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De Frias JM, De Decker S, De Stefani A, Llabres-Diaz F. Description and clinical relevance of the variable conformation of canine spinal arachnoid diverticula. Vet Radiol Ultrasound 2024; 65:344-351. [PMID: 38572892 DOI: 10.1111/vru.13365] [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: 02/11/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
The conformation of spinal arachnoid diverticula (SAD) and their clinical implications are poorly characterized in dogs. This retrospective cross-sectional study describes different SAD conformations in dogs and aims to identify if there is an association between SAD conformation and clinical features, localization, syringomyelia (SM) presence, concurrent vertebral condition, treatment option, and short as well as long-term outcome. Sixty-two dogs were included (12 cervical and 50 thoracolumbar SAD). All dogs with a cervical SAD had a cranial tethered conformation and were not included in the statistical analysis. Half of the dogs with a thoracolumbar SAD were cranial tethered, and the other half were caudal tethered. SM associated with SAD had a moderate prevalence in the cervical region (58.3%) and a high prevalence in the thoracolumbar region (82%). All dogs with the presence of SM and caudal tethered SAD had a cranial positioned SM, and all dogs with SM and a cranial tethered SAD had a caudal positioned SM. The SM absolute length and SM length/L2 ratio were significantly higher (P = .018, respectively) in the caudal tethered SAD compared with the cranial tethered SAD. The short-term outcome was statistically different (P = .045) between caudal and cranial tethered thoracolumbar SAD, but not the long-term outcome (P = .062). Multivariable logistic regression identified thoracolumbar caudal tethered SAD conformation had a better short-term outcome (P = 0.017, OR: 0.043, CI: 0.003-0.563), independently of SM length measurements. SAD conformation in dogs can influence SM formation. A possible link between short-term outcome and SAD conformation was found, but further research is warranted.
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Affiliation(s)
- Joao Miguel De Frias
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Alberta De Stefani
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - Francisco Llabres-Diaz
- Department of Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, UK
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Knafo S, Herbrecht A, Cauquil C, Sarov M, Not A, Ancelet C, Nasser G, Benhamou D, Oillic PA, Guey S, Lenglet T, Parker F, Aghakhani N. Spinal Anterior Dural Dissection: Moving From Differential to Unifying Diagnosis. Neurosurgery 2024:00006123-990000000-01057. [PMID: 38358283 DOI: 10.1227/neu.0000000000002871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebrospinal fluid (CSF) collections extending longitudinally at the anterior aspect of the spinal dura have been reported in association with various conditions and under multiple names. The aim of this study was to report cases associated with brachial amyotrophy (BA) and examine its relationship with other clinical variants. METHODS We conducted a retrospective cohort study including patients who presented with a motor deficit of the upper limbs and an anterior interdural CSF collection on spinal MRI. We performed a systematic review of the literature to include cases revealed by BA. RESULTS Seven patients presenting with BA and a confirmed dural dissection on spinal MRI were included. All patients were male with a slowly progressing history of asymmetrical and proximal motor deficit of the upper limbs. Chronic denervation affecting mostly C5 and C6 roots was found on electroneuromyography. Spinal MRI demonstrated an anterior CSF collection dissecting the interdural space and exerting a traction on cervical motor roots. Dynamic computed tomography myelogram localized the dural defect every time it was performed (4/7 cases), and surgical closure was possible for 3 patients, leading to resolution of the collection. Literature review yielded 18 other published cases of spinal dural dissections revealed by BA, including 4 in association with spontaneous intracranial hypotension and 4 others in association with superficial siderosis. CONCLUSION We propose a unifying diagnosis termed "spinal anterior dural dissection" (SADD) to encompass spinal dural CSF collections revealed by BA (SADD-BA), spontaneous intracranial hypotension (SADD-SIH), or superficial siderosis (SADD-SS).
