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Lim DJ. Atypical intradural extramedullary spinal schwannoma causing cauda equina syndrome: A case report and literature review. Int J Surg Case Rep 2023; 108:108396. [PMID: 37311324 DOI: 10.1016/j.ijscr.2023.108396] [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: 05/19/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Spinal schwannomas are slow-growing benign tumors that are generally asymptomatic. However, we describe an atypical case in which an intradural extramedullary schwannoma presented as an acute cauda equina syndrome. PRESENTATION OF CASE This was a 58-year-old woman with a 2-month history of severe low back pain and worsening neurological deficits and a 2-day period of acute onset of lower extremity numbness and urinary incontinence. Physical and neurological examination revealed significant lower extremity weakness, tenderness on palpation of the spine, positive straight leg test bilaterally, decreased sensation below the L4 dermatome, reduced sphincter tone, saddle anesthesia, decreased deep tendon reflexes, and loss of sphincter control, consistent with compression of the cauda equina. Magnetic resonance imaging revealed a large mass of heterogeneous composition at the level of L3 lumbar, intruding into the cauda equina. Wide decompression was successfully performed, and histopathological examination confirmed the diagnosis. With rehabilitation, there was some recovery of lower extremity motor function. DISCUSSION Spinal schwannomas are rare, accounting for only about 2 % of spinal tumors. Cauda equina syndrome is also rare, with an incidence of 0.08-0.27 % among patients presenting with low back pain. Therefore, it is important for clinicians to have an awareness of the possible association between spinal schwannoma and cauda equina syndrome and to complete a comprehensive assessment of patients with back pain, including magnetic resonance imaging. CONCLUSION Early recognition and treatment of a spinal schwannoma causing neurological symptoms can improve patient outcomes.
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Affiliation(s)
- Dong-Ju Lim
- Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggye Paik Hospital, College of Medicine, Inje University, Republic of Korea.
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Baig Mirza A, Bartram J, Sinha S, Gebreyohanes A, Boardman T, Vastani A, Dyson E, Lavrador JP, Russo V, Choi D, Vasan AK, Grahovac G. Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres. Acta Neurochir (Wien) 2022; 164:1217-1228. [PMID: 34705099 DOI: 10.1007/s00701-021-05027-3] [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: 09/05/2021] [Accepted: 10/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC). METHODS Cases were identified from electronic records of two major neurosurgical centres in London over the last 10 years (October 2009-October 2019) that have been surgically treated in both institutions. Clinical findings, surgical technique, and recurrence by procedure were statistically analysed. Statistical analysis was performed with STATA 13.1 Software. RESULTS A total of 42 patients with SIAC were identified for this study with a mean age at the time of surgery of 53.6 years and a male:female ratio of 8:13. There were 31 patients with primary SIACs and 11 with secondary SIACs. The most common presenting symptom was paraesthesia (n = 27). The most common location of the cyst was in the thoracic region (n = 33). Syrinx was present in 26.2% of SIACs (n = 11). Resection was associated with significantly better postoperative pain compared to other surgical techniques (p = 0.01), significantly poorer postoperative urinary function (p = 0.029), and lower rates of sensory recovery in patients who presented preoperatively with sensory deficit (p = 0.041). No significant difference was seen in symptomatic outcomes between patients with primary and secondary SIACs. CONCLUSION Resection and drainage are both effective methods of managing SIACs. In this observational study, resection was associated with significantly reduced pain postoperatively when compared with drainage, however also with significantly less improvement in postoperative urinary function. Therefore, resection should be the gold standard management option for SIACs, with drainage as an option where resection is unsafe, and drainage should also be considered in patients presenting with urinary dysfunction.
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Yuen J, McGavin L, Adams W, Haden N. Intradural symptomatic arachnoid cyst formation following non-instrumented lumbar decompression. Br J Neurosurg 2020; 35:352-357. [PMID: 32924618 DOI: 10.1080/02688697.2020.1817313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Intradural arachnoid cyst is a rare complication of lumbar puncture, post-trauma or post-intraoperative durotomies. We aim to estimate the incidence of early intradural arachnoid cyst radiologically in non-instrumented posterior lumbar decompression among symptomatic patients, and establish clinical correlation. MATERIALS AND METHODS Patients who underwent lumbar decompression without instrumentation at a tertiary spinal service between December 2014 and January 2018 were identified. When MRI scans were performed post-operatively within 14 days, imaging, medical and operative records were reviewed by two consultant neuroradiologists. RESULTS 488 operations were included. 46 operations were followed by an early MRI scan. 59% were requested to investigate new or ongoing pain. Ten demonstrated an intradural arachnoid cyst - seven had no documented durotomy. Eight were primary operations, three were emergency operations. Statistically, we have not identified durotomy, primary-vs-revision surgery, and elective-vs-emergency surgery as risk factors. Two patients required revision operations, of these, one had a repeat post-operative scan, where the cyst resolved following further decompression at the index level, without intradural exploration. CONCLUSIONS Intradural arachnoid cyst may complicate posterior lumbar decompression. To our knowledge, this is the first study to assess its incidence as an early post-operative radiological finding, which is likely to be commoner than we recognise. It may be a cause of persisting post-operative pain.
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Affiliation(s)
- Jason Yuen
- South West Neurosurgery Centre, Derriford Hospital, Plymouth, UK
| | - Lucy McGavin
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Will Adams
- Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Nicholas Haden
- South West Neurosurgery Centre, Derriford Hospital, Plymouth, UK
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Congenital Spinal Cysts: An Update and Review of the Literature. World Neurosurg 2020; 145:480-491.e9. [PMID: 32822959 DOI: 10.1016/j.wneu.2020.08.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
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.
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Chiang LJ, Wang CK, Tsai HW, Lee JS. Diagnostic Dilemma in Discriminating Between Spinal Neurenteric Cysts and Simple Arachnoid Cysts Based on Embryogenesis and Surgical Correlation. World Neurosurg 2019; 134:489-494. [PMID: 31756499 DOI: 10.1016/j.wneu.2019.11.069] [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: 08/13/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurenteric cyst (NEC) is a rare intradural spinal tumor, but a correct preoperative diagnosis remains challenging. A misdiagnosis of arachnoid cyst (AC) often leads to conflicting surgical management and significantly higher recurrence. CASE DESCRIPTION We report the case of a 26-year-old woman who presented with progressive spastic quadriparesis with myelopathy below the C4 level, which was caused by a ventral intradural extramedullary cystic tumor at the C3-4 level. Magnetic resonance images showed the cystic content as identical to cerebrospinal fluid, which prompted the tentative diagnosis of spinal AC. Surgical fenestration was scheduled. However, intraoperative findings of a thick-walled cyst and severe adhesion to the neural structure without a history of trauma and inflammation were more compatible with the pathogenesis of an NEC. Because of the high recurrence rate after an incomplete resection of an NEC, we did a complete resection of the cyst with adhesive rootlets instead. Pathology analysis and immunohistochemical staining confirmed the diagnosis of an endodermal-derived NEC. CONCLUSIONS NECs must be differentiated from ACs because they are different diseases and require different surgical management. In cases with clear cystic content, however, the diagnosis is likely to be AC, but a thick cystic wall and structural adhesions should suggest the differential diagnosis of NEC. Gross total removal of NECs should be attempted to reduce NEC recurrence.
