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Parapati VR, Divakar G, Hv E, Matham G, Kesavapisharady K, Stanley A. Pediatric spinal arachnoid cysts with compressive myelopathy: single-center experience and update on surgical management. Childs Nerv Syst 2024:10.1007/s00381-024-06605-3. [PMID: 39249509 DOI: 10.1007/s00381-024-06605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. METHODS We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. RESULTS There were 10 males and seven females with a mean age of 10.4 years (range:6-14 years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. CONCLUSION Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.
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Affiliation(s)
- Vamshi Reddy Parapati
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Ganesh Divakar
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India.
| | - Easwer Hv
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Gowtham Matham
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Krishnakumar Kesavapisharady
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
| | - Antony Stanley
- Neurosurgery Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
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Diyora B, Purandare A, Devani K, Palave P, Dhall G, Gawali S. Spinal Arachnoid Cysts-Our Experience. Asian J Neurosurg 2024; 19:362-368. [PMID: 39205909 PMCID: PMC11349412 DOI: 10.1055/s-0043-1772825] [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: 09/04/2024] Open
Abstract
Introduction Spinal arachnoid cysts are rare. Most of these lesions are located in the thoracic and thoracolumbar regions. Magnetic resonance imaging is a valuable tool for understanding their location and provides important information regarding their origin and expansion. The aim of our study was to evaluate the demographics, presentations, surgical management, and outcome of a spinal arachnoid cyst. Materials and Methods All the patients from January 2003 to December 2021 who were symptomatic for spinal arachnoid cysts were taken for study. A retrospective analysis was performed. Radiological investigations were performed, and patients were graded according to the Nabors classification. Operative results were graded according to surgical technique. Results The study included 22 patients, 11 female and 11 male patients, with a male-to-female ratio of approximately 1:1. The mean age of presentation was 34.7 years (4-60 years). Of 22 patients, 15 have intradural arachnoid cysts, 7 have an intradural extramedullary arachnoid cyst, and 8 have an intramedullary arachnoid cyst. Symptoms varied from weakness in the lower limbs (50%), quadriparesis and spasticity (32%), bladder/bowel incontinence (14%), and pain (10%). Out of 22 patients, complete cyst excision was performed in 17 patients, marsupialization in 4 patients, and cystic-subarachnoid shunt in one patient. Weakness and spasticity gradually recovered over a period of time. At 1-year follow-up, all the patients had complete improvement in their weakness, spasticity, and bladder functions. No recurrence of the cyst was seen at 1-year follow-up. Conclusion Spinal arachnoid cysts are very rare in the spinal cord. Most of the lesions are located in the thoracic and thoracolumbar regions. Asymptomatic cyst requires counseling and conservative management, whereas symptomatic cyst, if operated on with surgical expertise, recurrence and complications are very low. The best surgical technique for operating these spinal arachnoid cysts is still under question, but symptom improvement is seen in all operative procedures.
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Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Anup Purandare
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Kavin Devani
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Prakash Palave
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Gagan Dhall
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sagar Gawali
- Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
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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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Mehrotra A, Singh K, Kanjilal S, Dikshit P, Kumar A, Verma PK, Das KK, Jaiswal AK, Kumar R. Expanding the Horizons of Minimally Invasive Spine Surgery: Experience of the Destandau Technique for the Treatment of Multiple Spinal Diseases. World Neurosurg 2024; 181:e970-e977. [PMID: 37951463 DOI: 10.1016/j.wneu.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Minimally invasive spine surgery is rapidly gaining popularity because of its versatile nature. Traditionally, prolapsed disc has been the most common disease targeted using this technique. However, its usefulness for various other diseases has also been shown in studies. We present our experience of using this technique for various spinal diseases apart from prolapsed discs. METHODS This is a retrospective study in which patients operated on by a single surgeon from January 2019 to April 2023 were included. Cases that required conversion to open technique were excluded. Intraoperative findings and postoperative courses were obtained from patient records. RESULTS A total of 47 patients were included in the study, of whom 29 were male and 18 were female. The various diseases treated comprised intradural extramedullary (IDEM) tumors (n = 23), hypertrophied/ossified ligamentum flavum (n = 9), arachnoid cysts (n = 6), dermoid/epidermoid cysts (n = 4), detethering of cord (n = 3), and posterior cervical decompression for an ossified posterior longitudinal ligament (n = 2). The average duration of surgery was 2.1 ± 1.2 hours and the mean intraoperative blood loss was 138.4 ± 59.1 mL. The mean length of hospital stay was 2.3 ± 0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients. CONCLUSIONS Minimally invasive techniques for dealing with multiple diseases involving the spine are as good as traditional open techniques, with some additional advantages of lesser tissue trauma, early return to work, and so on. However, one must overcome the steep learning curve before adopting them in day-to-day practice.