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Affiliation(s)
- Steven Knafo
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anne Herbrecht
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- Department of Neurology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Mariana Sarov
- Department of Neurology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Adeline Not
- Department of Neurology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Claire Ancelet
- Department of Neuroradiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Ghaida Nasser
- Department of Neuroradiology, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Dan Benhamou
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Pierre-Antoine Oillic
- Department of Anesthesiology and Intensive Care, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Stéphanie Guey
- Department of Neurology, Lariboisière Hospital, AP-HP, Paris, France
- Faculty of Medicine, University Paris-Cité, Paris, France
| | - Timothée Lenglet
- Department of Neurophysiology, La Pitié-Salpétrière Hospital, AP-HP, Paris, France
| | - Fabrice Parker
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nozar Aghakhani
- Department of Neurosurgery, Bicêtre Hospital, AP-HP, Le Kremlin-Bicêtre, France
- Faculty of Medicine, University Paris-Saclay, Le Kremlin-Bicêtre, France
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Hagihara S, Ohta H, Tanaka J, Shiokawa T, Matsumoto Y, Kida Y, Iguchi Y, Tatsumi M, Tahara K, Shibata T, Kyoichi Sanada, Kida H, Takemitsu Y, Yamamoto T. Perineural cyst with intracystic cerebrospinal fluid leakage by traction of nerve root -a case report. J Orthop Sci 2023; 28:1561-1565. [PMID: 34801339 DOI: 10.1016/j.jos.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shusuke Hagihara
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | - Hideki Ohta
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Jun Tanaka
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan.
| | - Teruaki Shiokawa
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
| | | | - Yoshikuni Kida
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Yohei Iguchi
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Masato Tatsumi
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Kenichi Tahara
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Tatsuya Shibata
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Kyoichi Sanada
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | - Hirotaka Kida
- Oita Orthopaedic Hospital, 1-1-41 Iwata-machi, Oita, 870-0936, Japan
| | | | - Takuaki Yamamoto
- Department of Orthopaedics Surgery, Faculty of Medicine, Fukuoka University 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 810-0180, Japan
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Huang H, Wei M, Zhou Q, Peng R, Ding X, Xi J. Spinal extradural arachnoid cysts: A novel formation mechanism and dural defect location technology. Heliyon 2023; 9:e12969. [PMID: 36820184 PMCID: PMC9938496 DOI: 10.1016/j.heliyon.2023.e12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose The formation mechanism of spinal extradural arachnoid cysts (SEACs) remains unclear. There are several hypotheses for the formation of SEACs, but none of them can fully explain its pathological findings and surgical procedures. In this study, we retrospectively analyzed the cases of SEACs, aiming to clarify the formation mechanism of SEACs. In addition, we summarize a concise method for locating dural defects preoperatively and formulate a putative explanation of this method. Methods The clinical data of 14 patients with SEACs underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed. Results Fourteen patients were identified during the study period. The cysts all spanned the T12/L1 segment, and dural defects were also located at the T12/L1 level (2 cases not recorded) as well as the middle or the upper-middle level of the cysts. Nine cases were treated with total cyst excision, 2 cases were treated with dural defect closure only, and 3 cases were treated with total cyst excision and dural defect closure. Histopathological examination demonstrated that the cyst wall contained both the arachnoid epithelial and compact fibrous connective tissue. The symptoms were relieved in all patients, and no recurrence was observed. Conclusions According to intraoperative and pathological findings, the dural outer layer cyst (DOLC) is a more reasonable hypothesis about SEACs formation. When CT myelography or cinematic MRI cannot determine the location of the dural defect preoperatively, it can be located according to the middle level of the SEACs with high accuracy.
