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Khan MSI, Ahmed N, Barua KK, Chaurasia B, Vats A, Goel A. Pathogenesis, management strategies, and outcome of non-communicating extradural spinal arachnoid cyst (NEAC): a systematic review. Br J Neurosurg 2023; 37:213-219. [PMID: 35766304 DOI: 10.1080/02688697.2022.2090505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Non-communicating extradural spinal arachnoid cysts (NEACs) are extremely rare aetiology of symptomatic spinal cord compression. The aim of this study was to address their pathogenesis, optimum management strategy and outcome through systematic review of existing published studies. MATERIALS AND METHOD We have found 13 eligible publications by searching through PubMed, ScienceDirect, and Google Scholar databases, published from inception to December 2020. We have analysed the data of 21 patients extracted from those 13 publications by IBM SPSS version 23. RESULTS According to our analysis congenital predisposition, trauma, and previous surgery history are the aetiology of NEAC. Clinical presentation of cyst depends upon the location and extent of compression or involvement of the neurovascular structures. Paraparesis with variable degree of sensory disturbance was seen among patients. Based on neuroimaging findings, NEACs are most commonly found at dorsal and dorsolumbar region. Magnetic resonance imaging (MRI) is the diagnostic modalities of choice and CT myelography can demonstrate the communication with the subarachnoid space. Recurrence rate of cyst after surgery is very low as only one out of twenty patients showed recurrence. If dural defect is not accurately addressed, the recurrence rate increased significantly. CONCLUSIONS Our study has highlighted aetiology, treatment strategies, and neurological outcome of NEAC. These findings may help neurosurgeons to manage this rare surgical entity for favourable outcome.
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Affiliation(s)
- Mohammad Shahidul Islam Khan
- Department of Orthopaedic Surgery, Spine Surgery Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Nazmin Ahmed
- Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | - Kanak Kanti Barua
- Department of Neurosurgery,, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Atul Vats
- James Cook University Hospital, Middlesborough, UK
| | - Atul Goel
- Department of Neurosurgery, King Edward Memorial Hospital and Seth G. S. Medical College, Mumbai, India
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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.
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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.
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Khan SI, Ahmed N, Chaurasia B, Ahsan K. Diagnosis and treatment of noncommunicating extradural spinal thoracolumbar arachnoid cyst. Surg Neurol Int 2020; 11:405. [PMID: 33365168 PMCID: PMC7749955 DOI: 10.25259/sni_579_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/05/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Noncommunicating extradural spinal arachnoid cysts are extremely rare. They are believed to arise from congenital defects in the dura mater and become enlarged as a consequence of increased cerebro-spinal fluid (CSF) pressure within the subarachnoid space. Most retain a communicating pedicle through which the extradural cyst maintains connection with the subarachnoid space, and only rarely does this communication become sealed. The optimal treatment consists of complete surgical removal of the cyst with ligation of the communicating pedicle. Case Description: A 29-year-old male presented with a progressive spastic paraparesis of 6 months’ duration. The MRI showed a circumscribed intradural extramedullary cystic lesion located from D11-L2. Notably, peroperatively, the cyst appeared to be entirely extradural, without a communicating intradural pedicle. Further, no CSF leak was observed even after Valsalva maneuvers. Following surgical extirpation of the cyst, the patient sustained an uneventful recovery within 1 postoperative month. Conclusion: Noncommunicating extradural arachnoid cysts are extremely rare causes of spinal cord compression and should be fully excised.
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Affiliation(s)
- Shahidul Islam Khan
- Department of Orthopedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Nazmin Ahmed
- Department of Neurosurgery, Ibn Sina Diagnostic and Consultation Centre, Dhaka, Bangladesh
| | - Bipin Chaurasia
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Kamrul Ahsan
- Department of Orthopedic Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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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.
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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
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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.
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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
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A symptomatic spinal extradural arachnoid cyst with lumbar disc herniation. Case Rep Orthop 2015; 2015:250710. [PMID: 25861499 PMCID: PMC4377437 DOI: 10.1155/2015/250710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/02/2015] [Indexed: 12/15/2022] Open
Abstract
Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.