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Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Kavindra Singh
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Joseph J, Raju KP, Jonathan E, Makkina C. Spinal Arachnoid Cyst Analysis of Surgical Experience in a Single Tertiary Care Centre and Review of Literature. World Neurosurg 2023; 178:e731-e740. [PMID: 37544604 DOI: 10.1016/j.wneu.2023.07.151] [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: 04/15/2023] [Revised: 07/30/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE To study patients with spinal arachnoid cysts, who underwent cyst excision with dural defect repair or marsupialization, and their outcomes. METHODS The retrospective analysis involved reviewing the records of 38 patients who underwent surgical treatment for spinal arachnoid cysts in the Department of Neurosurgery at Christian Medical College, Vellore, between August 2004 and December 2022. The study examined the demographics, clinical presentation, imaging, surgical intervention, and outcomes of these patients. RESULTS The majority of patients in the study were male (29/38, with 76.3%) and the thoracic region was the most common location for the cyst (17, with 44.7%). Weakness was the primary complaint and 94.7% of patients had myelopathy. The bladder was affected in 13 patients (34.2%). Of the 38 patients, 26 (71%) had cysts in extradural locations, while the rest were intradural. In total, 45.5% of intradural cysts were located in the ventral region. Seventeen (65.4%) had dural defects along the root sleeve and 29 (76.3%) underwent complete excision. All extradural cysts underwent complete excision and repair of the dural defect. Thirty patients (78.9%) experienced improved outcomes with reduced spasticity and improved weakness. One patient developed new-onset weakness postoperatively due to epidural hematoma. The mean follow-up period was 41 months and one patient experienced a recurrence. CONCLUSIONS Spinal arachnoid cyst is a rare benign spinal condition that is typically treated with surgery in symptomatic patients. Surgical intervention may involve either the excision of the cyst or marsupialization.
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Affiliation(s)
- Jeena Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Krishna Prabhu Raju
- Department of Neurological Sciences, Christian Medical College, Vellore, India.
| | - Edmond Jonathan
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | - Charan Makkina
- Department of Neurological Sciences, Christian Medical College, Vellore, India
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6
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Afana HB, Kananeh SF, Duraisamy R, Farah A, Figueiredo N. Long-Term Recurrent Intramedullary Arachnoid Cyst: Case Report and Literature Review. Asian J Neurosurg 2023; 18:667-675. [PMID: 38152523 PMCID: PMC10749842 DOI: 10.1055/s-0043-1774380] [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
Objectives This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to an intramedullary arachnoid cyst (IMAC). For literature review, the authors used the phrase "intramedullary arachnoid cyst" in PubMed search engine. 23 articles describing cases with IMAC were included in this review, with a total of 26 patients. Materials and Methods We report a case with long term recurrant intramedullary arachnoid cyst and present a review on spinal intramedullary arachnoid cyst. Result IMAC is showing bimodal incidence and trending to occur below 10 years and after 30 years. However, rarely, it should be considered in the differential diagnosis of intramedullary cystic lesions. Authors suggest doing laminoplasty or fusion for the pediatric patients to prevent kyphoscoliosis deformity in the long run, but doing early surgery to gain better outcome. Resection of the cyst wall should be done as much as possible; if it could not be achieved, then marsupialization or cysto-subarachnoid shunt should be considered. Aspiration alone or fenestration is not enough to eradicate the cyst. Long-term and prospective studies are recommended to achieve the best treatment options. Conclusion Review supports early surgical treatment of symptomatic IMACs with resection of the cyst wall as much as possible.
