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Choi JW, DeSimone KE, Dacumos VM, Hoshide RR, Qiao Y, Hui FK. Scalpellum occulta: A rare case of dorsal spinal arachnoid web without the scalpel sign. Radiol Case Rep 2024; 19:1552-1555. [PMID: 38317702 PMCID: PMC10839584 DOI: 10.1016/j.radcr.2024.01.036] [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: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024] Open
Abstract
Spinal arachnoid web is a rare condition characterized by extramedullary bands of arachnoid tissue at the level of the dorsal thoracic spinal cord that may lead to progressive, permanent neurological deficits. To date, this condition has been radiographically characterized by a scalpel sign, which has been pathognomonic in all reported cases of spinal arachnoid webs. In this case, we report the first known patient with confirmed spinal arachnoid web without radiographic evidence of the scalpel sign. In reporting our finding, we encourage a higher clinical suspicion for spinal arachnoid web in patients presenting with progressive thoracic myelopathy following trauma, and radiographic evidence of ventrally displaced spinal cord and turbulent cerebrospinal fluid flow, even in the absence of a scalpel sign.
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Affiliation(s)
- Joo Won Choi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Kulani E. DeSimone
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Vianca Mae Dacumos
- College of Tropical Agriculture and Human Resources, University of Hawaiʻi at Mānoa, 3050 Maile Way, Honolulu, HI 96822, USA
| | - Reid R. Hoshide
- Department of Neurosurgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
| | - Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, 7000 Fannin Street Suite #1200, Houston, TX 77030, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA
| | - Ferdinand K. Hui
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
- Department of Neurointerventional Surgery, The Queen's Medical Center, 550 South Beretania Street, Honolulu, HI 96813, USA
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El-Ghandour NMF. Commentary: Thoracic Laminoplasty for Post-Traumatic Syrinx Fenestration with Duraplasty, Syringo-Subarachnoid, and Subarachnoid-Subarachnoid Shunts: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:475-476. [PMID: 38032209 DOI: 10.1227/ons.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
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Adib SD, Schittenhelm J, Kurucz P, Hauser TK, Tatagiba M. Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes. Neurosurg Rev 2023; 46:152. [PMID: 37358703 PMCID: PMC10293323 DOI: 10.1007/s10143-023-02071-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of the spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and CINE), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were T2/3, T6, and T8. Excision of the arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary, SAW can be safely treated by surgery. Even though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).
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Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Jens Schittenhelm
- Department of Neuropathology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Peter Kurucz
- Department of Neurosurgery, Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Till-Karsten Hauser
- Department of Neuroradiology, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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Bugdadi A, Herbrecht A, Alzahrani A, Aghakhani N, Parker F. Long-term outcome of surgical treatment for idiopathic spinal arachnoid web: A case series. Neurochirurgie 2023; 69:101455. [PMID: 37269747 DOI: 10.1016/j.neuchi.2023.101455] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Spinal arachnoid web (SAW) is a rare condition of the spine with limited long-term follow-up data in the literature. The longest reported follow-up period was an average 3.2 years. The objective of this study is to report our long-term results of patients who underwent surgical treatment for symptomatic idiopathic SAW. METHODS We conducted a retrospective review of cases of idiopathic SAW that were operated between 2005-2020. We collected preoperative and last follow-up (LFU) data on motor force, sensory loss, pain, upper motor neuron (UMN) sign, gait disorder, sphincter dysfunction, syringomyelia, hyperintensity on T2-MRI, appearance of newer symptoms and number of reoperations. RESULTS Our study included 9 patients with a mean follow-up period of 3.6years (range 2-9.1years). The surgical intervention involved a standard centered laminectomy, durotomy and arachnoid lysis. At presentation, motor weakness was present in 77.8% of patients, sensory loss in 66.7%, pain in 88.9%, sphincter dysfunction in 33.3%, UMN sign in 22%, gait disorder 55.6%, syringomyelia in 55.6% and MRI T2 hyperintensity in 55.6% of patients. At LFU, there was an improvement in all symptoms and signs to varying degrees. No new neurological symptoms appeared postoperatively, and there was no recurrence during the follow-up period. CONCLUSION Our results demonstrate that the reported immediate and short-term favorable outcomes following arachnoid lysis for symptomatic SAW persist over a long-term period and the risk of readhesion-correlated neurological deterioration following conventional surgical intervention is low.
