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Sharma R, Kumarasamy S, Tiwary SK, Kedia S, Sawarkar D, Doddamani R, Laythalling RK. Multiple spinal extradural arachnoid cysts presenting as compressive myelopathy in a teenager: case report and literature review with special emphasis on postoperative spine deformity in the current minimally invasive era. Childs Nerv Syst 2024; 40:729-747. [PMID: 37917405 DOI: 10.1007/s00381-023-06183-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Multiple synchronous spinal extradural arachnoid cysts are extremely rare in children and can lead to cord compression and disability. Multiple spinal extradural arachnoid cysts (SEDACs) in children with immature and growing spine need to be studied separately from multiple SEDACs in adults with mature and fully grown spine because of multiple surgical limitations in children (blood loss, surgery duration, long-term spinal stability after long segment exposure, etc.). MATERIAL AND METHODS We planned a non-systematic literature review of similar cases described in literature to analyse the pattern of presentation, management, and outcome of this surgically curable disease. RESULTS A total of 28 cases of paediatric multiple SEDACs in the age range of 5 months to 17 years and mean age of 11.54 years were analysed. Exposure was achieved by laminectomy in 9, laminoplastic laminotomy in 13, laminectomy in first surgery followed by laminoplasty in second surgery (re-exploration) in 1, hemilaminectomy in 2, and technique "not reported" in 3 children. Complete/near-complete recovery was seen in 27 (96.42%) children. Postoperative spine deformity was reported in 7 (25%) children and was progressive in 2 children during serial follow-up. CONCLUSIONS Symptomatic multiple synchronous SEDACs in children is a rare surgically curable condition. Sincere attempt to find out a dural defect in all cysts is a very important step in multiple SEDAC surgery. Total cyst wall excision with closure of all dural defects is the gold standard treatment for symptomatic cases. Laminoplasty is preferred for excision of multiple SEDACs in children to prevent postoperative spine deformity during long-term follow-up. Long serial follow-up for postoperative spine deformity is necessary.
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Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
| | | | - Shashi Kala Tiwary
- Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Shweta Kedia
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India
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Sharma V, Bhaskar S, Tiwari S. Multiple Symptomatic Spinal Intradural Arachnoid Cysts: A Case Report. Asian J Neurosurg 2023; 18:696-697. [PMID: 38152537 PMCID: PMC10749836 DOI: 10.1055/s-0043-1774376] [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: 12/29/2023] Open
Abstract
A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region. Spinal arachnoid cysts may cause debilitating symptoms. The disease is completely curable if the detection and classification are early as in our case.
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Affiliation(s)
- Vikrant Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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El-Hajj VG, Edström E, Elmi-Terander A, Fletcher-Sandersjöö A. An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature. Acta Neurochir (Wien) 2023; 165:2699-2705. [PMID: 37526744 PMCID: PMC10477091 DOI: 10.1007/s00701-023-05732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
Spinal arachnoid cysts (SACs) arise either intra- or extradurally and are usually solitary, while cases of multiple SACs have been scarcely reported in the literature. Herein, we report on a rare case of multiple and recurring intradural spinal arachnoid cysts (SACs) causing severe spinal cord compression and neuropathic radicular pain, in a 35-year-old female with a 10-year follow-up. Two separate attempts at surgery were performed but only provided temporary relief since the cysts recurred and new ones formed along the entirety of the spinal cord. Finally, a conservative approach with physiotherapy and a combination of analgesic medications was pursued.
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Affiliation(s)
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Capio Spine Center Stockholm, Löwenströmska Hospital, Box 2074, 194 02, Upplands Väsby, Sweden.
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Horak VJ, Jimenez MJD, LoPresti MA, Raskin JS. Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23217. [PMID: 37581591 PMCID: PMC10555594 DOI: 10.3171/case23217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis. OBSERVATIONS The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old. LESSONS Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.
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Affiliation(s)
- Victoria Jane Horak
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and
| | - Med Jimson D. Jimenez
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois; and
| | - Melissa A. LoPresti
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | - Jeffrey S. Raskin
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
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Santipas B, Wejjakul W, Luksanapruksa P, Wilartratsami S. Nonfusion Muscle-Sparing Technique to Treat Long-Segment Thoracolumbar Extradural Arachnoid Cyst in a Child: A Case Report and Review of the Literature. World Neurosurg 2020; 142:222-226. [PMID: 32615296 DOI: 10.1016/j.wneu.2020.06.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Spinal extradural arachnoid cyst is an uncommon cause of spinal cord compression. It results from a small dural defect that leads to cerebrospinal fluid (CSF) accumulation in the cyst and subarachnoid space, and the cyst can compress the spinal cord and nerve roots. Surgery is the treatment of choice in symptomatic patients, and most cases have an immediately satisfying outcome after surgery. CASE DESCRIPTION A 10-year-old Thai boy presented with progressive weakness in both legs. Magnetic resonance imaging (MRI) demonstrated a giant cystic lesion 23 cm in length from T1-L2 level. To our knowledge, this is the longest arachnoid cyst that has been reported in children. The operation included unilateral paraspinal muscle dissection with spinous process translation techniques, T1-L4 laminectomy, total cyst excision, and dural defect repair at the T4 level. The symptoms were fully resolved within 2 months after surgery. However, thoracic kyphosis was slightly increased, but the patient still has a normal sagittal profile. CONCLUSIONS Spinal arachnoid cyst is rare, especially in children. Early diagnosis and treatment are essential for improving the chance of full recovery, and for avoiding complication and irreparable defect. Total cyst removal with dural repair remains the best treatment alternative; however, potential complications, especially spinal malalignment after extensive laminectomy, must be considered. Postoperative MRI showed normal CSF flow and no spinal cord compression. The muscle-sparing technique with multiple-level laminectomy without spinal fusion that we used in this case provided a satisfying outcome.