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Detection of the communicating hole(s) of spinal extradural arachnoid cysts using time-spatial labeling inversion pulse magnetic resonance imaging. Spine (Phila Pa 1976) 2014; 39:E1394-7. [PMID: 25202934 DOI: 10.1097/brs.0000000000000591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Report of 2 cases. OBJECTIVE To report the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) for detection of the communicating hole(s) of spinal extradural arachnoid cysts (SEACs). SUMMARY OF BACKGROUND DATA SEACs normally communicate with the subarachnoid space via small communicating hole(s) in the dura. It is necessary to identify the accurate locations of these communicating hole(s) before attempting to close them through limited laminotomy/laminectomy. Myelocomputed tomography or conventional MRI may fail to detect the locations of the hole(s) because they comprise small dural defects. METHODS Case 1: A 33-year-old female presented with an SEAC at the T11–L2 vertebral level. Case 2: An 82-year-old female presented with an SEAC at T12–L4 vertebral level. RESULTS Case 1: T-SLIP MR image of the left parasagittal plane (not the midsagittal or right parasagittal plane) revealed cerebrospinal fluid flow from the subarachnoid space into the cyst at L1. After limited laminotomy at T12–L1 and partial cyst resection, we identified 2 contiguous dural holes immediately medial to the left L1 pedicle; this corroborated the preoperative T-SLIP MRI findings. The holes were sutured. Postoperative conventional MR image confirmed significant cyst shrinkage. Case 2: T-SLIP MR image revealed a curved line at the L1 pedicle in the right parasagittal plane. After L1 laminectomy and partial cyst resection, a dural hole was identified L1 pedicle, which was in agreement with the preoperative T-SLIP MRI findings. After surgery, the lower extremity pain disappeared. Postoperative conventional MR image revealed significant cyst shrinkage. CONCLUSION T-SLIP MRI is useful for detection of the communicating hole(s) of SEACs. LEVEL OF EVIDENCE N/A.
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8
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Nerve root prolapse into a spinal arachnoid cyst—An unusual cause of radiculopathy. Clin Neurol Neurosurg 2009; 111:460-4. [DOI: 10.1016/j.clineuro.2008.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 12/02/2008] [Accepted: 12/19/2008] [Indexed: 12/19/2022]
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9
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Boudawara MZ, Bahloul K, Ghorbel M, Mahfoudh KB, Rebai R. [Extra dural arachnoid cyst: case report]. Neurochirurgie 2008; 54:93-6. [PMID: 18342340 DOI: 10.1016/j.neuchi.2007.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 12/22/2007] [Indexed: 11/30/2022]
Abstract
Extradural arachnoid cysts are uncommon expanding lesions in the spinal canal, which may communicate with the subarachnoid space. Usually located in the lower thoracic spine, they may cause symptoms by compressing the spinal cord or nerve roots. We report a case of an extradural thoracic arachnoid cyst revealed by progressive spinal cord compression. CT myelography and MRI enabled diagnosis. Rapid neurological improvement was observed after surgical resection.
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Affiliation(s)
- M Z Boudawara
- Service de neurochirurgie, CHU Habib Bourguiba, 3929 Sfax, Tunisie.
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10
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Abstract
STUDY DESIGN Report of 2 operated cousin cases of the multiple spinal extradural arachnoid cysts. OBJECTIVE To report the operative findings of cousin cases of the multiple spinal extradural arachnoid cysts and analyze a genetic etiology with the pedigree of all family members. SUMMARY OF BACKGROUND DATA Spinal extradural arachnoid cyst is a relatively rare condition that occupies the intraspinal space and sometimes causes neurologic disturbances. The exact etiology is unknown since most reported cases are sporadic. Minimally invasive treatments have been recently applied to a single extradural arachnoid cyst. However, it is still unknown which minimally invasive treatments can be applied to the multiple extradural arachnoid cysts. METHODS We experienced 2 cousin cases of multiple spinal extradural arachnoid cysts. Operative findings were described. The pedigree of all family members was made, and a genetic etiology was discussed. RESULTS Minimally invasive treatment was tried in Case 1. However, it failed to remove all cysts completely. Each cyst had each stalk communicating with subarachnoid space in both cases. Pedigree showed that the mode of inheritance was likely autosomal dominant. CONCLUSION When the cysts are multiple, it is necessary to identify a dural defect in each cyst. The etiology of the multiple extradural arachnoid cysts may be hereditary.
