Dural Repair for Intraspinal Extradural Meningeal Cyst -Case Report-

Extradural thoracic meningeal cyst without spinal dysraphism causing adulthood myelopathy: Case illustration and review of the literature

Extradural spinal meningeal cysts are rare lesions in the adult spine and are an uncommon cause of neurologic deficits. We present the case of an adult who presented with myelopathic symptoms related to a dorsally based extradural thoracic meningeal cyst in the absence of any defect in the posterior spinal elements and no history of spinal dysraphism or trauma. We also performed a review of the literature to evaluate the surgical techniques for extradural meningeal cysts. Most thoracic cysts are intradural arachnoid cysts, yet this lesion is an extradural meningeal cyst, not an intradural arachnoid cyst. Because of the rarity of this lesion, its anatomic characterization can be difficult to conceptualize. An artist's illustration helps illustrate the anatomic characteristics of this cyst and our surgical management.

Traumatic fracture of thin pedicles secondary to extradural meningeal cyst

Spinal dural meningoceles and diverticula are meningeal cysts that have a myriad of clinical presentations and sequelae, secondary to local mass effect. Our objective is to report a technical case report, illustrating a traumatic spinal injury with multiple pedicle fractures, secondary to atrophic lumbar pedicles as well as the diagnostic workup and surgical management of this problem. Posterior lumbar decompression, resection of the meningeal cyst, ligation of the cyst ostium, instrumentation, and fusion were performed with the assistance of intraoperative isocentric fluoroscopy. The cyst's point of communication was successfully located with intraoperative fluoroscopy and the lesion was successfully excised. We suggest that patients with traumatic spinal injuries, having evidence of pre-existing anomalous bony architecture, undergo advanced imaging studies, to rule out intraspinal pathology. The positive clinical and radiographic results support the removal and closure of the pre-existing meningeal cyst at the time of treatment of traumatic spinal injury. Intraoperative isocentric fluoroscopy is a helpful tool in the operative management of these lesions.

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

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