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Affiliation(s)
- Hatem B. Afana
- Departments of Orthopaedic and Spine Surgery, King's College Hospital London, Dubai, UAE
| | - Salman F.M. Kananeh
- Internal Medicine, Capital Health Regional Medical Center, Trenton, New Jersey, United States
| | | | - Abdulkadir Farah
- Department of Radiology, Medcare Orthopaedic and Spine Hospital, Dubai, UAE
| | - Nicandro Figueiredo
- Departments of Orthopaedic and Spine Surgery, King's College Hospital London, Dubai, UAE
- Medical School, University of Cuiaba (UNIC), Cuiaba, MT, Brazil
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
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Huang H, Wei M, Zhou Q, Peng R, Ding X, Xi J. Spinal extradural arachnoid cysts: A novel formation mechanism and dural defect location technology. Heliyon 2023; 9:e12969. [PMID: 36820184 PMCID: PMC9938496 DOI: 10.1016/j.heliyon.2023.e12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose The formation mechanism of spinal extradural arachnoid cysts (SEACs) remains unclear. There are several hypotheses for the formation of SEACs, but none of them can fully explain its pathological findings and surgical procedures. In this study, we retrospectively analyzed the cases of SEACs, aiming to clarify the formation mechanism of SEACs. In addition, we summarize a concise method for locating dural defects preoperatively and formulate a putative explanation of this method. Methods The clinical data of 14 patients with SEACs underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed. Results Fourteen patients were identified during the study period. The cysts all spanned the T12/L1 segment, and dural defects were also located at the T12/L1 level (2 cases not recorded) as well as the middle or the upper-middle level of the cysts. Nine cases were treated with total cyst excision, 2 cases were treated with dural defect closure only, and 3 cases were treated with total cyst excision and dural defect closure. Histopathological examination demonstrated that the cyst wall contained both the arachnoid epithelial and compact fibrous connective tissue. The symptoms were relieved in all patients, and no recurrence was observed. Conclusions According to intraoperative and pathological findings, the dural outer layer cyst (DOLC) is a more reasonable hypothesis about SEACs formation. When CT myelography or cinematic MRI cannot determine the location of the dural defect preoperatively, it can be located according to the middle level of the SEACs with high accuracy.
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Affiliation(s)
- He Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Min Wei
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Quanwei Zhou
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Renjun Peng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xiping Ding
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xi
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Corresponding author. Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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Thoracic spinal arachnoid cyst in a pediatric patient presenting with isolated bladder and bowel incontinence. Urol Case Rep 2022; 44:102129. [PMID: 35800148 PMCID: PMC9253583 DOI: 10.1016/j.eucr.2022.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/03/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
Spinal arachnoid cysts (SAC) are uncommon benign spinal cord lesions, particularly in children, that can result in a variety of neurologic symptoms, including neurogenic bladder. Here we present the case of a 7-year-old female with new onset, isolated urinary and stool incontinence who was found to have a T4-T7 SAC. Though this was initially believed to be an incidental imaging finding, after thorough work-up and persistence of her symptoms despite conservative measures she underwent neurosurgical intervention with complete resolution of incontinence. SAC represents a very rare but potentially reversible cause of neurogenic bladder that the urologist should be aware of.
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Imperato A, Cinalli MA, Iammarrone FS, Ruggiero C, Cinalli G. Minimally invasive endoscopic fenestration of a spinal arachnoid cyst in a child with tetrasomy 18p: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21682. [PMID: 35734234 PMCID: PMC9204922 DOI: 10.3171/case21682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/13/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Spinal arachnoid cysts (SAC) are rare, especially in children. Patients can be asymptomatic or present symptoms of spinal cord compression. In this latter case, surgery is indicated to relieve the compression. Different surgical techniques have been described to treat these cysts, endoscopic or endoscopy-assisted fenestration being the least invasive. Tetrasomy 18p describes the condition in which two copies of the short arms of chromosome 18 are present. It is an extremely rare pathology with a variable phenotype, including 100% of cases cognitive impairment and developmental delay. Different central nervous system (CNS) abnormalities have been found in these patients. OBSERVATIONS The authors describe the case of a 3-year-old boy with a tetrasomy 18p and a wide spinal arachnoid cyst that received an endoscope-assisted treatment with a significantly improved motor outcome. LESSONS Tetrasomy 18p is an extremely rare pathology and different CNS abnormalities have been described in association with, but to date spinal arachnoid cyst has never been reported. These children typically show global hypotonia and cognitive impairment. The authors recommend a thorough neurological assessment with cranio-spinal magnetic resonance imaging to rule out any possible malformation that could be improved by surgery.