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Affiliation(s)
- Liang-Jui Chiang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Kuo Wang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Nakahashi M, Uei H, Tokuhashi Y. Recurrence of a symptomatic spinal intradural arachnoid cyst 29 years after fenestration. J Int Med Res 2019; 47:4530-4536. [PMID: 31448656 PMCID: PMC6753568 DOI: 10.1177/0300060519870092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Symptomatic arachnoid cysts are relatively rare, and no case reports have described recurrence of such cysts almost 30 years after surgery. We herein report a case in which a symptomatic intradural arachnoid cyst recurred 29 years after fenestration of the primary lesion. The patient was a 64-year-old woman who presented with paralysis of the left lower limb. She had undergone surgical treatment for an intradural arachnoid cyst at the T12 level 29 years previously. Magnetic resonance imaging (MRI) revealed an intradural mass at the T12–L1 level. The mass was compressing the spinal cord and cauda equina. Its localization and shape on MRI were similar to those of the primary cyst 29 years previously. Partial resection was performed under a diagnosis of a recurrent intradural arachnoid cyst. After surgery, the patient’s left lower limb paralysis improved. The pathological findings were suggestive of an intradural arachnoid cyst. The MRI findings 29 years previously provided useful information. The possibility of very late recurrence should be considered in patients who undergo surgical removal of intradural arachnoid cysts.
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Affiliation(s)
- Masahiro Nakahashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yasuaki Tokuhashi
- Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan
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Watanabe A, Nakanishi K, Kataoka K. Intradural spinal arachnoid cyst contributing to sudden paraparesis. Surg Neurol Int 2019; 10:102. [PMID: 31528440 PMCID: PMC6744768 DOI: 10.25259/sni-246-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 11/04/2022] Open
Abstract
Background: Spinal arachnoid cysts are cystic lesions filled with cerebrospinal fluid that contributes to neurological deficits depending on their size/location within the spinal canal. Here, we report a patient with a spinal subarachnoid cyst who suddenly developed paraparesis. CASE Description: A 37-year-old female with a thoracic spinal arachnoid cyst at the T7 level suddenly developed lower abdominal pain followed by immediate paraparesis. Two weeks following the onset of symptoms, she underwent a T6-T8 laminectomy; this included with full cyst excision. By the 4th postoperative week, her signs/symptoms fully resolved. Conclusions: A 37-year-old female with a T7 thoracic spinal subarachnoid cyst who presented with acute paraparesis regained normal function 2 weeks following a T6-T8 laminectomy.
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Affiliation(s)
- Akira Watanabe
- Departments of Neurosurgery, Nara Hospital, Kindai University, Ikoma, Nara, Japan
| | - Kinya Nakanishi
- Departments of Neurosurgery, Yuaikai Hospital, Suminoe-ku, Osaka, Osaka-fu, Japan
| | - Kazuo Kataoka
- Departments of Neurosurgery, Nara Hospital, Kindai University, Ikoma, Nara, Japan
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8
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Surgical Management of Spinal Arachnoid Cysts in Adults. World Neurosurg 2019; 122:e1146-e1152. [DOI: 10.1016/j.wneu.2018.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
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9
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Spontaneous Repeated Disappearance and Recurrence of Multiple Spinal Intradural Arachnoid Cysts in a Child. World Neurosurg 2018; 111:358-360. [DOI: 10.1016/j.wneu.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022]
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10
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Kobayashi T, Miyakoshi N, Abe T, Kikuchi K, Abe E, Takahashi M, Shimada Y. Cervical arachnoid cyst mimicking the cause of cervical radiculopathy: A case report. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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11
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Menezes AH, Hitchon PW, Dlouhy BJ. Symptomatic spinal extradural arachnoid cyst with cord compression in a family: case report. J Neurosurg Spine 2017; 27:341-345. [DOI: 10.3171/2017.3.spine17186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Arnold H. Menezes
- 1Department of Neurosurgery and
- 2Division of Pediatric Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | | | - Brian J. Dlouhy
- 1Department of Neurosurgery and
- 2Division of Pediatric Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Shrestha P, Shrestha P, Devkota UP. Excision of an anterior intradural arachnoid cyst of the cervical spine through central corpectomy approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:154-157. [PMID: 28168341 DOI: 10.1007/s00586-017-4973-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/22/2017] [Indexed: 11/28/2022]
Abstract
Anterior cervical intradural arachnoid cyst is a rare entity which has been mostly approached posteriorly, commonly resulting in incomplete resection. Incomplete resection is associated with recurrence; hence, we describe the anterior central corpectomy approach with complete neurologic recovery in a twenty year old with an anterior cervical intradural arachnoid cyst in front of the third and fourth cervical vertebra, who had presented with spastic quadriparesis.
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Affiliation(s)
- Pratyush Shrestha
- National Institute of Neurological and Allied Sciences, Basbari, Kathmandu, Nepal.
| | - Prateek Shrestha
- National Institute of Neurological and Allied Sciences, Basbari, Kathmandu, Nepal
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13
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Zekaj E, Saleh C, Servello D. Intramedullary cyst formation after removal of multiple intradural spinal arachnoid cysts: A case report. Surg Neurol Int 2016; 7:S473-4. [PMID: 27512608 PMCID: PMC4960930 DOI: 10.4103/2152-7806.185779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background: A rare cause of spinal cord compression is spinal arachnoid cysts. Symptoms are caused by spinal cord compression, however, asymptomatic patients have been also reported. Treatment options depend upon symptom severity and clinical course. Case Description: We report the case of a 47-year-old patient who developed an intramedullary arachnoid cyst after removal of an intradural extramedullary cyst. Conclusion: Surgery should be considered early in a symptomatic disease course. Longstanding medullary compression may reduce the possibility of neurological recovery as well as secondary complications such as intramedullary cyst formation.