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Affiliation(s)
- He Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wei
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Quanwei Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Renjun Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiping Ding
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Corresponding author. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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5
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Ahmed AK, Anisetti B, Huynh T, Agarwal A, Gupta V, Desai A, Singh R, Vibhute P. Clinical and imaging features of spinal extradural arachnoid cysts: a retrospective study of 50 cases. Neuroradiology 2022; 64:2409-2416. [PMID: 35970946 DOI: 10.1007/s00234-022-03042-4] [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: 05/10/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Spinal extradural arachnoid cysts (SEDACs) are thought to arise from leakage of CSF through a spinal dural defect. This study investigates the demographics and imaging spectrum of SEDACs at our academic institution and compares them with those reported in the literature. METHODS Fifty cases with documented MRI diagnosis of SEDAC, Nabors criteria type I meningeal cyst (MC), were identified from retrospective review of imaging records between 1999 and 2020. Patient demographics, presenting symptoms, cyst characteristics, and management outcomes were studied. Statistical analysis was performed to determine associations between maximum cyst size and presenting symptoms along with other imaging findings. RESULTS In all 50 subjects, SEDACs were solitary (single) and sporadic (non-familial). The majority were incidental (62%), located posteriorly (92%) and laterally (80%) in the thoracic and thoracolumbar regions (34%, 30%). They were associated with mild mass effect upon the thecal sac (50%) and bone remodeling (92%). Among symptomatic SEDACs, back pain and radiculopathy were the most reported (68%). Larger cysts were located caudally in the spinal canal, and were associated with greater thecal mass effect, bone remodeling, and septations. Four out of six subjects who underwent surgical management had complete or partial remission. One had cyst recurrence. CONCLUSION In this largest series of SEDACs, most were discovered incidentally, stable over time, and located in the thoracic spine dorsal to the thecal sac. When symptomatic, back pain and radiculopathy were the most common presenting symptoms. Treatment with complete surgical excision may yield the best results for symptomatic lesions.
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Affiliation(s)
- Ahmed K Ahmed
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
| | | | - Thien Huynh
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
| | - Amit Agarwal
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
| | - Amit Desai
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
| | - Rahul Singh
- Department of Radiology, Mayo Clinic, FL, Jacksonville, USA
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Jian Q, Song G, Liu Z, Duan W, Guan J, Jian F, Chen Z. Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center. Neurospine 2022; 19:188-201. [PMID: 34990537 PMCID: PMC8987550 DOI: 10.14245/ns.2142526.263] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).
Methods The authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up.
Results Thirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84%±26.63%.
Conclusion Most fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.
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Affiliation(s)
- Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Thakrar R, Tranmer B, Penar P. Chiari malformation and spinal interdural cyst: A proposed association and review of the literature. Surg Neurol Int 2021; 12:626. [PMID: 35350823 PMCID: PMC8942192 DOI: 10.25259/sni_1034_2021] [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: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Interdural cysts are rare meningeal cysts with an unclear etiology. They are often mistaken for other mass lesions, including arachnoid cysts and tumors. Correctly identifying and classifying these cysts, as well as how they have formed in individual patients, are crucial to providing effective treatment options for patients. Case Description: We report a case of a patient with shunted idiopathic intracranial hypertension who developed a symptomatic Chiari malformation and was subsequently discovered to have a spinal interdural cyst. The Chiari malformation was likely due to intracranial hypotension secondary to lumbar cerebrospinal fluid (CSF) diversion. Once the shunt was removed, a spinal interdural cyst became clinically and radiographically evident, and the Chiari resolved, suggesting that both entities were effects of shared CSF flow dynamics. Conclusion: This cyst likely originated due to the trauma from remote repeated lumbar punctures and lumboperitoneal shunt placement, allowing CSF to enter the interdural space after the catheter was removed.
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Affiliation(s)
- Raj Thakrar
- Department of Neurosurgery, University of Vermont, Burlington, Vermont, United States
| | - Bruce Tranmer
- Department of Neurosurgery, University of Vermont, Burlington, Vermont, United States
| | - Paul Penar
- Department of Neurosurgery, University of Vermont, Burlington, Vermont, United States
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Zhang P, Liu H, Sun Z, Guo Y, Wang G, Wang JJ. Ultrafine Flexible endoscope visualization to assist in the removal of a huge spinal extradural arachnoid cyst: a case report and literature review. World Neurosurg 2021; 159:130-133. [PMID: 34973437 DOI: 10.1016/j.wneu.2021.12.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Peihai Zhang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China.
| | - Huiting Liu
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Zhenxin Sun
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Yi Guo
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Guihuai Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - James Jin Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
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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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Yun ZH, Zhang J, Wu JP, Yu T, Liu QY. Transforaminal endoscopic excision of bi-segmental non-communicating spinal extradural arachnoid cysts: A case report and literature review. World J Clin Cases 2021; 9:9598-9606. [PMID: 34877296 PMCID: PMC8610881 DOI: 10.12998/wjcc.v9.i31.9598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/06/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal extradural arachnoid cysts (SEACs) are a rare cause of spinal cord compression. Typically, these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac. For symptomatic SEACs, the standard treatment is to remove the cyst in total with a (hemi)laminectomy or laminoplasty. We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to remove bi-segmental non-communicating SEACs.