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Affiliation(s)
- Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Maria Allegra Cinalli
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
- Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy; and
| | - Fernanda Servodio Iammarrone
- Department of Neurosciences, Intensive rehabilitation and Neurorehabilitation Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Claudio Ruggiero
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, Naples, Italy
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Ventral Intrameningeal Cyst Treatment and Management: Technical Note. World Neurosurg 2022; 164:156-158. [PMID: 35525438 DOI: 10.1016/j.wneu.2022.04.117] [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: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. To the authors' knowledge, no such descriptions exist regarding purely dural-based cystic lesions; however, the authors hypothesize similar mechanisms may be involved. Most notably, a traumatic injury to the dura leading to a one-way valve mechanism may allow for egress of cerebrospinal fluid (CSF) between the dural layers, splitting them open. This progressive enlargement can lead to displacement of neural elements and subsequent neurological compromise. METHODS We describe a 17-year-old girl who presented with progressive neck and back pain, left-upper extremity numbness, bilateral lower-extremity weakness, paresthesias, and numbness without obvious etiology despite an extensive neurologic investigation. She had undergone conservative management options including multiple medications, physical and chiropractic therapy, and epidural steroid injections. Computed tomography myelography revealed a CSF leak into the lumbar epidural space for which surgical exploration was performed. Despite utilizing fluoroscopy and intrathecal fluorescein, no leak source was identified. Fluid collection was found contained within the dural layers rather than the epidural space. RESULTS An intracystic blood patch was performed with near-complete resolution of the lesion by 6-week follow-up and near-complete return of neurologic function. CONCLUSION Ventral panspinal cysts are an exceedingly rare cause of radiculopathy and myelopathy that can be resolved by an intracystic blood patch.
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Ordaz JD, Huh A, Desai V, Raskin JS. Iatrogenic Spinal Deformity Following Spinal Intradural Arachnoid Cyst Fenestration Despite Minimal Access With Laminoplasty and Endoscopy in a Pediatric Patient. Cureus 2022; 14:e22053. [PMID: 35295352 PMCID: PMC8916916 DOI: 10.7759/cureus.22053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/22/2022] Open
Abstract
Spinal intradural arachnoid cysts (SAC) are non-neoplastic lesions that can cause spinal cord compression and present with myelopathy, radiculopathy, and/or back pain. Because these cysts typically span multiple levels, endoscopy could be a useful tool to avoid wide exposure. We present an 8-year-old patient with a history of gait imbalance and urinary incontinence who was found to have a SAC spanning C7 to T6 causing spinal cord compression. An osteoplastic laminoplasty was performed from T4 to T7 followed by ultrasonic verification of intracystic septations, dural opening, and cyst fenestration. A flexible endoscope was then introduced into the cystic cavity to guide complete rostral and caudal decompression of the arachnoid cyst. At six months follow-up, the patient was able to ambulate independently, but his urinary incontinence remained unchanged. Despite the combination of ultrasound and neuroendoscopy to minimize exposure, our patient suffered from worsening kyphosis from 36 degrees preoperative to 55 degrees postoperative and worsening scoliosis from 17 to 39 degrees which required treatment with a thoracolumbar sacral orthosis. Preoperative imaging demonstrated a reverse S-shaped scoliosis with the apex at T6 and T7 which were the levels included in the laminoplasty. This illustrates the need for careful preoperative risk stratification to avoid this postoperative complication.
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Patil AK, Swain SK, Sharma S, Arora RK, Sharma A, Arora P, Mittal RS. Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1731623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs.
Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome.
Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome.
Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome.
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Affiliation(s)
- Aditya K. Patil
- Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Srikant K. Swain
- Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Suresh Sharma
- College of Nursing, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Achal Sharma
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Poonam Arora
- Department of Emergency Medicine, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Radhey S. Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
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13
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Zhang P, Liu H, Sun Z, Guo Y, Wang G, Wang JJ. Ultrafine Flexible endoscope visualization to assist in the removal of a huge spinal extradural arachnoid cyst: a case report and literature review. World Neurosurg 2021; 159:130-133. [PMID: 34973437 DOI: 10.1016/j.wneu.2021.12.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Peihai Zhang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China.