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Affiliation(s)
- Edvin Zekaj
- Department of Neurosurgery, IRCCS Galeazzi Hospital, Milan, Italy
| | - Christian Saleh
- Department of Neurosurgery, IRCCS Galeazzi Hospital, Milan, Italy
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Krstačić A, Krstačić G, Butković Soldo S. Atypical cause of radiculopathy - Intradural spinal arachnoid cyst. Acta Clin Belg 2016; 71:267-8. [PMID: 27104760 DOI: 10.1080/17843286.2016.1139288] [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: 10/21/2022]
Abstract
Intradural spinal arachnoid cysts are a relatively uncommon lesion that may be either intra, or extradural, and intradural spinal arachnoid cysts are even less common. Arachnoid cysts are cerebrospinal fluid collections in the spine that can present with neurological symptoms. The objective of this paper is to describe a rare case of radicular pain due to a spinal arachnoid cyst.
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Nath PC, Mishra SS, Deo RC, Satapathy MC. Intradural Spinal Arachnoid Cyst: A Long-Term Postlaminectomy Complication: A Case Report and Review of the Literature. World Neurosurg 2016; 85:367.e1-4. [DOI: 10.1016/j.wneu.2015.09.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 09/19/2015] [Indexed: 11/27/2022]
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16
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Anterior cervical intradural arachnoid cyst, a rare cause of spinal cord compression: a case report with video systematic literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25 Suppl 1:19-26. [DOI: 10.1007/s00586-015-4026-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
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17
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Candela S, Puerta P, Alamar M, Barcik U, Guillén A, Muchart J, García-Fructuoso G, Ferrer-Rodríguez E. [Epidemiology and classification of arachnoid cysts in children]. Neurocirugia (Astur) 2015; 26:234-40. [PMID: 25843209 DOI: 10.1016/j.neucir.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 12/21/2022]
Abstract
The prevalence of arachnoid cysts in children is 1-3%. They are more frequent in boys. They can be located intracranially or in the spine. Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch). Supratentorial are divided into middle cranial fossa, convexity, inter-hemisferic, sellar region, and intraventricular. Infratentorial are classified into supracerebellar, infracerebellar, hemispheric, clivus, and cerebellopontine angle. Finally spinal arachnoid cysts are classified taking into account whether they are extra- or intradural, and nerve root involvement.
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Affiliation(s)
- Santiago Candela
- Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España.
| | - Patricia Puerta
- Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España
| | - Mariana Alamar
- Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España
| | - Uli Barcik
- Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España
| | - Antonio Guillén
- Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España
| | - Jordi Muchart
- Servicio de Diagnóstico por la Imagen, Hospital Sant Joan de Déu, Barcelona, España
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Kizilay Z, Yilmaz A, Ozkul A, Ismailoglu O. Cervicothoracic Arachnoid Cyst Causing Cervical Myelopathy: A Case Report. Open Access Maced J Med Sci 2015; 3:135-8. [PMID: 27275210 PMCID: PMC4877772 DOI: 10.3889/oamjms.2015.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/08/2015] [Accepted: 02/09/2015] [Indexed: 11/05/2022] Open
Abstract
Several types of intraspinal cyst develop within the spinal canal from the craniovertebral junction to the sacrum. These lesions occur in both children and adults. Arachnoid cysts are one of them and are more frequent in the paediatric population, being a relatively uncommon lesion in adults. The arachnoid cyst may be located intradurally or extradurally. The intradural type may be congenital or from spinal trauma, infection or spondylosis. Although intradural arachnoid cysts are often asymptomatic, they may give early symptoms when they exist with synchronous pathologies constricting the spinal canal gradually as in cervical spondylosis. In this report, a 60-year-old man with an arachnoid cyst of the cervicothoracic spine is presented. His cyst remained undiagnosed because of the nonspecific nature of the symptoms. It was only when he developed right hemiparesis that a posterior fluid collection compressing the spinal cord was found in Magnetic resonance imaginig. An intradural extramedullary cyst was removed with successful surgery and cord compression and symptoms were reversed. We discuss radiological diagnosis and surgical treatment of an arachnoid cyst in this report.
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Affiliation(s)
- Zahir Kizilay
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ali Yilmaz
- Adnan Menderes University, Medical Faculty, Neurosurgery, Aytepe Campus, Aydin 09100, Turkey
| | - Ayca Ozkul
- Adnan Menderes University, Medical Faculty, Department of Neurology, Aydin 09100, Turkey
| | - Ozgur Ismailoglu
- Süleyman Demirel University, Neurosurgery, 32260 Isparta, Turkey
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Awad AW, Hardesty DA, Tomei K, Bhardwaj RD. Paraplegia induced by mild trauma in a child with thoracic spinal arachnoid cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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20
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Novegno F, Umana G, Di Muro L, Fraioli B, Fraioli MF. Spinal intramedullary arachnoid cyst: case report and literature review. Spine J 2014; 14:e9-15. [PMID: 24262859 DOI: 10.1016/j.spinee.2013.10.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/21/2013] [Accepted: 10/31/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Intramedullary arachnoid cysts are extremely rare; only 14 cases have been reported in the literature so far. PURPOSE We report on the case of a 31-year-old woman who presented with back pain and progressive paraparesis secondary to a dorsal intramedullary arachnoid cyst detected on magnetic resonance imaging (MRI): the surgical planning and clinico-radiological outcome are discussed along with a review of the relevant literature. STUDY DESIGN Case report and literature review. PATIENT SAMPLE One patient affected by intramedullary arachnoid cyst. OUTCOME MEASURES Magnetic resonance imaging and pathological findings from operative specimens were used to confirm the diagnosis. METHODS A 31-year-old woman presented with a 7-year history of back pain that had worsened 3 months before admission to our department; for this reason, the patient had undergone a spinal MRI revealing the presence of a 1-cm cystic intramedullary lesion at the level T11-T12, with no contrast enhancement. After 2 months, the patient presented with a worsening of clinical symptoms complaining of severe back pain radiating to the lower extremities associated with a progressive paraparesis, urinary incontinence, and abdominal pain. Referred to our department, at the time of admission the patient was bedridden because of the impossibility of maintaining a standing position. The patient underwent a T11-T12 laminectomy with fenestration of the cyst. RESULTS She experienced an immediate relief of pain symptoms, and by the seventh postoperative day she was able to stand without help and walk a few meters with assistance. By the sixth postoperative month, the patient had significantly improved, having gained the ability to walk alone without assistance with complete resolution of the bladder dysfunctions, with no cyst recurrence after approximately 2 years of follow-up. CONCLUSIONS Intramedullary arachnoid cysts should be considered in the differential diagnosis for intramedullary cystic lesions. A particular consideration deserves their occurrence in asymptomatic patients, who should be adequately informed on the possible natural evolution: when symptomatic, surgical therapy should be promptly offered, considering that a postoperative complete recovery is usually observed, regardless of the surgical technique.