CASE SUMMARY A 79-year-old female presented with pain related to bi-segmental SEACs at the T11-L1 segments. She underwent sequential transforaminal percutaneous endoscopic thoracic cystectomy of the SEACs. Following her first procedure, spinal magnetic resonance imaging demonstrated complete excision of the cyst at the T12-L1 segment. However, the cyst at the T11-T12 segment was still present. Thus, a second procedure was performed to remove this lesion. The patient’s right-sided lumbar and abdominal pain improved significantly postoperatively. Her Japanese Orthopaedic Association score increased from 11 to 25, her visual analogue scale score was reduced from 8 to 1. The physical and mental component summary of the 36-item short-form health survey (SF-36) were 15.5 and 34.375 preoperatively, and had increased to 79.75 and 77.275 at the last follow-up visit, respectively.
CONCLUSION Bi-segmental non-communicating SEACs are extremely rare. Endoscopic surgery is a safe, effective, and reliable method for treating these cysts. In the event of bi-segmental SEACs, it is important to identify whether both cysts are communicating before surgery, and if not, to remove both cysts separately during the index surgery to avoid re-operation.
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Affiliation(s)
- Zhi-He Yun
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jun Zhang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Jiu-Ping Wu
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Tong Yu
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Qin-Yi Liu
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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11
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Kozłowski P, Kalinowski P, Kozłowska M, Jankiewicz M, Budny A, Starosławska E, Burdan F. Spinal Perineural Cysts among European Patients. J Neurol Surg A Cent Eur Neurosurg 2021; 82:463-467. [PMID: 33822351 DOI: 10.1055/s-0040-1722194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A perineural (Tarlov) cyst is a fluid-filled lesion occurring between the perineurium and the endoneurium of spinal nerve roots. The aim of the study was to evaluate the prevalence and morphology of perineural cysts, detected incidentally in patients with symptomatic degenerative disk disease. MATERIALS/METHODS The study was based on the retrospective data gathered during magnetic resonance imaging (MRI) examinations. RESULTS AND CONCLUSIONS Out of 3,128 spinal MRI examinations, perineural cysts were detected in 286 patients (9%). The cysts were most commonly observed in the sacral region, followed by thoracic, cervical, and lumbar regions. Cysts were more common in women than in men and the average age of patients was 54.8 years. In the majority, a single cyst was found. The average longest dimension of the lesion was 11.72 mm.
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Affiliation(s)
- Piotr Kozłowski
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Paweł Kalinowski
- Independent Epidemiology Unit, Medical University of Lublin, Lublin, Lubelskie, Poland
| | - Magdalena Kozłowska
- Oncology Department, Medical University of Lublin, Lublin, Lubelskie, Poland
| | - Małgorzata Jankiewicz
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Agnieszka Budny
- Radiation Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Elżbieta Starosławska
- Oncology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland
| | - Franciszek Burdan
- Radiology Department, Lublin Cancer Hospital of Saint John from Dukla, Lublin, Poland.,Humana Anatomy Department, Medical University of Lublin, Lublin, Lubelskie, Poland
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12
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Xu F, Jian F, Li L, Guan J, Chen Z. Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine. J Korean Neurosurg Soc 2021; 64:238-246. [PMID: 33715325 PMCID: PMC7969037 DOI: 10.3340/jkns.2020.0244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making.
Methods Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded.
Results Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up.
Conclusion SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.