| | - Huiting Liu
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Zhenxin Sun
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Yi Guo
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - Guihuai Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
| | - James Jin Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University , Beijing 102218 China
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14
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Chan JL, Tan ALJ, Ng LP, Low DCY, Wan Tew S, Low SYY. Paediatric arachnoid cysts: Surgical outcomes from a Singapore children's hospital. J Clin Neurosci 2021; 85:122-131. [PMID: 33581782 DOI: 10.1016/j.jocn.2020.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/13/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022]
Abstract
Arachnoid cysts (AC) are reported to have a prevalence of up to 2.6% in children. Most AC remain indolent, but others may expand or rupture to cause life-threatening symptoms of raised intracranial pressure. Currently, there are 2 controversial topics with regards to the management of ACs: the indications for surgery and the choice of surgical procedure. We therein report our institution's neurosurgical experience for symptomatic AC over a 22-year period and corroborate our results with published literature. This is a single institution, retrospective study conducted at KK Women's and Children's Hospital from 01 January 1998 to 31 December 2019. A total of 38 patients with ACs that required surgery were recruited. The 3 most common anatomical locations were in the middle cranial fossa (40.5%), posterior fossa (24.3%) and interhemispheric (13.5%). Typical clinical presentations included symptoms of raised intracranial pressure (34.2%), obstructive hydrocephalus (28.9%) and AC rupture (21.1%). Surgical approaches included 17 craniotomy-based procedures, 7 endoscopic fenestrations, 11 cystoperitoneal shunts, 2 burrhole drainage operations and 1 excision of spinal AC. Thirteen patients (34.2%) underwent either another operation due to the lack of resolution of their AC-related symptoms or secondary to complications directly related to their initial surgery. Average length of followup from time of first operation was 84.1 months. Overall, our results demonstrate similarities in epidemiology, clinical presentation and surgical experience, in comparison to larger cohort studies. We advocate collaborative efforts to better understanding of the pathophysiology of paediatric ACs, particularly for deciding between the various surgical treatment modalities.
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Affiliation(s)
- Jasmine L Chan
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Audrey L J Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; Singhealth Duke-NUS Neuroscience Academic Clinical Program, National Neuroscience Institute, 11, Jalan Tan Tock Seng, 308433, Singapore
| | - Seow Wan Tew
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; Singhealth Duke-NUS Neuroscience Academic Clinical Program, National Neuroscience Institute, 11, Jalan Tan Tock Seng, 308433, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; Singhealth Duke-NUS Neuroscience Academic Clinical Program, National Neuroscience Institute, 11, Jalan Tan Tock Seng, 308433, Singapore.
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15
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Yoo KH, Kim MC, Ju CI, Kim SW. Extradural Spinal Arachnoid Cyst as a Cause of Cauda Equina Syndrome in a Child. Korean J Neurotrauma 2020; 16:355-359. [PMID: 33163450 PMCID: PMC7607013 DOI: 10.13004/kjnt.2020.16.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022] Open
Abstract
Although spinal arachnoid cysts are relatively common findings observed incidentally in adults, they are much rarely reported in children. They are usually asymptomatic and are mainly located in the middle and lower thoracic regions. However, in rare circumstances, these cysts can cause mass effects that lead to neurologic symptoms. We report the rare case of a spinal extradural arachnoid cyst in a 12-year-old boy who showed signs and symptoms of cauda equina syndrome. Magnetic resonance imaging of the lumbar spine revealed a huge extradural arachnoid cyst extending from L2 to L5. Emergent laminectomy and repair of dural defect was performed after total resection of the extradural arachnoid cyst. There were no postoperative complications. Total recovery was achieved 6 months after surgery. Here, we report this rare case with a review of the literature.
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Affiliation(s)
- Kyoung Hwan Yoo
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Min Chan Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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16
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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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Tang W, Shao T, Guan F, Zhang Z, Gao Q, Guan G, Hu Y, Sun W, Fu G, Li G, Gu J, Yu Z. Transdural Approach to Resection of Intraspinal Extradural Ventral Cysts in the Lumbar Spine. World Neurosurg 2020; 140:347-352. [PMID: 32434012 DOI: 10.1016/j.wneu.2020.05.110] [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: 04/26/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intraspinal extradural ventral cysts in the lumbar spine can cause back pain and neurological deficits of the lower extremities. For the resection of this type of space-occupying lesion, the transdural approach has not been reported in the literature. CASE DESCRIPTION A 66-year-old man presented, suffering from progressive radiation pain of his bilateral lower extremities. Imaging examination revealed a cystic lesion in ventral side of lumbar spinal canal. We conducted the excision of the cyst with the transdural approach. The symptoms of the patient disappeared immediately after the operation and recurrence of the symptoms has not been observed in the 3-month follow-up. CONCLUSIONS This operation approach is safe and effective. Compared with the previous surgical approach reported in the literature, by this approach surgeons could achieve less injury, shorter operation time, and the same surgical outcomes in the short term. Therefore, we would like to present this approach to provide an alternative to deal with similar lesions.