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Affiliation(s)
- Abdulgadir Bugdadi
- Department of Neurosurgery, Bicêtre University Hospital, Kremlin-Bicêtre, France; Department of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia.
| | - Anne Herbrecht
- Department of Neurosurgery, Bicêtre University Hospital, Kremlin-Bicêtre, France
| | - Abdullah Alzahrani
- Department of Neurosurgery, Bicêtre University Hospital, Kremlin-Bicêtre, France
| | - Nozar Aghakhani
- Department of Neurosurgery, Bicêtre University Hospital, Kremlin-Bicêtre, France
| | - Fabrice Parker
- Department of Neurosurgery, Bicêtre University Hospital, Kremlin-Bicêtre, France
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Nagashima Y, Nishimura Y, Ito H, Oyama T, Nishii T, Gonda T, Kato H, Saito R. Atypical radiographic case of arachnoid web without scalpel sign. Surg Neurol Int 2022; 13:108. [PMID: 35399890 PMCID: PMC8986712 DOI: 10.25259/sni_179_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 12/16/2022] Open
Abstract
Background:
Spinal arachnoid webs (SAW) occur when abnormally thickened bands of arachnoid membranes commonly located dorsal to the thoracic spine cause blockage of normal cerebrospinal fluid (CSF) flow, resulting in focal cord compression and myelopathy. The pathognomonic MR finding for SAW is the “positive scalpel sign” comprised of an enlarged dorsal CSF space with a normal ventral subarachnoid space. The main differential diagnostic consideration for SAW is idiopathic spinal cord herniation (ISCH); however, for ISCH, MR studies classically demonstrate ventral displacement of the spinal cord through an anterior dural defect. Here, we describe a 60-year-old female with an atypical SAW at the T3-T4 level (i.e., the preoperative MR failed to demonstrate the “positive scalpel sign”). Nevertheless, at surgery, intraoperative ultrasonography confirmed that SAW was present and was decompressed/marsupialized/removed.
Case Description:
A 60-year-old female presented with sensory impairment to both lower extremities. The thoracic MR images showed an enlarged dorsal CSF space at the T3-T4 level but without the “scalpel sign” suggesting “interruption” of CSF flow by thickened bands of focal dorsal arachnoidal tissues. Although the initial preoperative diagnosis was ISCH, intraoperative ultrasound (IOUS) confirmed the presence of a thickened arachnoid band, confirming the diagnosis of a SAW that was appropriately decompressed/resected.
Conclusion:
Correctly, establishing the preoperative diagnosis of a SAW based on MR imaging may sometimes be difficult as the typical “scalpel sign” may not be present in all patients. Notably, in cases like this one, IOUS may critically confirm the diagnosis of SAW thus leading to appropriate SAW decompression/removal.
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Strong MJ, North RY, Yee TJ, Oppenlander ME. Commentary: Decompression of a Dorsal Arachnoid Web of the Spine: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 20:E144-E145. [PMID: 33294934 DOI: 10.1093/ons/opaa359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Robert Y North
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Timothy J Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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YAMAMOTO A, FUJIMOTO M, AOKI K, SUZUKI Y, MIZUNO M, SUZUKI H. A Dorsal Arachnoid Web of the Cervical Spine: A Case Report. NMC Case Rep J 2021; 8:281-286. [PMID: 35079476 PMCID: PMC8769406 DOI: 10.2176/nmccrj.cr.2020-0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Atsushi YAMAMOTO
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masashi FUJIMOTO
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kazuaki AOKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yume SUZUKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaki MIZUNO
- Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
- Department of Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Hidenori SUZUKI
- Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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Tuleasca C, Ducos Y, Levivier M, Parker F, Aghakhani N. Letter to the Editor. Arachnoid webs: preoperative differential diagnosis and surgical exploration. J Neurosurg Spine 2019; 31:919-921. [PMID: 31470403 DOI: 10.3171/2019.6.spine19671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Constantin Tuleasca
- 1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Service de Neurochirurgie, Le Kremlin-Bicêtre, France
- 2Sorbonné Université, Faculté de Médecine, Paris, France
- 3Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- 4Université de Lausanne (Unil), Faculté de Biologie et de Médecine (FBM), Lausanne, Switzerland
- 5Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Yohan Ducos
- 1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Service de Neurochirurgie, Le Kremlin-Bicêtre, France
| | - Marc Levivier
- 3Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- 4Université de Lausanne (Unil), Faculté de Biologie et de Médecine (FBM), Lausanne, Switzerland
| | - Fabrice Parker
- 1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Service de Neurochirurgie, Le Kremlin-Bicêtre, France
| | - Nozar Aghakhani
- 1Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Sud, Centre Hospitalier Universitaire de Bicêtre, Service de Neurochirurgie, Le Kremlin-Bicêtre, France
