 PMCID: PMC8986646 DOI: 10.25259/sni_153_2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Spinal arachnoid cysts (SAC) are typically congenital, spontaneous, traumatic (i.e., including iatrogenic/surgical), or inflammatory in origin. In descending order, they occur in the thoracic, lumbar, and cervical spine, and originate from focal entrapment of the arachnoid membrane. Arachnoid cysts represent 1–2% of all cystic spinal masses/tumors. The majority are extradural arachnoid cysts (EDAC) while 10% of all arachnoid cysts are intradural (IDAC) including subarachnoid, or extra-arachnoidal/subdural. Only rarely are they intramedullary in location. The clinical symptoms/signs of IDAC/EDAC include; intracranial hypotension (i.e., due to continued cerebrospinal fluid drainage), radiculopathy, and/or myelopathy.
Methods:
Magnetic Resonance Images (MR) and Myelo-Computed Tomography (Myelo-CT) studies classically document the predominant dorsal location of IDAC/EDAC. They also show their extent and severity contributing to root, cord, and/or cauda equina compression. In the cervical/thoracic spine, MR/Myelo-CT studies classically show the “double cord” or “windsock” signs, while the “fake arachnoiditis sign” may be seen in the lumbar spine. The latter sign signals the presence of a circumferential extra-arachnoidal-subdural cyst that centrally “traps” the cauda equina. Note, that this resembles and is often misinterpreted as adhesive archnoiditis.
Results:
Patients with significant SAC-related neurological deficits typically warrant early surgery. That surgery includes; partial/total resection/fenestration of cyst walls, and occlusion of communicating fistulas with or without accompanying shunts.
Conclusion:
It is critical to recognize the clinical (i.e., intracranial hypotension, radiculopathy, and/or myelopathy) and radiographic MR/Myelo-CT signs (i.e., “double cord,” “windsock signs”, or “fake arachnoiditis sign”) of IDAC, EDAC, or intramedullary spinal arachnoid cysts to appropriately offer treatment. For those with significant neurological deficits, early surgery (i.e. optimally 0-< 24 hours after the onset of symptoms/signs consisting of laminectomies, partial/total cyst resection/fenestration, and ligation/occlusion of the subarachnoid-cyst fistula with or without shunt placement), is essential to avoid significant permanent neurological sequelae.
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5
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Kurogi A, Murakami N, Mukae N, Shimogawa T, Shono T, Suzuki SO, Morioka T. Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst. Pediatr Neurosurg 2022; 57:184-190. [PMID: 35259748 DOI: 10.1159/000523976] [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: 04/24/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The retained medullary cord (RMC) is a newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during the last phase of secondary neurulation. The terminal myelocystocele (TMC) is an unusual type of closed spinal dysraphism, characterized by localized cystic dilatation of the terminal part of the central canal that then herniates through a posterior spinal bifida. The co-occurrence of RMC and TMC is extremely rare. CASE PRESENTATION We treated a baby girl with a huge sacrococcygeal meningocele-like sac with two components. Untethering surgery and repair surgery for the sac revealed that RMC, associated with intramedullary arachnoid cyst (IMAC), was terminated at the bottom of the rostral cyst, forming the septum of the two cystic components, and the caudal cyst was TMC derived from the central canal-like ependymal lining lumen (CC-LELL) of the RMC at the septum. IMAC within the RMC communicated with TMC, and both contained xanthochromic fluid with the same properties. CONCLUSION We speculated that the mass effect of the coexistent IMAC impeded the flow of cerebrospinal fluid in the CC-LELL within the RMC and eventually formed a huge TMC. In surgical strategies for such complex pathologies, it is important to identify the electrophysiological border between the functional cord and nonfunctional RMC and the severe RMC to untether the cord, as with a typical or simple RMC.
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Affiliation(s)
- Ai Kurogi
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobuya Murakami
- Department of Neurosurgery, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
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6
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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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7
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[Nonneoplastic lesions of the spinal canal]. Radiologe 2021; 61:283-290. [PMID: 33566131 DOI: 10.1007/s00117-021-00829-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
Numerous vascular, inflammatory, degenerative and tumorous lesions of the spinal canal can cause paraplegic symptoms. In addition to the neurological examination and the leading symptoms, the first topographical classification of the (suspected) disease is essential for further diagnostics. Hence, high-resolution magnet resonance imaging (MRI) is the gold standard for the majority of questions. To avoid diagnostic and therapeutic mistakes, differentiation of intraspinal tumors from tumor-like (nonneoplastic) lesions is indispensable, which is often only possible after follow-up imaging or surgical exploration.