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Affiliation(s)
- Weilong Tang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tuo Shao
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fulin Guan
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhizhuang Zhang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qichang Gao
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guofa Guan
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhang Hu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wencheng Sun
- The Hulunbuir Second People's Hospital, Hulunbuir, China
| | - Guomin Fu
- Moqi People's Hospital, Hulunbuir, China
| | - Guozhong Li
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaao Gu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Zhange Yu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Ichinose T, Miyashita K, Tanaka S, Oikawa N, Oishi M, Nambu I, Kinoshita M, Nakada M. Recurrent Spinal Intramedullary Arachnoid Cyst: Case Report and Literature Review. World Neurosurg 2020; 138:68-72. [PMID: 32142944 DOI: 10.1016/j.wneu.2020.02.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Symptomatic intramedullary arachnoid cysts are rarely observed lesions, particularly in the pediatric age group. Treatment includes cyst fenestration or resection of the cyst wall, and recurrence after surgery has never been reported. We report a rare case of a spinal intramedullary arachnoid cyst, which recurred after cyst fenestration and required reoperation after a certain period. CASE DESCRIPTION A 4-year-old boy presented to our hospital with tetraparesis and bladder and rectum disorder. A cystic intramedullary lesion in the cervical spinal cord was detected in preoperative imaging. An emergency fenestration of cyst was performed, and his symptoms were resolved immediately. One month after the operation, the symptoms and cyst recurred. The symptoms improved in the natural course without reoperation. However, the cyst increased in size and the symptoms recurred after 27 months from the first relapse and the cyst was removed urgently. The diagnosis was an arachnoid cyst. After the reoperation, the cyst has disappeared and not recurred. CONCLUSIONS To the best of our knowledge, this is the first report of recurrence of an intramedullary arachnoid cyst. This case indicates the importance of considering the resection of cyst wall as possible because of the probability of cyst recurrence after fenestration, while careful observation is the option in the short term, especially for children or high-risk cases.
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Affiliation(s)
- Toshiya Ichinose
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | | | - Shingo Tanaka
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Nozomu Oikawa
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Iku Nambu
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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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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20
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Han S, Choi SW, Park BS, Lim JW, Kim SH, Youm JY. Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst. Korean J Neurotrauma 2019; 15:214-220. [PMID: 31720280 PMCID: PMC6826104 DOI: 10.13004/kjnt.2019.15.e31] [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: 08/19/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 11/15/2022] Open
Abstract
We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.
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Affiliation(s)
- Sanghyun Han
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Bum-Soo Park
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jeong-Wook Lim
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Jin-Young Youm
- Department of Neurosurgery, Chungnam National University Hospital, School of Medicine, Chungnam National University, Daejeon, Korea
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21
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Patankar AP. Spinal intradural arachnoid cyst associated with diastematomyelia in an adult: a case report and review of literature. Br J Neurosurg 2019:1-3. [DOI: 10.1080/02688697.2019.1666087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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22
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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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23
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Kaloostian SW, Vartanian TK, Ordookhanian C, Vartanian T, Kaloostian PE. Recurrent Caterpillar-like Arachnoid Cysts Following Initial Resection: A Unique Presentation of a Disorder Where the Limits of Modern Medicine Are Reached. Cureus 2019; 11:e3946. [PMID: 30937244 PMCID: PMC6433457 DOI: 10.7759/cureus.3946] [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: 11/21/2022] Open
Abstract
Of the many emergent neurological cases presenting to the emergency department (ED) and operating room (OR) for resection, arachnoid cysts are amongst one of the rarer pathologies. The proper resection of arachnoid cysts has substantially decreased the risk of recurrence. Current medicinal and surgical approaches have been refined over the years and prove to be successful for many patients. Where current practices begin to fail is during the treatment of complex and rare cases, such as the one presented in this manuscript. The commonly accepted surgical practices that were utilized to aid in the management of our patient, who initially presented with a simple arachnoid cyst, unexpectedly resulted in the further development of additional arachnoid cysts, a very rare occurrence, and a complication that should be discussed amongst all specialists in the hope of identifying more focused, novel, and less-invasive approaches to cyst removal and recurrence prevention.