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Affiliation(s)
- Federica Novegno
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy.
| | - Giuseppe Umana
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Licia Di Muro
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Bernardo Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
| | - Mario Francesco Fraioli
- Department of Neurosurgery, University of Rome "Tor Vergata", V.le Oxford 81, 00133 Rome, Italy
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Long segment dorsolumbar spinal arachnoid cyst: a case report. ROMANIAN NEUROSURGERY 2014. [DOI: 10.2478/romneu-2014-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Congenital spinal intradural arachnoid cyst involving almost the entire spine is very rare. We report a case of 15 years old boy, who presented with progressive spastic paraparesis with gait instability for last 4 months. MRI spine revealed thoracolumbar arachnoid cyst extending from D4 to L3 segment. Complete surgical excision of arachnoid cyst and laminoplasty was done. Patient recovered completely and histopathological examination of specimen confirmed the diagnosis of arachnoid cyst.
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22
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Pasoglou V, Janin N, Tebache M, Tegos TJ, Born JD, Collignon L. Familial adhesive arachnoiditis associated with syringomyelia. AJNR Am J Neuroradiol 2014; 35:1232-6. [PMID: 24481329 DOI: 10.3174/ajnr.a3858] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Adhesive arachnoiditis is a rare condition, often complicated by syringomyelia. This pathologic entity is usually associated with prior spinal surgery, spinal inflammation or infection, and hemorrhage. The usual symptoms of arachnoiditis are pain, paresthesia, and weakness of the low extremities due to the nerve entrapment. A few cases have had no obvious etiology. Previous studies have reported one family with multiple cases of adhesive arachnoiditis. We report a second family of Belgian origin with multiple cases of arachnoiditis and secondary syringomyelia in the affected individuals.
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Affiliation(s)
- V Pasoglou
- From the Departments of Radiology (V.P.)
| | - N Janin
- Genetics (N.J.), Cliniques Universitaires St. Luc, Brussels, Belgium
| | - M Tebache
- Departments of Radiology (M.T., L.C.)
| | - T J Tegos
- Department of Neurology (T.J.T.), AHEPA Hospital, Thessaloniki, Greece
| | - J D Born
- Neurosurgery (J.D.B.), Centre Hospitalier Régional de la Citadelle, Liège, Belgium
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23
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Qi J, Yang J, Wang G. A novel five-category multimodal T1-weighted and T2-weighted magnetic resonance imaging-based stratification system for the selection of spinal arachnoid cyst treatment: a 15-year experience of 81 cases. Neuropsychiatr Dis Treat 2014; 10:499-506. [PMID: 24672241 PMCID: PMC3964166 DOI: 10.2147/ndt.s52517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Idiopathic spinal arachnoid cysts are rare cystic masses of the spinal canal generally classified as intra- or extradural, based on anatomical presentation. However, this system may not effectively indicate treatment. OBJECTIVE To investigate the incidence, resection modality, and prognosis of spinal arachnoid cyst in a 15-year case series. PATIENTS AND METHODS A retrospective study was conducted in 81 spinal arachnoid cyst patients (male:female 34:47, mean age 36.5 years, age range 6-66 years) classified using a novel five-category T1-weighted and T2-weighted magnetic resonance imaging (MRI) classification system (intramedullary, subdural extramedullary, subdural/epidural, intraspinal epidural, or intraspinal/extraspinal). Conservative treatment failed in all patients. They underwent spinal surgery between January 1995 and December 2010 and were followed up for 69 (range 3-187) months. Performance outcomes were assessed using the Fugl-Meyer (FM) scale 90 days after operation. Recurrences and deaths were recorded. RESULTS Subdural/epidural and intraspinal epidural cysts accounted for 66.7% (54 of 81) of patients, but exhibited relatively lower rates of postsurgical improvement using FM, with only 66.7% (36 of 54) of patients showing improvements. Excellent outcomes using the FM scale were reached in 100% (eight of eight) of intramedullary, intraspinal/extraspinal, and subdural extramedullary cyst patients, 86.7% (13 of 15) of subdural extramedullary cyst patients, and 66.7% (36 of 54) of epidural intraspinal cyst patients. CONCLUSION The proposed five-category multimodal MRI-based stratification system for spinal arachnoid cyst patients may more effectively allow clinicians to select the appropriate surgical intervention, and may help to predict outcomes.
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Affiliation(s)
- Ji Qi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
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24
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Rohdin C, Nyman HT, Wohlsein P, Hultin Jäderlund K. Cervical spinal intradural arachnoid cysts in related, young pugs. J Small Anim Pract 2013; 55:229-34. [PMID: 24372140 DOI: 10.1111/jsap.12167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
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.
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Affiliation(s)
- C Rohdin
- Department of Clinical Sciences, University Animal Hospital, Swedish University of Agricultural Sciences, 750 07, Uppsala, Sweden; Albano Small Animal Hospital, Rinkebyvägen 21, 182 36, Danderyd, Sweden
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25
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Nishimura Y, Hara M, Natsume A, Nakajima Y, Fukuyama R, Wakabayashi T, Ginsberg HJ. Spinal intradural cystic venous angioma originating from a nerve root in the cauda equina. J Neurosurg Spine 2013; 19:716-20. [DOI: 10.3171/2013.8.spine121012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A spinal intradural extramedullary venous angioma is extremely rare and has not been previously reported. In this paper, the authors report on this entity with morphological and immunohistochemical evidence, and discuss the surgical strategy for its treatment. A 54-year-old woman presented to Nagoya University Hospital complaining of left-sided pain in the hip, thigh, and inguinal and perianal regions, with progressive worsening during the previous 2 weeks. Lumbar spine MRI showed an intradural extramedullary cyst at the level of T12–L1, which extended from the conus medullaris to the cauda equina. The cyst wall was not enhanced on T1-weighted MRI with Gd. Intraoperatively, a midline dural opening allowed the authors to easily visualize a dark-reddish cyst behind the spinal nerve rootlets in the cauda equina adjacent to the conus medullaris. The cyst was believed to originate from one of the spinal nerve rootlets in the cauda equina and a cluster of veins was identified on the cyst wall. The cyst was resected with the affected nerve rootlet. The surgery left no detectable neurological deficit. Based on the morphological and immunohistochemical evidence, the lesion was diagnosed as a venous angioma. No tumor recurrence was confirmed based on MRI at the time of the 2-year follow up. This is the first report of an intradural extramedullary cystic venous angioma that was successfully resected.
