Extradural giant multiloculated arachnoid cyst causing spinal cord compression in a child

Multiple spinal extradural arachnoid cysts presenting as compressive myelopathy in a teenager: case report and literature review with special emphasis on postoperative spine deformity in the current minimally invasive era

INTRODUCTION

Multiple synchronous spinal extradural arachnoid cysts are extremely rare in children and can lead to cord compression and disability. Multiple spinal extradural arachnoid cysts (SEDACs) in children with immature and growing spine need to be studied separately from multiple SEDACs in adults with mature and fully grown spine because of multiple surgical limitations in children (blood loss, surgery duration, long-term spinal stability after long segment exposure, etc.).

MATERIAL AND METHODS

We planned a non-systematic literature review of similar cases described in literature to analyse the pattern of presentation, management, and outcome of this surgically curable disease.

RESULTS

A total of 28 cases of paediatric multiple SEDACs in the age range of 5 months to 17 years and mean age of 11.54 years were analysed. Exposure was achieved by laminectomy in 9, laminoplastic laminotomy in 13, laminectomy in first surgery followed by laminoplasty in second surgery (re-exploration) in 1, hemilaminectomy in 2, and technique "not reported" in 3 children. Complete/near-complete recovery was seen in 27 (96.42%) children. Postoperative spine deformity was reported in 7 (25%) children and was progressive in 2 children during serial follow-up.

CONCLUSIONS

Symptomatic multiple synchronous SEDACs in children is a rare surgically curable condition. Sincere attempt to find out a dural defect in all cysts is a very important step in multiple SEDAC surgery. Total cyst wall excision with closure of all dural defects is the gold standard treatment for symptomatic cases. Laminoplasty is preferred for excision of multiple SEDACs in children to prevent postoperative spine deformity during long-term follow-up. Long serial follow-up for postoperative spine deformity is necessary.

Extradural arachnoid cyst with bony erosion: a rare case report

The authors present the case of an otherwise healthy 38-year-old female with an atypical extradural arachnoid cyst with multi-level involvement in the lumbar spine leading to left quadriceps weakness and dysesthesia. Upon presentation, a lumbar spine MRI with contrast and plain radiographs revealed extensive L4 bony erosion. An MR angiogram and cervical spine MRI with contrast were then obtained in order to rule out any aortic root or cervical spine pathology. With no other apparent clinically relevant pathology revealed by these additional tests, an L3-5 posterior decompression and fusion procedure was performed. Her preoperative symptoms were successfully resolved following the procedure, with no resultant surgical complications. The cyst is atypical not only due to its size and location, but also due of the significant bony erosion of the left L4 pedicle and vertebral body. To the authors' knowledge, this is the first reported case of an extradural arachnoid cyst in the lumbar spine with bony erosion of the pedicle and vertebral body. In cases such as this, a CT myelogram may be useful in planning the operative approach through visualization of the exact communication between cyst and dura. This approach may also aid in diagnosing and identifying atypical cyst presentations such as the one presented here.

Congenital Spinal Cysts: An Update and Review of the Literature

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.

Nonfusion Muscle-Sparing Technique to Treat Long-Segment Thoracolumbar Extradural Arachnoid Cyst in a Child: A Case Report and Review of the Literature

BACKGROUND

Spinal extradural arachnoid cyst is an uncommon cause of spinal cord compression. It results from a small dural defect that leads to cerebrospinal fluid (CSF) accumulation in the cyst and subarachnoid space, and the cyst can compress the spinal cord and nerve roots. Surgery is the treatment of choice in symptomatic patients, and most cases have an immediately satisfying outcome after surgery.

CASE DESCRIPTION

A 10-year-old Thai boy presented with progressive weakness in both legs. Magnetic resonance imaging (MRI) demonstrated a giant cystic lesion 23 cm in length from T1-L2 level. To our knowledge, this is the longest arachnoid cyst that has been reported in children. The operation included unilateral paraspinal muscle dissection with spinous process translation techniques, T1-L4 laminectomy, total cyst excision, and dural defect repair at the T4 level. The symptoms were fully resolved within 2 months after surgery. However, thoracic kyphosis was slightly increased, but the patient still has a normal sagittal profile.

CONCLUSIONS

Spinal arachnoid cyst is rare, especially in children. Early diagnosis and treatment are essential for improving the chance of full recovery, and for avoiding complication and irreparable defect. Total cyst removal with dural repair remains the best treatment alternative; however, potential complications, especially spinal malalignment after extensive laminectomy, must be considered. Postoperative MRI showed normal CSF flow and no spinal cord compression. The muscle-sparing technique with multiple-level laminectomy without spinal fusion that we used in this case provided a satisfying outcome.

Spinal extradural arachnoid cyst in a child-a case report

Extradural spinal arachnoid cysts are rare lesions. They frequently communicate with the subarachnoid space through a defect in the dura. Symptoms result from compression of the spinal cord or nerve roots. The treatment of choice is complete surgical excision. We report the case of a 12-year-old girl with extradural spinal arachnoid cyst who had complete surgical excision with good outcome.

Symptomatic spinal extradural arachnoid cyst with cord compression in a family: case report

A family with familial spinal extradural arachnoid cyst is presented. A 14-year-old boy had an extensive T-8 through L-2 dorsal extradural arachnoid cyst with spinal cord compression and slowly progressive myelopathy. His mother had presented 4 years earlier with acute excruciating back pain due to the combination of a lumbar extradural arachnoid cyst at L2–4 and an extruded disc at L3–4. The literature is reviewed in light of the pathogenesis, imaging, and surgical technique required for treatment.