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Affiliation(s)
- Feifan Xu
- Department of Neurosurgery, Peking University First Hospital, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liang Li
- Department of Neurosurgery, Peking University First Hospital, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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13
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Regensburger M, Schlachetzki JCM, Klekamp J, Doerfler A, Winkler J. Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: case report illustrating diagnostic and therapeutic implications. BMC Neurol 2020; 20:321. [PMID: 32861240 PMCID: PMC7455782 DOI: 10.1186/s12883-020-01891-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anterior spinal cord herniation (aSCH) is a rare cause of myelopathy which may present as pure motor syndrome and mimic other degenerative diseases of the spinal cord. In slowly progressive cases, diagnosis may be impeded by equivocal imaging results and mistaken for evolving upper motor neuron disease. As early imaging studies are lacking, we aimed to provide a detailed description of imaging and neurophysiology findings in a patient with aSCH, focusing on the early symptomatic stages. CASE PRESENTATION We here present the case of a 51-year old male patient with an episode of pain in the right trunk and a normal spinal MRI. After a symptom-free interval of 8 years, spasticity and paresis evolved in the right leg. There was subtle ventral displacement and posterior indentation of the thoracic spinal cord on MRI which, in retrospect, was missed as an early sign of aSCH. After another 3 years, symptoms spread to the left leg and a sensory deficit of the trunk became evident. Follow-up MRI now clearly showed an aSCH. Neurosurgical intervention consisted of remobilization of the herniated spinal cord and patch closure of the dura defect. Over the following years, motor and sensory symptoms partially improved. CONCLUSIONS The history of this patient with aSCH illustrates the importance of careful longitudinal clinical follow-up with repeated imaging studies in progressive upper motor neuron syndromes. Specific attention should be paid to a history of truncal pain and to MRI findings of a ventrally displaced spinal cord. Neurosurgical intervention may halt the progression of herniation.
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Affiliation(s)
- Martin Regensburger
- Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. .,Center for Rare Diseases Erlangen (ZSEER), University Hospital Erlangen, Erlangen, Germany. .,Department of Stem Cell Biology, University Hospital Erlangen, Erlangen, Germany.
| | - Johannes C M Schlachetzki
- Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Jörg Klekamp
- Department of Neurosurgery, Christliches Krankenhaus, Quakenbrück, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
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14
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Schmutzer M, Tonn JC, Zausinger S. Spinal intradural extramedullary arachnoid cysts in adults-operative therapy and clinical outcome. Acta Neurochir (Wien) 2020; 162:691-702. [PMID: 31813001 DOI: 10.1007/s00701-019-04156-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spinal arachnoid cysts (SAC) are rare mostly idiopathic intradural lesions with compression of the spinal cord and clinical signs of radiculo- and/or myelopathy. We retrospectively analyzed radiological and clinical characteristics of patients with surgical treatment of SAC including a subgroup evaluation of long-term outcome and QoL. METHOD Patients with SAC treated between 1993 and 2017 were evaluated. Craniocaudal (c.c.) and anteroposterior (a.p) cyst diameters were measured pre- and post-OP. McCormick and Odom score for myelopathy, general outcome and QoL (SF-36, EORTC-QLQ30) were recorded. RESULTS A total of 72 patients (female:male = 1.9:1) were analyzed with mean FU of 44.8 ± 60 months (long-term data from 25 patients with FU 78.2 ± 63.9 months). All had surgery due to solitary cysts: 10 cervical (13.9%), 45 thoracic (62.5%), and 17 lumbosacral (23.6%), the majority (79.2%) located dorsally. Main symptoms were gait disturbance (80%), dysesthesia (64%) and paresis (80%). Patients had (hemi-)laminectomy with cyst fenestration in 48 (66.7%) and complete resection in 18 cases (25.0%). Four cases (5.5%) were treated by cystoperitoneal shunt, 2 by marsupialization (2.8%). In total, 11 revisions were necessary in 9/72 (12.5%) patients (one patient underwent 3 revisions). Two patients were reoperated for wound revision/epidural hematoma (each n = 1). Seven patients needed additional cyst wall resection after 1.5-31.0 months due to insufficient cyst shrinking and persistent clinical symptoms after first surgery; most of the cysts were multiple septated and of post-hemorrhagic origin. The mean c.c. size decreased from 5.2 ± 3.7 cm pre-OP to 2.7 ± 3.9 cm (p < 0.05); the a.p. diameter decreased from 1.0 ± 0.5 cm to 0.3 ± 0.3 cm (p < 0.0001) without significant differences between fenestration and resection. McCormick and Odom scores revealed improved symptoms, particularly of gait disturbance, sensory deficits, and general performance. Long-term FU displayed satisfying QoL performance without differences of fenestration or resection. CONCLUSION SAC mostly affect women and are predominantly located in the thoracic spine, becoming apparent with clinical myelopathy. For cysts without intracystic septae and compartments, both fenestration and resection of the cyst wall provided significant reduction of cyst size and clinical improvement.