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Affiliation(s)
- Borriwat Santipas
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Witchuree Wejjakul
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panya Luksanapruksa
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Schmutzer M, Tonn JC, Zausinger S. Spinal intradural extramedullary arachnoid cysts in adults-operative therapy and clinical outcome. Acta Neurochir (Wien) 2020; 162:691-702. [PMID: 31813001 DOI: 10.1007/s00701-019-04156-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Spinal arachnoid cysts (SAC) are rare mostly idiopathic intradural lesions with compression of the spinal cord and clinical signs of radiculo- and/or myelopathy. We retrospectively analyzed radiological and clinical characteristics of patients with surgical treatment of SAC including a subgroup evaluation of long-term outcome and QoL. METHOD Patients with SAC treated between 1993 and 2017 were evaluated. Craniocaudal (c.c.) and anteroposterior (a.p) cyst diameters were measured pre- and post-OP. McCormick and Odom score for myelopathy, general outcome and QoL (SF-36, EORTC-QLQ30) were recorded. RESULTS A total of 72 patients (female:male = 1.9:1) were analyzed with mean FU of 44.8 ± 60 months (long-term data from 25 patients with FU 78.2 ± 63.9 months). All had surgery due to solitary cysts: 10 cervical (13.9%), 45 thoracic (62.5%), and 17 lumbosacral (23.6%), the majority (79.2%) located dorsally. Main symptoms were gait disturbance (80%), dysesthesia (64%) and paresis (80%). Patients had (hemi-)laminectomy with cyst fenestration in 48 (66.7%) and complete resection in 18 cases (25.0%). Four cases (5.5%) were treated by cystoperitoneal shunt, 2 by marsupialization (2.8%). In total, 11 revisions were necessary in 9/72 (12.5%) patients (one patient underwent 3 revisions). Two patients were reoperated for wound revision/epidural hematoma (each n = 1). Seven patients needed additional cyst wall resection after 1.5-31.0 months due to insufficient cyst shrinking and persistent clinical symptoms after first surgery; most of the cysts were multiple septated and of post-hemorrhagic origin. The mean c.c. size decreased from 5.2 ± 3.7 cm pre-OP to 2.7 ± 3.9 cm (p < 0.05); the a.p. diameter decreased from 1.0 ± 0.5 cm to 0.3 ± 0.3 cm (p < 0.0001) without significant differences between fenestration and resection. McCormick and Odom scores revealed improved symptoms, particularly of gait disturbance, sensory deficits, and general performance. Long-term FU displayed satisfying QoL performance without differences of fenestration or resection. CONCLUSION SAC mostly affect women and are predominantly located in the thoracic spine, becoming apparent with clinical myelopathy. For cysts without intracystic septae and compartments, both fenestration and resection of the cyst wall provided significant reduction of cyst size and clinical improvement.
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Paredes I, Munarriz PM, Toldos O, Castaño-León AM, Panero I, Eiriz C, García-Pérez D, Pérez-Núñez A, Lagares A, Alen JAF. True Dural Spinal Epidural Cysts: Report of 5 Cases. World Neurosurg 2019; 135:87-95. [PMID: 31841718 DOI: 10.1016/j.wneu.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Spinal arachnoid cysts are a rare cause of compressive myelopathy. Spinal extradural arachnoid cysts (SEACs) are even rarer. METHODS We retrospectively reviewed the SEACs operated on in our hospital between 2015 and 2019, according to their clinical and radiologic findings, treatments performed, and outcomes. RESULTS We identified 5 cases (2 males and 3 females), ranging in age from 21 months to 78 years. Except for the pediatric case, all patients presented with pain and 3 had some grade of neurologic impairment. Preoperative magnetic resonance imaging showed multiloculated cyst in 4 cases, and the communication with the dura was properly identified in only 1 case. The patients were operated through a laminectomy or laminoplasty and total removal of the cyst, and the communication with the dura was identified and repaired in all cases. In all cases, the defect was near the exit of a nerve root, and rootlets were seen through it, producing a ball-like valve mechanism. Histology of the cyst wall showed true dura in every case. One patient needed a reoperation for evacuation of a fluid collection (related to the dural sealant). Following Odom's criteria, 3 patients had an excellent outcome and 2 had a fair outcome. CONCLUSIONS Total excision of a symptomatic SEAC through either laminectomy or laminoplasty is a safe and effective treatment option. Although isolated repair of the dural communication without cyst removal may seem appealing, we have found it very difficult to identify the point of communication preoperatively.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain.