Multiple spinal extradural arachnoidal cysts: An uncommon cause of thoracic cord compression

Spinal extradural arachnoid cysts are one of the rare causes of symptomatic spinal cord compression. Among them, occurrence of multiple cysts at the same spinal segment is rarely described in the literature. They appear to be extradural outpouchings of arachnoid that communicate with the intraspinal sub-arachnoid space through a small defect in the dura, filled by cerebrospinal fluid. Pathogenesis of these lesions is still unclear. Surgical excision is considered as the gold standard treatment. We present a 7-year-old female child who presented with spastic paraparesis. Her magnetic resonance imaging showed a thoracic posterior extradural arachnoid cyst, whereas, intraoperatively we found multiple cysts, which were excised completely. Neurological symptoms gradually recovered after surgical decompression.

Cervical spinal intradural arachnoid cysts in related, young pugs

Seven related young pugs were diagnosed with cervical spinal intradural arachnoid cysts by magnetic resonance imaging (n = 6) and myelography (n = 1). All dogs were presented with skin abrasions on their thoracic limbs and non-painful neurological deficits, indicating a C1-T2 myelopathy. In all six dogs examined by magnetic resonance imaging not only the spinal arachnoid cyst but also a concomitant, most likely secondary, syringohydromyelia was confirmed. Pedigree analysis suggested a genetic predisposition for spinal arachnoid cysts in this family of pugs. Generalised proprioceptive deficits more pronounced in the thoracic limbs suggesting a focal cervical spinal cord lesion, with concomitant skin abrasions on the dorsal aspect of the thoracic limbs in a young pug, should alert veterinarians to the possibility of cervical spinal arachnoid cysts.

Spinal extradural arachnoid cysts

OBJECTIVE: Extradural arachnoid cysts (EACs) are rare causes of spinal cord compression and cauda equina. These benign lesions appear in the literature mainly as single case reports. In this article, we present the largest series found in literature, with four new cases of spinal extradural arachnoid cysts. The characteristic imaging features, details of surgical steps and strategies to prevent postoperative kyphosis in this cystic pathology will be discussed.

Management of complex giant spinal arachnoid cysts presenting with myelopathy

A giant spinal arachnoid cyst is an unusual cause of progressive epidural compressive syndrome. The authors describe 4 cases of a “complex” subtype of this lesion and discuss aspects of surgical management. The patients presented with progressive spastic paraparesis and were found to harbor extensive spinal extradural arachnoid cysts with multiple septations and significant paraspinal extensions. Extensive laminotomy and excision of the cyst along with its extensions were performed in all cases.

Compared with previously indexed cases of surgically managed extensive spinal extradural arachnoid cysts, the cases reported here are unique because of their complex nature. Curative treatment consists of radical excision inclusive of the paraspinal extensions as well as closure of a dural defect, if found. A laminotomy or laminoplasty should be performed to avoid postoperative instability related to the extensive exposure. Extended follow-up and instrumentation may be required in select cases.

Intra-dural spinal arachnoid cysts: a short series of 10 patients

OBJECTIVE

To describe intra-dural arachnoid cysts as the cause of compressive myelopathy.

MATERIAL AND METHODS

A short series of 10 patients harbouring intra-dural arachnoid cysts is described. A detailed description of symptomatology, radiological findings, surgical approach, techniques and outcome is discussed. Microsurgical excision was performed in all patients. In two patients, intra- and extra-spinal communications of cysts were found and were ligated.

RESULTS

Good long-term results were achieved in all 10 patients, after surgical intervention.

CONCLUSION

Rarely, intradural, extramedullary lesions like arachnoid cysts may lead on to compressive myelopathy causing spastic paraparesis. Except for the catastrophic complication like intra-cystic haemorrhage or subdural haematoma, the fatal complication is unlikely. The congenital dural defect is considered the cause behind the development of these cysts. Though uncommon, but intradural arachnoid cysts are important cause of compressive myelopathy. These lesions are curative, if excised surgically with precision.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

Spinal extradural arachnoid cyst

BACKGROUND CONTEXT

Spinal extradural arachnoid cysts are uncommon expanding lesions. Idiopathic arachnoid cysts are not associated with trauma or other inflammatory insults. If they enlarge, they usually present with progressive signs and symptoms of neural compression.

PURPOSE

Total removal of the cyst and repair of the dural defect is the primary treatment for large thoracolumbar spinal extradural arachnoid cysts causing neurogenic claudication. Laminoplasty may prevent spinal deformities in long segmental involvement.

STUDY DESIGN

A clinical case was performed.

PATIENT SAMPLE

We report a case of 25-year-old man with 1-year history of progressive back pain radiating to both legs. His diagnosis was dorsal intraspinal extradural cystic lesion longing from the level of T11 to L2 on magnetic resonance imaging.

OUTCOME MEASURES

The patient's pain levels were noted as he reported. Physiologic outcome was assessed on pre- and postoperative motor and sensory examination.

METHODS

The patient underwent a T11-L2 laminotomy and radical cyst wall resection was performed. A small communication with the subarachnoid space was seen at the level of T12. It was sealed with tissue fibrinogen after repair with primary suture. Titanium miniplates were used for laminoplasty.

RESULTS

Follow-up magnetic resonance imaging demonstrated cyst resolution, and neurologic examination revealed no sensory and motor deficit.

CONCLUSION

Extradural arachnoid cysts are primarily treated with total removal of the cyst wall and closure of the dural defect. Surgical treatment is curative for this rare lesion.