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15
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Dayyani M, Zabihyan S. Giant Tarlov Cyst of Infancy. World Neurosurg 2018; 123:348-350. [PMID: 30576828 DOI: 10.1016/j.wneu.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
We report an 8-month-old female infant with complaints of irritability and recent inability to sit in a stable position. On physical examination, a palpable mass in the left upper quadrant of her abdomen was evident. Sonography and magnetic resonance imaging showed a giant cyst, consisting of 2 communicating compartments: dorsal and ventrolateral. The dorsal part compressed the conus medullaris, and the ventrolateral part compressed the left kidney. Partial cyst wall resection and imbrication for the dorsal pouch were done, and diagnosis of Tarlov cyst was confirmed via the visualization of the endocystic nerve root during surgery. Familiarizing physicians with this unusual presentation of Tarlov cyst may help them in early recognition of this lesion, and subsequent surgery might be considered to prevent clinical sequela. To our knowledge, a lumbar Tarlov cyst presenting as a giant abdominal cyst in an infant has not been reported in the English-language literature.
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Affiliation(s)
- Mojtaba Dayyani
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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16
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Maier C, Eitner L, Altenscheidt J, Nicolas V, Martinez R. [Unsuccessful pain treatment over 6 years of a thoracic radiculopathy caused by an unrecognized Tarlov cyst]. Schmerz 2017; 32:56-60. [PMID: 29270852 DOI: 10.1007/s00482-017-0262-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents a case of unsuccessful pharmaceutical and invasive pain treatment for 6 years without any adequate diagnostics in a female suffering from unilateral thoracic radiculopathy (Th8, right) leading to severe disability and unemployment. The origin was an undetected Tarlov cyst. After resection of the cyst the pain and other complaints disappeared (follow up: 8 months) without need for further pain medication. This case underlines the necessity of adequate diagnostics ahead of long-term pain treatment. Thoracic Tarlov cysts are very uncommon but should be included in the differential diagnosis because curative treatment may be possible.
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Affiliation(s)
- C Maier
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - L Eitner
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - J Altenscheidt
- Abteilung für Schmerzmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - V Nicolas
- Institut für Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - R Martinez
- Abteilung für Neurochirurgie und Neurotraumatologie, , Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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17
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Grassner L, Grillhösl A, Griessenauer CJ, Thomé C, Bühren V, Strowitzki M, Winkler PA. Spinal Meninges and Their Role in Spinal Cord Injury: A Neuroanatomical Review. J Neurotrauma 2017; 35:403-410. [PMID: 28922957 DOI: 10.1089/neu.2017.5215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Current recommendations support early surgical decompression and blood pressure augmentation after traumatic spinal cord injury (SCI). Elevated intraspinal pressure (ISP), however, has probably been underestimated in the pathophysiology of SCI. Recent studies provide some evidence that ISP measurements and durotomy may be beneficial for individuals suffering from SCI. Compression of the spinal cord against the meninges in SCI patients causes a "compartment-like" syndrome. In such cases, intentional durotomy with augmentative duroplasty to reduce ISP and improve spinal cord perfusion pressure (SCPP) may be indicated. Prior to performing these procedures routinely, profound knowledge of the spinal meninges is essential. Here, we provide an in-depth review of relevant literature along with neuroanatomical illustrations and imaging correlates.
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Affiliation(s)
- Lukas Grassner
- 1 Department of Neurosurgery, Trauma Center Murnau , Germany .,2 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .,3 Institute of Molecular Regenerative Medicine, Paracelsus Medical University , Salzburg, Austria .,4 Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University , Salzburg, Austria
| | | | - Christoph J Griessenauer
- 6 Department of Neurosurgery, Geisinger Health System , Danville, Pennsylvania.,7 Neurosurgical Service, Department of Surgery, Harvard Medical School , Boston, Massachusetts
| | - Claudius Thomé
- 8 Department of Neurosurgery, Medical University Innsbruck , Austria
| | - Volker Bühren
- 2 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany
| | | | - Peter A Winkler
- 9 Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Medical University , Salzburg, Austria
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