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Affiliation(s)
- Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima City, Fukushima, Japan.
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Abstract
✓ The authors examine the natural history of a spinal epidural arachnoid cyst and present their experience with its treatment in a 25-year-old man who presented with progressive cauda equina syndrome. Neuroimaging revealed two neighboring sacral epidural cysts. The cysts were completely removed via a sacral S1–4 laminectomy; no communication with the subarachnoid space could be found. The patient's postoperative course was uneventful. He experienced progressive improvement and, finally, complete resolution of symptoms and no recurrence of the cyst. Nabors Type I sacral epidural arachnoid cysts are rare; in some cases their origins and the mechanism by which they cause deterioration in the patients' clinical condition are debatable. Findings in the present case support the idea that some of these cysts are noncommunicating but progressive in their clinical presentation. This lesion type is also known to occur intracranially. A brief review of the literature is provided.
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12
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Tei R, Morimoto T, Miyamoto K, Aketa S, Shimokawara T, Shin Y, Hironaka Y. Dural Repair for Intraspinal Extradural Meningeal Cyst -Case Report-. Neurol Med Chir (Tokyo) 2007; 47:434-7. [PMID: 17895619 DOI: 10.2176/nmc.47.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 52-year-old woman presented with an intraspinal extradural meningeal cyst in the thoracolumbar region manifesting as progressive sensory disturbance of the bilateral lower extremities. Magnetic resonance imaging and computed tomography myelography showed an extradural meningeal cyst extending from the T-12 to L-4 levels in the thoracolumbar region with a dural defect and a valve-like mechanism developed in the enlarging cyst. Operative findings revealed a dural defect that allowed communication between the extradural cyst cavity and the subarachnoid space. Surgical resection of the cyst wall and repair of the dural defect resolved the symptoms.
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Affiliation(s)
- Rinsei Tei
- Department of Neurosurgery, Osaka Police Hospital, Japan.
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13
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Choi JY, Kim SH, Lee WS, Sung KH. Spinal extradural arachnoid cyst. Acta Neurochir (Wien) 2006; 148:579-85; discussion 585. [PMID: 16505968 DOI: 10.1007/s00701-006-0744-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Accepted: 12/01/2005] [Indexed: 10/25/2022]
Abstract
Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. They usually present with progressive signs and symptoms caused by spinal cord compression if they enlarge. A comprehensive review about spinal extradural arachnoid cyst is made including the author's own case of a 59-year-old woman with a 6-month history of progressive back pain radiating to both legs. Key points concerning the possible pathogenesis including symptomatology, diagnosis, and the implications for treatment are highlighted. Surgical treatment is curative and this rare clinical entity should be considered in the differential diagnosis of spinal extradural lesions.
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Affiliation(s)
- J Y Choi
- Department of Neurosurgery, 21st Century Hospital, and Department of Neuropathology, Yonsei University College of Medicine, Seoul, Korea.
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14
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Ghannane H, Lmejjati M, Ait Benali S. [Extradural thoracic arachnoid cyst. Case report and review of the literature]. Neurochirurgie 2006; 51:595-8. [PMID: 16553333 DOI: 10.1016/s0028-3770(05)83635-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report an unusual and asymptomatic cause of cord compression treated surgically with good clinical outcome. METHODS AND MATERIAL We report a case of extradural arachnoid cyst in the thoracic region and review the literature on the clinical, neuroradiologic and therapeutic features. RESULTS A 17-year-old man, with unremarkable past medical history was referred to our institution of Neurosurgery, CHU Mohammed-VI, Marrakech, with progressive spastic paraparesis. Magnetic resonance imaging (MRI) showed a posterior extradural cystic lesion in the thoracic region from T6-T7 thoracic vertebra. The cyst was completely removed by posterior approach. An arachnoid cyst was confirmed at the histological study. Neurological symptoms improved after surgery. CONCLUSION Given its infrequency, the diagnosis of arachnoid cyst should be suspected when a cystic lesion causes cord compression. Surgery is the treatment of choice, providing good clinical outcome.