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Affiliation(s)
| | - Tara K Vartanian
- Internal Medicine, White Memorial Medical Center, Los Angeles, USA
| | | | - Talia Vartanian
- Physical Medicine and Rehabilitation, University of Southern California, Pomona, USA
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Diyora B, Bhende B, Dhall G, Patil A, Nayak N. Ventral Craniovertebral Junction Arachnoid Cyst in an Elderly Patient-A Case Report of a Unique Occurrence at Extremes of Age. World Neurosurg 2018; 122:577-582. [PMID: 30472283 DOI: 10.1016/j.wneu.2018.11.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Craniovertebral junction arachnoid cysts are uncommon. Among those reported, ventrally located arachnoid cysts at the extremes of age have been even rarer. We report a successfully managed case of a ventrally placed arachnoid cyst in an 88-year-old man using an unconventional surgical approach. CASE DESCRIPTION An 88-year-old man presented to us with complaints of tingling and numbness in both upper and lower limbs. He had a weak handgrip on both sides. Spinal magnetic resonance imaging (MRI) showed a non-contrast-enhancing cystic lesion over the anterior lip of the foreman magnum that had displaced the cervicomedullary junction posteriorly. The lesion was homogenously hypointense on T1-weighted MRI and hyperintense on T2-weighted MRI. The lesion was excised using a posterior approach. The cyst contents were drained, followed by complete wall excision. Complete improvement in clinical symptoms and an absence of neurological deficits were noted in the patient. CONCLUSION Arachnoid cysts are congenital lesions and can present at the extremes of age. Ventrally placed small symptomatic arachnoid cysts can be managed successfully through the posterior approach, especially in the elderly population.
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Affiliation(s)
- Batuk Diyora
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India.
| | - Bhagyashri Bhende
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Gagan Dhall
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Aditya Patil
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
| | - Naren Nayak
- Department of Neurosurgery, Lokmanya Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India
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25
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Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery. Appl Bionics Biomech 2018; 2018:7435746. [PMID: 30116296 PMCID: PMC6079604 DOI: 10.1155/2018/7435746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
Recent studies of robotic rehabilitation have demonstrated its efficacy for neurological disorders. However, few studies have used the Hybrid Assistive Limb (HAL) during the early postoperative stage of spine disorders. We aimed to evaluate the safety and efficacy of HAL treatment during the early postoperative period for spine disorder patients. We retrospectively identified patients who underwent spine surgery and who could complete HAL treatment. We evaluated the 10-m walking test (10MWT), the modified Gait Abnormality Rating Scale (GARS-M), Barthel Index (BI), and the walking index for spinal cord injury II (WISCI II) score results before and after robotic rehabilitation. Clinical outcomes were compared after treatment. We included nine patients with various spine problems. After HAL treatment, the speed during the 10MWT significantly improved from 64.1 ± 16.0 to 74.8 ± 10.8 m/min, and the walking cadence decreased from 102.7 ± 17.6 to 92.7 ± 10.9 steps/min. The BI score also improved from 83.3 ± 16.0 to 95.6 ± 5.8, and the WISCI II score improved from 19.7 ± 0.5 to 20.0 ± 0.0. Furthermore, the total GARS-M score improved from 6.0 ± 5.7 to 2.3 ± 3.3. The maximum angles of the trunk swing were improved from 2.2 ± 1.9 to 1.2 ± 0.9 degrees. Neurorehabilitation therapy using HAL for spinal surgery patients was considered feasible following spine surgery.
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26
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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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27
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Satyarthee GD. Pediatric Symptomatic Sacral Extradural Arachnoid Cyst: Surgical Management Review. J Pediatr Neurosci 2018; 13:211-213. [PMID: 30090139 PMCID: PMC6057208 DOI: 10.4103/jpn.jpn_93_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Spinal arachnoid cyst (SAC) constitutes about less than 1% of all spinal tumors. It commonly occurs in third to fifth decades of life and mostly located in the thoracic region. Sacral extradural arachnoid cyst in the pediatric age group is an extremely rare location of occurrence. A such rare case of extradural arvwachnoid cyst of the sacral region, who presented with urinary incontinence is reported. The patient was managed surgically with laminectomy at S1–S3 vertebral level and complete excision of the extradural sacral arachnoid cyst with closure of transdural communication. The patient tolerated surgical procedure very well with regained bladder sphincter control at 6 months of follow-up. Early diagnosis and surgery are recommended for the treatment of symptomatic pediatric sacral arachnoid cysts.