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Affiliation(s)
- Yusuke Nishimura
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Masahito Hara
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | - Atsushi Natsume
- 1Department of Neurosurgery, Nagoya University, Nagoya, Japan
| | | | | | | | - Howard J. Ginsberg
- 3Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Abstract
This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome.
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27
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Evangelou P, Meixensberger J, Bernhard M, Hirsch W, Kiess W, Merkenschlager A, Nestler U, Preuss M. Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review. Childs Nerv Syst 2013; 29:657-64. [PMID: 23224408 DOI: 10.1007/s00381-012-1990-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare. PATIENTS AND METHODS We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts. RESULTS In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %). CONCLUSION Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.
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Affiliation(s)
- Petros Evangelou
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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28
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Foster KA, Zwagerman NT, Ricks C, Greene S. Symptomatic thoracic arachnoid cyst with coexisting tick paralysis: case report and review of the literature. Pediatr Neurosurg 2013; 49:360-4. [PMID: 25531213 DOI: 10.1159/000368278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/07/2014] [Indexed: 11/19/2022]
Abstract
Tick paralysis is an uncommon phenomenon resulting from the release of a neurotoxin from the salivary glands of an engorged, gravid female tick about 5-7 days after attachment. The neurotoxin produces ascending weakness, mimicking other ascending paralytic processes. We present a case of a child presenting with weakness of the lower extremities and frequent falls who was found to have a compressive thoracic arachnoid cyst and a large distal syrinx. After surgical decompression, the patient made significant improvement in her leg strength, but quickly developed an ascending quadriparesis, followed by respiratory depression. Subsequent imaging and physical examination revealed an engorged tick embedded in her scalp. The tick was removed, and the patient made a rapid and complete clinical recovery. We present a unique case of concomitant tick paralysis and a symptomatic spinal intradural arachnoid cyst, and review the literature on tick paralysis.
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Jain SK, Sundar IV, Sharma V, Goel RS. Lumbosacral arachnoid cyst with tethered cord: A rare case report. J Craniovertebr Junction Spine 2012; 3:73-5. [PMID: 24082689 PMCID: PMC3777317 DOI: 10.4103/0974-8237.116551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Arachnoid cysts are cerebrospinal fluid collections in the spine that can present with neurological symptoms or be discovered accidentally. Intradural location of such cysts especially in the lumbosacral region is relatively rare. The association of such cysts with other congenital anomalies such as tethered cord lends evidence to the developmental origin of arachnoid cysts. We report a case of lumbosacral arachnoid cyst with tethered cord in a 6-year-old male child and discuss the etiopathogenesis and management options.
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Affiliation(s)
- S K Jain
- Department of neurosurgery, SMS Medical college and hospital, Jaipur, India
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30
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Ramaswamy V, Delaney H, Haque S, Marghoob A, Khakoo Y. Spectrum of central nervous system abnormalities in neurocutaneous melanocytosis. Dev Med Child Neurol 2012; 54:563-8. [PMID: 22469364 DOI: 10.1111/j.1469-8749.2012.04275.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Neurocutaneous melanocytosis is a rare neurocutaneous syndrome defined by the presence of large and/or multiple congenital cutaneous nevi and melanocytic deposits in the central nervous system. We sought to define the spectrum of central nervous system abnormalities in children with neurocutaneous melanocytosis. METHOD We retrospectively reviewed cases of neurocutaneous melanocytosis referred to the pediatric neuro-oncology service at our center from 2003 to 2010. RESULTS Of 14 patients (11 males, 3 females) identified, eight were living. Median age of survivors was 31 months (range 12mo-6y 10mo) while median age of death was 81 months (19mo-28y). Of the six patients who died, all had diffuse leptomeningeal melanocytic deposits and four had leptomeningeal melanoma. All patients had neuroimaging: six had findings suggestive of diffuse leptomeningeal melanocytosis; seven had multifocal melanocytic deposits; and one patient had normal neuroimaging but focal seizures. Spinal abnormalities were common: three patients had extensive dorsal spinal arachnoid cysts and one had a benign cervical spindle cell tumor. Seven patients had epilepsy. Three patients had profound developmental delay; the other 11 patients had no or mild delay. INTERPRETATION Children with neurocutaneous melanocytosis exhibit a wide range of intracranial and intraspinal abnormalities and variable clinical outcomes.
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Affiliation(s)
- Vijay Ramaswamy
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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31
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Bond AE, Zada G, Bowen I, McComb JG, Krieger MD. Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature. J Neurosurg Pediatr 2012; 9:432-41. [PMID: 22462711 DOI: 10.3171/2012.1.peds11391] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT The goal of this study was to review all cases of pediatric spinal arachnoid cysts (SACs) surgically treated at the authors' institution between 1992 and 2008 and to compare these cases to the published literature for the general population. METHODS The charts of all pediatric patients with SACs were reviewed for demographics, medical history, presenting symptoms, imaging findings, operative procedure(s), complications, and outcomes. Following a complete literature review, the pediatric data were compared with data from the general population and unique findings associated with pediatric patients were identified. RESULTS Thirty-one pediatric patients (median age 6.9 years) underwent operative intervention for SACs between 1992 and 2008 (median duration of follow-up 4.2 years). There were 17 female patients (55%) and 14 male patients (45%). Twenty-one patients (68%) presented with symptoms of radiculopathy or myelopathy. The most common presenting symptoms were pain (42%), lower-extremity weakness (39%), gait instability (32%), spasticity (19%), sensory loss (10%), and bladder dysfunction (7%). In 3 patients (10%) SACs were incidental findings. Intradural SACs were more common (18 patients, 58%) than extradural SACs (11 patients, 36%). One patient (3%) had extradural and intradural components. One patient (3%) had a purely intramedullary cyst, and 1 patient (3%) had both an intradural and intramedullary component. Of the 18 intradural SACs, 9 (50%) were located ventral to the spinal cord and 9 (50%) were dorsally situated. One dorsal intradural SAC had an intramedullary component. All extradural SACs were located dorsal to the spinal cord. Intradural SACs were primarily concentrated in the cervical and thoracic regions (67%), whereas extradural cysts were more evenly distributed between the thoracic, lumbar, and sacral regions. Of the 18 patients with intradural SACs, 13 (72%) had significant previous CNS abnormalities, compared with 3 (27%) of 11 patients with extradural SACs. There were 2 operative complications. One patient had a CSF leak treated with a lumbar drain, and the second patient had a pseudomeningocele. No patients had neurological deterioration as a result of surgical intervention. Twenty-one patients (68%) had complete remission of symptoms, 6 (19%) had improvement, 3 (10%) were stable, and 1 (3%) has worsening of symptoms with recurrence that ultimately required cystoperitoneal shunting, despite multiple failed attempts at fenestration. CONCLUSIONS Spinal arachnoid cysts are rare lesions in the pediatric population. Affected patients present with back pain, weakness, and/or gait instability. In children, SACs predominantly develop in the thoracic region and are more likely to occur intradurally, compared with SACs in the general population. Overall outcomes following surgical fenestration or excision of SACs are excellent, with complete remission or improvement of symptoms achieved in 87% of cases.