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Oscar Toldos
- Department of Pathology, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Carla Eiriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Angel Pérez-Núñez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - José Antonio F Alen
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
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Multiple Spinal Arachnoid Cysts in a Child. Pediatr Neurol 2016; 55:76-7. [PMID: 25987363 DOI: 10.1016/j.pediatrneurol.2015.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 12/30/2022]
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Hakky MM, Justaniah AI, David C, French RJ, Martin D, Kwok N, Erbay SH. The Neuroimaging Spectrum of Septum Posticum Derangement and Associated Thoracic Myelopathy. J Neuroimaging 2015; 25:818-23. [DOI: 10.1111/jon.12243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Michael M. Hakky
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | | | - Carlos David
- Department of Neurosurgery; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Robert J. French
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Dann Martin
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
| | - Nathan Kwok
- Tufts University School of Medicine; Boston Massachusetts
| | - Sami H. Erbay
- Department of Radiology; Lahey Clinic Medical Center; Burlington Massachusetts
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Abstract
Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.
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A symptomatic spinal extradural arachnoid cyst with lumbar disc herniation. Case Rep Orthop 2015; 2015:250710. [PMID: 25861499 PMCID: PMC4377437 DOI: 10.1155/2015/250710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/02/2015] [Indexed: 12/15/2022] Open
Abstract
Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.
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Abstract
Arachnoid cysts are a congenital disorder, and most cases begin during infancy; however, onset may be delayed until adolescence. Here we present an unusual case of atypical Paraplegia with Lymphoedema, with onset during adolescence and rapid progression in a young female patient who showed the characteristic appearance of cyst on magnetic resonance imaging (MRI) of spinal cord. This report intends to highlight paraplegia with lymphoedema, as a rare cause of spinal cord compression in pediatric population along with congenital defect manifestations and an interesting radiology finding of the disease.
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Tyagi HR, Kalra KL, Acharya S, Singh RP. Scalloping Sacral Arachnoid Cyst as a Cause of Perianal Pain- A Case Report. J Orthop Case Rep 2014; 4:28-32. [PMID: 27298955 PMCID: PMC4719369 DOI: 10.13107/jocr.2250-0685.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Scalloping sacral arachnoid cyst though a rare condition, should be suspected in cases of persistent perianal pain without any obvious urological or anorectal pathology. Such difficult cases justify ordering an M.R.I of spine as plain X-Rays and clinical examination may come out to be inconclusive. X-ray in later stages may show changes corresponding to scalloping of bone due pressure effect of cyst on surrounding tissue. Diagnosis may further be confirmed by doing contrast MRI which differentiates arachnoid cyst from other intradural and extradural pathologies. Though anatomically spinal arachnoid cysts are just an out pouching from the spinal meningeal sac or nerve root sheath they may be extradural or intradural in their location, communicating to main C.S.F column through their pedicle or an ostium leading to continuous enlargement in size. Case Report: A 32 year old female was admitted under our spine unit with 1.5 year history of chronic pain, swelling and reduced sensation in perianal region. On examination she had tenderness and hypoesthesia over lower sacral region. The pain was continuous, dull aching in nature, not related to activity, localized over lower sacrum and perianal area. The neurological examination of her both lower limbs were unremarkable. Anal tone and anal reflex were normal. No sign of inflammation or tenderness was found over coccyx. Since the X-rays were inconclusive an MRI scan was done which showed a cystic lesion in the sacral area extending from S2 to S4 region with mechanical scalloping effect on the surrounding bone. The lesion had same intensity as C.S.F in both T1 &T2 weighted images. The treatment was done by way of surgical decompression with complete excision of cyst and obliteration of space by a posterior midline approach. Presently the patient is 1 year post operative and no sign of recurrence is there. Conclusion: Sacral arachnoid cysts should be considered as a differential diagnosis of perianal pain. Large symptomatic sacral cysts should be treated early with complete removal of the cyst including the cyst wall, to reduce the chances of recurrence. Complete decompression of the cyst cavity should be aimed at, but careful dissection of neural element is of highest importance.
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Affiliation(s)
| | - Kashmiri Lal Kalra
- Dept. of Orthospine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India-110060
| | - Shankar Acharya
- Dept. of Orthospine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India-110060
| | - Rupinder Pal Singh
- Dept. of Orthospine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India-110060
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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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Seo JY, Oh IS, Son IN, Kim KW, Shin DC, Ha KY. Pancreatic cancer metastasis presenting as an arachnoid cyst of the cervical spine: a case report. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY 2012. [DOI: 10.1007/s00590-011-0788-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spinal extradural arachnoid cyst: Review of surgical techniques. J Clin Neurosci 2011; 18:559-60. [DOI: 10.1016/j.jocn.2010.07.126] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/04/2010] [Indexed: 12/17/2022]
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