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Nisson PL, Hussain I, Härtl R, Kim S, Baaj AA. Arachnoid web of the spine: a systematic literature review. J Neurosurg Spine 2019; 31:175-184. [PMID: 31003220 DOI: 10.3171/2019.1.spine181371] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE An arachnoid web of the spine (AWS) is a rare and oftentimes challenging lesion to diagnose, given its subtle radiographic findings. However, when left untreated, this lesion can have devastating effects on a patient's neurological function. To date, only limited case reports and series have been published on this topic. In this study, the authors sought to better describe this lesion, performing a systematic literature review and including 2 cases from their institution's experience. METHODS A systematic literature search was performed in September 2018 that queried Ovid MEDLINE (1946-2018), PubMed (1946-2018), Wiley Cochrane Library: Central Register of Controlled Trials (1898-2018), and Thompson Reuters Web of Science: Citation Index (1900-2018), per PRISMA guidelines. Inclusion criteria specified all studies and case reports of patients with an AWS in which any relevant surgery types were considered and applied. Studies on arachnoid cysts and nonhuman populations, and those that did not report patient treatments or outcomes were excluded from the focus review. RESULTS A total of 19 records and 2 patients treated by the senior authors were included in the systematic review, providing a total of 43 patients with AWS. The mean age was 52 years (range 28-77 years), and the majority of patients were male (72%, 31/43). A syrinx was present in 67% (29/43) of the cases. All AWSs were located in the thoracic spine, and all but 2 (95%) were located dorsally (1 ventrally and 1 circumferentially). Weakness was the most frequently reported symptom (67%, 29/43), followed by numbness and/or sensory loss (65%, 28/43). Symptoms predominated in the lower extremities (81%, 35/43). It was found that nearly half (47%, 20/43) of patients had been experiencing symptoms for 1 year or longer before surgical intervention was performed, and 35% (15/43) of reports stated that symptoms were progressive in nature. The most commonly used surgical technique was a laminectomy with intradural excision of the arachnoid web (86%, 36/42). Following surgery, 91% (39/43) of patients had reported improvement in their neurological symptoms. The mean follow-up was 9.2 months (range 0-51 months). CONCLUSIONS AWS of the spine can be a debilitating disease of the spine with no more than an indentation of the spinal cord found on advanced imaging studies. The authors found this lesion to be reported in twice as many males than females, to be associated with a syrinx more than two-thirds of the time, and to only have been reported in the thoracic spine; over 90% of patients experienced improvement in their neurological function following surgery.
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Affiliation(s)
- Peyton L Nisson
- 1University of Arizona, College of Medicine, Tucson, Arizona; and
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Ibrahim Hussain
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Roger Härtl
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Samuel Kim
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
| | - Ali A Baaj
- 2Department of Neurosurgery, Weill Cornell Brain and Spine Center, New York, New York
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Sarica C, Ziyal MI. Retroclival Arachnoid Cysts: Case Series, Literature Review, and New Classification Proposal. World Neurosurg 2018; 121:e898-e907. [PMID: 30315978 DOI: 10.1016/j.wneu.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/29/2018] [Accepted: 10/01/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The retroclival region is among the rarest locations for an arachnoid cyst (AC), with only a few reported cases. No accepted classification system is available for these rare cysts. Such a classification system would solve the nomenclature problem and could result in easier and more systematic management. We reviewed and analyzed data from databases and reported studies of retroclival ACs (RACs) and have proposed a classification system. METHODS A retrospective review of RACs was conducted in Marmara and Adiyaman University Hospitals, Turkey. Cysts in the prepontine and/or premedullary cisterns that spared the chiasmatic cistern were included. Additionally, the reported data were searched for relevant studies on cysts. The findings were analyzed to establish a clear nomenclature and classification system, and the clinical presentations, treatment strategies, and surgical approaches were reviewed. RESULTS We identified 1 adult and 1 pediatric patient, and only the adult had undergone surgery. Additional data searches yielded 14 patients with RACs. The cysts were classified as type 1 if they had extended superiorly beyond the borders of the diencephalic leaf of the Liliequist membrane. If they had not extended, they were classified as type 2. Finally, type 2 cysts that had extended to the anterior spinal cistern were classified as type 3. CONCLUSIONS RACs can be more easily and systematically managed using a simple clinical classification system. Together with the previously proposed suprasellar AC classification, our proposed RAC classification should be adequate to classify all ACs in the ventral midline cistern, which could solve the nomenclature problem.
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Affiliation(s)
- Can Sarica
- Department of Neurosurgery, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
| | - M Ibrahim Ziyal
- Department of Neurosurgery, Marmara University, Istanbul, Turkey
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