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Affiliation(s)
- Aaron E Bond
- Division of Neurosurgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Su DK, Ebenezer S, Avellino AM. Symptomatic spinal cord compression from an intradural arachnoid cyst with associated syrinx in a child: case report. Pediatr Neurosurg 2012; 48:236-9. [PMID: 23615079 DOI: 10.1159/000348885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 02/11/2013] [Indexed: 11/19/2022]
Abstract
Symptomatic intradural extramedullary arachnoid cysts in children are rare, and of the previously reported pediatric cases in the current literature, none to our knowledge were associated with a spinal cord syrinx. We describe an 8-year-old child who presented with paraparesis and regression of bowel and bladder control. An intradural extramedullary arachnoid cyst was identified on preoperative magnetic resonance imaging, with an associated spinal cord syrinx. We describe the preoperative imaging, surgical management, and clinical course of this patient, who had improvement in his paraparesis. This paper reviews relevant pediatric literature and the etiology of arachnoid cysts and associated spinal cord syrinx formation.
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Affiliation(s)
- David K Su
- Department of Neurological Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA 98195, USA.
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Oxley W, Pink J. Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst. J Small Anim Pract 2011; 53:67-72. [PMID: 22122126 DOI: 10.1111/j.1748-5827.2011.01146.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management.
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Affiliation(s)
- W Oxley
- Willows Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH
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Kumar A, Sakia R, Singh K, Sharma V. Spinal arachnoid cyst. J Clin Neurosci 2011; 18:1189-92. [DOI: 10.1016/j.jocn.2010.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 11/24/2010] [Accepted: 11/28/2010] [Indexed: 11/29/2022]
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Gómez E, Quiles A, Pedraza S. Spinal Arachnoid Cyst as an Infrequent Cause of Spinal Cord Compression. Neuroradiol J 2011; 24:535-45. [DOI: 10.1177/197140091102400407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/03/2011] [Indexed: 11/17/2022] Open
Abstract
Spinal arachnoid cysts are rare lesions that may produce symptoms by compressing the spinal cord or nerve roots. MRI is essential for diagnosing this entity. We retrospectively reviewed the medical charts, radiological examinations, and follow-up data of four adults with spinal arachnoid cysts diagnosed in our center over a two-year period (2007-2009). All cysts were located in the thoracic spine. Three were dorsolateral to the spinal cord and one was ventral. Most had multiple septa but one had a single septum. Cyst size varied greatly; one cyst extended through eight vertebral bodies. One patient treated expectantly died of cardiovascular problems one year after the cyst was diagnosed. The other three patients underwent laminectomy and cyst fenestration; two had clinical and imaging signs of relapse after surgery. One of the patients with a relapsed cyst worsened clinically, developing syringomyelia and requiring reintervention with shunting to the subarachnoid space. The outcome of the operation was good in the case of the single septum. Spinal arachnoid cyst is uncommon. Its diagnosis is complex because the symptoms are unspecific and the imaging findings are subtle. Spinal arachnoid cyst should be included in the differential diagnosis of chronic paraparesis. Imaging plays an essential role in the diagnosis, follow-up and management of spinal arachnoid cysts.
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Affiliation(s)
- E. Gómez
- Neuroradiology Section, IDI Girona, Hospital Universitari Josep Trueta; Girona, Spain
| | - A.M. Quiles
- Neuroradiology Section, IDI Girona, Hospital Universitari Josep Trueta; Girona, Spain
| | - S. Pedraza
- Neuroradiology Section, IDI Girona, Hospital Universitari Josep Trueta; Girona, Spain
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Symptomatic idiopathic noncommunicating intradural arachnoid cyst of the S1 nerve root: a case report. Spine (Phila Pa 1976) 2011; 36:E979-82. [PMID: 21289570 DOI: 10.1097/brs.0b013e3181fd679a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report of a rare symptomatic, idiopathic, noncommunicating intradural arachnoid cyst (IAC) of the proximal part of the S1 nerve root (NR). OBJECTIVE To discuss the possible pathophysiology, clinical and magnetic resonance imaging (MRI) presentation, intraoperative findings, and follow-up of IAC of the proximal part of the S1 NR. SUMMARY OF BACKGROUND DATA Rare variety of the Nabors's Type 3 spinal IAC. The etiopathogenesis are uncertain. Surgical NR decompression with extirpation of the cyst is the treatment of choice. METHODS A 37-year-old woman clinically presented as monoradiculopathy with a 9-month history of progressive, posture-dependent radicular pain, paresthesia and hypoesthesia in the right S1 dermatome, and mild weakness of the ipsilateral plantar flexors. Magnetic resonance imaging (MRI) showed a noncommunicating IAC of the proximal part of the S1 NR on the right side. Surgical exploration through the ipsilateral L5-S1 hemilaminectomy was performed with microsurgical arachnolysis of the compressed and stretched S1 NR fascicles that surrounded the cyst, during which the cyst spontaneously collapsed. The remnant of the cyst wall was extirpated and histopathology confirmed the diagnosis. RESULTS After surgery an excellent clinical outcome was archived: the leg pain was no longer present and the paraesthesia, hypoesthesia, and motor weakness were resolved within 3 months. At 12 months of follow-up, the patient continues to be completely asymptomatic with no evidence of recurrence on MRI. CONCLUSION A rare case of symptomatic, idiopathic, noncommunicating IAC of the proximal part of the S1 NR has been presented. Early recognition and treatment resulted in complete symptom resolution, with preservation of the full working capacity and good quality of life. Isolated monoradiculopathy with progressive, posture-dependent radicular pain seem to be typical clinical findings for such a lesion. Attending physicians should always be mindful of this fact in the total clinical evaluation of such cases.