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8
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Nicoletti GF, Umana GE, Graziano F, Florio A, Scalia G. Repair of a spinal pseudomeningocele in a delayed postsurgical cerebrospinal fluid leak using titanium U-clips: Technical note. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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9
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Umana GE, Passanisi M, Fricia M, Cicero S, Narducci A, Nicoletti GF, Scalia G. Letter to the Editor Regarding “Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation”. World Neurosurg 2020; 139:692-693. [DOI: 10.1016/j.wneu.2020.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
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10
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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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11
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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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12
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Nakahashi M, Uei H, Tokuhashi Y. Recurrence of a symptomatic spinal intradural arachnoid cyst 29 years after fenestration. J Int Med Res 2019; 47:4530-4536. [PMID: 31448656 PMCID: PMC6753568 DOI: 10.1177/0300060519870092] [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: 11/15/2022] Open
Abstract
Symptomatic arachnoid cysts are relatively rare, and no case reports have described recurrence of such cysts almost 30 years after surgery. We herein report a case in which a symptomatic intradural arachnoid cyst recurred 29 years after fenestration of the primary lesion. The patient was a 64-year-old woman who presented with paralysis of the left lower limb. She had undergone surgical treatment for an intradural arachnoid cyst at the T12 level 29 years previously. Magnetic resonance imaging (MRI) revealed an intradural mass at the T12–L1 level. The mass was compressing the spinal cord and cauda equina. Its localization and shape on MRI were similar to those of the primary cyst 29 years previously. Partial resection was performed under a diagnosis of a recurrent intradural arachnoid cyst. After surgery, the patient’s left lower limb paralysis improved. The pathological findings were suggestive of an intradural arachnoid cyst. The MRI findings 29 years previously provided useful information. The possibility of very late recurrence should be considered in patients who undergo surgical removal of intradural arachnoid cysts.
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Affiliation(s)
- Masahiro Nakahashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
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Abstract
CLINICAL ISSUE Spinal cysts can be classified as meningeal, not meningeal, and tumor-associated cysts. Due to the widespread availability of high-resolution computed tomography and magnet resonance imaging, spinal cysts can be detected with high sensitivity these days. Concerning the variety of potential cystic differential diagnoses, a precise classification is difficult and can often only be realized after surgical inspection or histological examination. PRACTICAL RECOMMENDATIONS Spinal cysts are generally incidental findings during a routine diagnostic workup and need no further therapy. Surgical treatment can be necessary if the spinal cyst reaches a certain size and causes neurological symptoms due to the compression of the spinal cord or the nerve root.
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14
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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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15
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Zekaj E, Saleh C, Servello D. Intramedullary cyst formation after removal of multiple intradural spinal arachnoid cysts: A case report. Surg Neurol Int 2016; 7:S473-4. [PMID: 27512608 PMCID: PMC4960930 DOI: 10.4103/2152-7806.185779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background: A rare cause of spinal cord compression is spinal arachnoid cysts. Symptoms are caused by spinal cord compression, however, asymptomatic patients have been also reported. Treatment options depend upon symptom severity and clinical course. Case Description: We report the case of a 47-year-old patient who developed an intramedullary arachnoid cyst after removal of an intradural extramedullary cyst. Conclusion: Surgery should be considered early in a symptomatic disease course. Longstanding medullary compression may reduce the possibility of neurological recovery as well as secondary complications such as intramedullary cyst formation.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery, IRCCS Galeazzi Hospital, Milan, Italy
| | - Christian Saleh
- Department of Neurosurgery, IRCCS Galeazzi Hospital, Milan, Italy
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16
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Ishibe T, Senzoku F, Kamba Y, Ikeda N, Mikawa Y. Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging of Cystic Lesions of the Spinal Cord. World Neurosurg 2015; 88:693.e13-693.e21. [PMID: 26732971 DOI: 10.1016/j.wneu.2015.12.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cystic lesions of the spinal cord such as spinal intradural arachnoid cysts (SIACs) and spinal extradural arachnoid cysts (SEACs) contain cerebrospinal fluid (CSF). The pathology of these lesions is often difficult to understand because it is difficult to detect abnormal CSF flow by conventional magnetic resonance imaging (MRI) or myelography. We preliminarily evaluated the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) of cystic lesions of the spinal cord. METHODS T-SLIP MRI was applied to the following 6 consecutive cystic lesions of the spinal cord: 3 SEACs, 1 SIAC, 1 spinal intramedullary cyst associated with adhesive arachnoiditis, and 1 chronic pseudomeningocele. Information obtained by T-SLIP MRI was evaluated with regard to the following: 1) whether exclusive pathologic information was obtained, 2) whether this information affected the therapeutic strategy, and 3) the time required for T-SLIP MRI. RESULTS Exclusive information was obtained in all 6 cases. In SEACs and the intramedullary cyst, pathologic CSF flow into the cyst was directly visualized, enabling us to narrow the therapeutic intervention targets. In SIAC, exclusive information involved detection of the cystic cranial wall and the absence of the caudal wall, enabling us to omit the exploration of the caudal wall. The examination required as long as 80 minutes for SIAC and <30 minutes for the other cases. CONCLUSIONS T-SLIP MRI is useful for obtaining pathologic information about cystic lesions of the spinal cord.
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Affiliation(s)
- Tatsuya Ishibe
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan.
| | - Fukuji Senzoku
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Yusuke Kamba
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Noboru Ikeda
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Yoshihiro Mikawa
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
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Abstract
Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.
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