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Affiliation(s)
- H Ghannane
- Service de Neurochirurgie, CHU Mohammed-VI, Marrakech, Maroc.
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15
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Kikuta KI, Hojo M, Gomi M, Hashimoto N, Nozaki K. Expansive duraplasty for the treatment of spinal extradural arachnoid cysts. J Neurosurg Spine 2006; 4:251-5. [PMID: 16572626 DOI: 10.3171/spi.2006.4.3.251] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors report the case of a 25-year-old man with a thoracolumbar extradural arachnoid cyst who underwent expansive duraplasty. Symptoms, preoperative magnetic resonance imaging features, and intraoperative findings suggested the involvement of entrapment neuropathy in the manifestation of symptoms. To the authors’ knowledge, this case represents the first evidence that expansive duraplasty can achieve complete resolution of the symptoms in a patient with a spinal extradural arachnoid cyst. The results indicate that duraplasty may be an alternative option in cases in which complete resection of the lesion is difficult and widening of the dural sac is necessary at surgery.
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Affiliation(s)
- Ken-Ichiro Kikuta
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Japan.
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16
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Robinson Y, Reinke M, Haschtmann D, Ertel W, Heyde CE. Spinal extradural meningeal cyst with spinal stenosis. Spinal Cord 2005; 44:457-60. [PMID: 16304568 DOI: 10.1038/sj.sc.3101848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE To present a rare pathology causing a common disease. SETTING Spine unit of the orthopaedic surgery department of a university hospital in Berlin/Germany. CASE REPORT A 39-year-old female with an intraspinal extradural arachnoid cyst of the lumbar spine presented with intermittent radiating lumbar pain. The magnetic resonance imaging (MRI) showed a dorsal spinal extradural arachnoid cyst at L3/4. After wide laminotomy L3, operative cyst resection and stabilisation at L3/4 by posterior lumbar interbody fusion (PLIF), major symptom relief occurred. CONCLUSION Spinal extradural arachnoid cysts are a rare entity causing low back pain and intermittent radicular syndromes. They can be caused by arachnoid herniation through dural weak spots which are hereditary or occur after trauma. A ball-valve mechanism promotes growth. The main diagnostic tool for spinal extradural cysts is the MRI scan. Additionally, myelography is helpful to demonstrate fluid communication. Complete surgical removal of the cyst should be attempted to reduce risk of recurrence. If extensive decompression is needed for the surgical approach causing segmental instability, interbody fusion is recommended. The outcome depends on age, duration and degree of neurological damage.
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Affiliation(s)
- Y Robinson
- Department of Trauma and Orthopaedic Surgery, Charité - Campus Benjamin Franklin, Berlin, Germany
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17
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Liu SH, Ho JT, Lai PH, Tseng HH, Yip CM, Liao WC, Hsu SS. Huge spinal extradural meningeal cyst in the thoracolumbar spine: a case report of a rare cause of low backpain. Kaohsiung J Med Sci 2005; 21:427-32. [PMID: 16248128 DOI: 10.1016/s1607-551x(09)70146-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Symptomatic intraspinal extradural meningeal cysts are rare. We present the case of a 17-year-old female with low back pain, progressive numbness, and radiation pain to the flank and lower limbs. Magnetic resonance imaging and computed tomographic myelography revealed a huge intraspinal extradural meningeal cyst extending from T12 to L3 with cord and dural sac compression. The patient underwent surgery to open the cyst and close the connecting dural defect. Pathologic examination of the cyst disclosed non-specific fibrous connective tissue without an inner arachnoid single-cell lining. She achieved complete recovery after the operation. There was no recurrence of the cyst at a 2-year follow-up.
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Affiliation(s)
- Su-Hao Liu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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