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Incidental Findings of the Lumbar Spine at MRI During Herniated Intervertebral Disk Disease Evaluation. AJR Am J Roentgenol 2011; 196:1151-5. [DOI: 10.2214/ajr.10.5457] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Rao ZX, Li J, Hang SQ, You C. Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele in a child. J Zhejiang Univ Sci B 2010; 11:429-32. [PMID: 20506573 DOI: 10.1631/jzus.b0900375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele is very rare. We report a case in a 9-year-old Chinese boy who presented with a two-week history of progressive paraparesis and gait ataxia. Magnetic resonance imaging revealed that a dorsal intradural extramedullary cystic lesion extended from T1 to T5 and compressed the spinal cord. A left lateral intrathoracic meningocele pouch was found incidentally at the level of T1. The arachnoid cyst as well as meningocele was removed and the spinal cord compression was relieved. Arachnoid cyst was confirmed by histological examination. The patient recovered well postoperatively. This is the second report of such a case in the world according to the available literature. The take-home message for our case is that the surgical approach should be individualized, depending on the size and location.
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Affiliation(s)
- Zheng-xi Rao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China
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Mohindra S, Gupta R, Bal A. Intra-dural spinal arachnoid cysts: a short series of 10 patients. Br J Neurosurg 2010; 24:679-83. [PMID: 20825292 DOI: 10.3109/02688697.2010.504052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Anan M, Ishii K, Murata K, Fujiki M. A ventral intradural arachnoid cyst on the cervical spine in a child. Acta Neurochir (Wien) 2010; 152:383-4. [PMID: 19588073 DOI: 10.1007/s00701-009-0440-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 06/11/2009] [Indexed: 11/25/2022]
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41
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Brass SD, Dinkin MJ, Williams Z, Krishnamoorthy KS, Copen WA, Freeman SH. Case Records of the Massachusetts General Hospital. Case 38-2009 - a 16-year-old boy with paroxysmal headaches and visual changes. N Engl J Med 2009; 361:2367-78. [PMID: 20007563 DOI: 10.1056/nejmcpc0905547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Steven D Brass
- Department of Neurology, Massachusetts General Hospital, USA
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Petridis AK, Doukas A, Barth H, Mehdorn HM. Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19 Suppl 2:S124-9. [PMID: 19763637 DOI: 10.1007/s00586-009-1156-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/18/2009] [Accepted: 08/24/2009] [Indexed: 11/29/2022]
Abstract
Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. The diagnosis is clinical and radiological with the use of MRI, CT myelography or a combination of both. The best treatment option is complete removal of the cyst. However, even when paresis is regressing there is no good recovery from neuropathic pain. Laminectomy approach can cause postoperative complications especially when the cyst(s) expand(s) in more than one level. Alternatively, a cyst fenestration can be performed, including the levels of the maximal spinal cord compression. The clinical outcome is as good as after the cyst resection enabling the patient to walk again. The neuropathic pain may persist and require medication. A clinical case is presented, and the literature is reviewed. In the present case we report a patient with intradural arachnoid cysts extending from T6 to L2 and causing severe gait ataxia as well as neuropathic pain and hypaesthesia. The spinal-cord was compressed at T8 and T12. Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.
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Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, University of Schleswig Holstein, Campus Kiel, Schittenhelmstr 10, 24105 Kiel, Germany.
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43
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Bitaraf MA, Zeinalizadeh M, Meybodi AT, Meybodi KT, Habibi Z. Multiple extradural spinal arachnoid cysts: a case report and review of the literature. CASES JOURNAL 2009; 2:7531. [PMID: 19829999 PMCID: PMC2740202 DOI: 10.1186/1757-1626-2-7531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 04/20/2009] [Indexed: 12/17/2022]
Abstract
Extradural spinal arachnoid cysts are rare lesions, which may become symptomatic due to mass effect. Multiple cysts are even rarer of which few are reported to date. A 17-year-old male with acute onset urinary retention and progressive paraparesis is presented. Magnetic resonance imaging of spine revealed multiple spinal extradural arachnoid cysts located dorsal to the spinal cord, causing mass effect. The patient underwent surgery for excision of the cyst and closure of dural defects. He gained urinary continence and near normal muscle strength of lower extremities over a period of two weeks following operation. Up to date, there have been only sixteen reported cases of multiple spinal extradural arachnoid cysts in the literature and the present case appears to be the second most extensive one reported so far. Appreciation of the rarity of such lesions as well as the importance of surgical planning (especially pre-operative localization of the dural defects) is highlighted.
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Affiliation(s)
- Mohammad Ali Bitaraf
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences Tehran 14197 Iran.
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44
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Medved F, Seiz M, Baur MO, Neumaier-Probst E, Tuettenberg J. Thoracic intramedullary arachnoid cyst in an infant. J Neurosurg Pediatr 2009; 3:132-6. [PMID: 19278313 DOI: 10.3171/2008.10.peds08202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic intramedullary arachnoid cysts are rare, especially in children; these lesions are rarely described as a cause of spinal cord compression in this age group. The authors report on an 18-month-old boy who experienced a sudden loss of his ability to stand and walk due to a paraparesis. Magnetic resonance imaging of the spine exhibited a cystic intramedullary lesion at the level of T5-6. A hemilaminectomy was performed, and after myelotomy the cystic lesion was decompressed by fenestration to the subarachnoid space. The histopathological examination verified the diagnosis of an arachnoid cyst. In the postoperative course the boy experienced complete resolution of the initial paraparesis.
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Affiliation(s)
- Fabian Medved
- Department of Neurosurgery, University Children's Hospital, and Department of Neuroradiology, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
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45
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Jain F, Chaichana KL, McGirt MJ, Jallo GI. Neonatal anterior cervical arachnoid cyst: case report and review of the literature. Childs Nerv Syst 2008; 24:965-70. [PMID: 18338174 DOI: 10.1007/s00381-008-0612-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 01/07/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Anterior cervical arachnoid cysts are rare in the pediatric population, with only 16 cases reported. We present the first case of an anterior cervical arachnoid cyst in a neonate and review the literature on pediatric cervical arachnoid cysts. CLINICAL PRESENTATION A 16-day-old baby girl with a history of myelomeningocele repair progressively developed symptoms of upper extremity weakness over the course of 2 weeks. Magnetic resonance imaging (MRI) demonstrated a compressive arachnoid cyst extending from C2 to C7. INTERVENTION The child was taken for posterior cervical laminoplasty and cyst fenestration. Intraoperatively, diffuse cervical arachnoiditis was noted. Rapid improvement in upper extremity paresis was noted within 24 h of surgery, and MRI confirmed decompression of the cyst. However, flaccid upper extremity paresis recurred within 2 weeks. MRI confirmed recurrence of the anterior cervical arachnoid cyst. The child was taken for a secondary fenestration and stenting of the cyst. Only partial improvement in arm function was noted by 1 month following reoperation. CONCLUSION Arachnoid cysts can be effectively treated with surgical fenestration, shunting, and complete or partial excision. Rapid identification and treatment results in improvement in myelopathic symptoms; however, the most efficacious treatment modality remains unknown. Of the 17 cases of anterior cervical arachnoid cysts reported in the literature, 11 (65%) have had either prior myelomeningocele repair or a history of spinal trauma. Anterior cervical arachnoid cysts should be considered in the differential diagnosis of acute onset myelopathy in the pediatric population especially in cases with a history of spinal trauma or myelomeningocele repair.
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Affiliation(s)
- Felipe Jain
- Harvard Medical School, MIT Division of Health, Science and Technology, Harvard University, Cambridge, MA, USA
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46
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Gezici AR, Ergün R. Cervical anterior intradural arachnoid cyst in a child. Acta Neurochir (Wien) 2008; 150:695-8; discussion 698. [PMID: 18536993 DOI: 10.1007/s00701-008-1603-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 04/17/2008] [Indexed: 11/28/2022]
Abstract
Intradural arachnoid cysts involving the spine are uncommon and especially rare in an anterior cervical location. In the literature, among 15 patients, 8 were in the paediatric age group and in 3 patients the cyst was localised to the full length of the cervical spinal canal. Although they occur secondary to trauma, haemorrhage, surgery or inflammation, most of them are known to be idiopathic or congenital. Although the disease shows a dramatic neurological course, early diagnosis and treatment could provide good results. We report a 2(1/2) year-old boy with progressive tetraparesis with a huge anterior intradural arachnoid cyst located from the cervico-medullary junction to the C7 level. In the paediatric age group, cervical anterior intradural arachnoid cyst is an unusual cause of quadriparesis. The rarity of this condition and the relevance of MRI in the accurate and early diagnosis is discussed here. A 2(1/2) year-old boy with a large intradural arachnoid cyst extending from the cervico-medullary junction to C7 situated anteriorly is reported here; diagnosis and treatment modalities are discussed.
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Affiliation(s)
- A R Gezici
- Department of Neurosurgery, Abant Izzet Baysal University, Bolu, Turkey
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47
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Campos WK, Linhares MN, Brodbeck IM, Ruhland I. Anterior cervical arachnoid cyst with spinal cord compression. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:272-3. [DOI: 10.1590/s0004-282x2008000200030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Irineu May Brodbeck
- Universidade Federal de Santa Catarina; Hospital Infantil Joana de Gusmão, Brasil
| | - Iraê Ruhland
- Universidade Federal de Santa Catarina; Hospital Infantil Joana de Gusmão, Brasil
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48
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Kahraman S, Anik I, Gocmen S, Sirin S. Extradural giant multiloculated arachnoid cyst causing spinal cord compression in a child. J Spinal Cord Med 2008; 31:306-8. [PMID: 18795482 PMCID: PMC2565559 DOI: 10.1080/10790268.2008.11760728] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Enlargement may cause progressive signs and symptoms caused by spinal cord compression. They are associated with trauma, surgery, arachnoiditis, and neural tube defects. Most nontraumatic spinal extradural arachnoid cysts are thought to be congenital. DESIGN Case report and literature review. FINDINGS A 9-year-old boy with mild paraparesis was found to have an extradural multiloculated arachnoid cyst with fibrous septa at T4-L3 levels and anterior compression and displacement of the spinal cord. CONCLUSIONS Definitive treatment of arachnoid cyst entails radical cyst removal and dura cleft repair. Formation of a postoperative cerebrospinal fluid fistula may require external lumbar drainage.
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Affiliation(s)
| | | | | | - Sait Sirin
- Department of Neurosurgery, GATA, Ankara, Turkey
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49
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Schmidt MJ, Schachenmayr W, Thiel C, Kramer M. Recurrent spinal arachnoid cyst in a cat. J Feline Med Surg 2007; 9:509-13. [PMID: 17618156 PMCID: PMC10911502 DOI: 10.1016/j.jfms.2007.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2007] [Indexed: 11/17/2022]
Abstract
Spinal arachnoid cysts (SACs) are uncommon expanding lesions in the spinal canal. They are rarely diagnosed in dogs, and there are only four published cases in cats. We report a case of a 12-year-old cat with recurrent signs of intermittent urinary incontinence and hind limb ataxia 2 years after surgical marsupialisation of a spinal arachnoid cyst at T11/12. Recurrence of a cyst was diagnosed by myelography. Repeated marsupialisation after laminectomy was successful and the cat recovered satisfactorily although intensive physical therapy was necessary. SACs are very rare in cats and seem to occur mainly as a secondary lesion to spinal and meningeal trauma or irritation due to bony changes of the vertebrae.
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50
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Ghannane H, Haddi M, Aniba K, Lmejjati M, Aït Benali S. Kyste arachnoïdien intramédullaire symptomatique. À propos de deux cas et résumé de la littérature. Neurochirurgie 2007; 53:54-7. [PMID: 17507047 DOI: 10.1016/j.neuchi.2007.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 02/21/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this work is to present and discuss the rare situation of curable medullary compression with favorable prognosis. MATERIAL AND METHOD Two cases of thoracic intramedullary arachnoid cysts are described. Clinical, paraclinical, therapeutics and outcome features are discussed with a review of the literature. RESULTS Two children, 4 and 8 years old, with an uneventful history were admitted for progressive spastic paraparesia. MRI demonstrated a thoracic intramedullary cystic lesion at level T3-T4 in both patients. The cyst was emptied with partial cyst wall resection via dorsomedial myelotomy. The pathology examination confirmed the diagnosis of arachnoid cyst. The initial clinical signs resolved completely in both patients. CONCLUSION Thought in children, intramedullary arachnoidian cyst is a potential cause of medullary compression. Direct surgery is the treatment of choice.
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Affiliation(s)
- H Ghannane
- Service de neurochirurgie, hôpital Ibn-Tofail, CHU Mohammed-VI, Marrakech, Maroc.
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