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28
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Li L, Ali M, Menezes AH, Dlouhy BJ. Intracranial extradural arachnoid cyst in a child. Childs Nerv Syst 2017; 33:2201-2204. [PMID: 28744688 DOI: 10.1007/s00381-017-3556-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/19/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Arachnoid cysts are benign developmental anomalies of arachnoid membrane origin that can occur anywhere along the neuro-axis. They are believed to develop from the splitting or duplication of the arachnoid membrane by CSF that is trapped by a ball-valve mechanism. Intracranial arachnoid cysts have only been described as intradural lesions while spinal arachnoid cysts can be both intradural or extradural. CASE REPORT After an extensive literature review, we report the first case of an intracranial, extradural arachnoid cyst in a 5-yearold girl. The child presented with a 2-week history of suspected seizure-like activity and imaging revealed a large midline extradural CSF-containing arachnoid cyst causing severe compression of the superior sagittal sinus and underlying brain. Venous flow through the sagittal sinus was nearly obliterated. Osseous changes and bone growth adjacent to the cyst was also noted on imaging and intraoperatively. She underwent a bifrontal craniotomy and cyst excision with decompression of underlying brain and reestablishment of venous flow through the sagittal sinus.
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Affiliation(s)
- Luyuan Li
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Muhammad Ali
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Brian J Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, 200 Hawkins Drive, Iowa City, IA, 52242, USA. .,University of Iowa Carver College of Medicine, Pappajohn Biomedical Institute, Iowa City, IA, 52242, USA.
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Clinical and Radiographical Differences Between Thoracic Idiopathic Spinal Cord Herniation and Spinal Arachnoid Cyst. Spine (Phila Pa 1976) 2017; 42:E963-E968. [PMID: 27926670 DOI: 10.1097/brs.0000000000002013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, multicenter, case-controlled study. OBJECTIVE The aim of this study was to investigate the clinical and radiographical differences between thoracic idiopathic spinal cord herniation (ISCH) and spinal arachnoid cyst (SAC). SUMMARY OF BACKGROUND DATA ISCH and SAC are relatively rare diseases. Preoperative misdiagnose was frequently reported in both; however, these clinical and radiographical differences remain unclear. METHODS Of 30,469 patients who underwent spinal surgery, 18 (0.059%) and 22 (0.072%) patients were diagnosed as ISCH or SAC at nine hospitals, respectively, and their clinical and radiographical data were retrospectively evaluated. The spinal cord kink angle was measured on magnetic resonance or computed tomography myelography sagittal images; the kink angle was the exterior angle formed between the two tangents to the dorsal-side inflection points at the maximally affected level. RESULTS There were no significant differences in age, gender, and duration of symptoms. Preoperative motor deficit was significantly higher (94.4%) and severer (manual muscle testing: 3.1 ± 1.1) in ISCH. Brown-Séquard syndrome was observed in 38.9% of ISCH, while no patients in SAC. In addition, leg sensory disorder and bladder rectal disorder were significantly more common in ISCH, while back pain was significantly frequent in SAC. With respect to radiographical findings, the length of disease (5.1 ± 2.7 levels) and altered cerebrospinal flow (CSF) (81.8%) in the lesion was significantly longer and more common in SAC. On the contrary, the kink angle was significantly greater in ISCH (54.0 ± 23.1°) than in SAC (14.1 ± 12.0°) (P < 0.001). The cut-off value of the kink angle to distinguish ISCH and SAC was 32.8°. CONCLUSION Patients with ISCH commonly had severe preoperative neurological deficit, Brown-Séquard syndrome, and higher kink angle, while patients with SAC had back pain, longer length of disease, and altered CSF in the lesion. LEVEL OF EVIDENCE 4.
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Uncommon Disorders Masquerading as Acute Flaccid Paralysis in Children. Indian J Pediatr 2017; 84:315-321. [PMID: 28000111 DOI: 10.1007/s12098-016-2276-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
The syndrome of acute flaccid paralysis (AFP) is a common medical emergency in children. In the era of poliomyelitis eradication, the common causes of AFP include Guillain-Barré syndrome (GBS), transverse myelitis and traumatic neuritis. However, many common diseases can uncommonly present as AFP and some uncommon diseases may also masquerade like it. Uncommon causes of AFP seen at a tertiary care pediatric hospital are discussed along with relevant points in diagnosis and management. Also, common pitfalls in diagnosis of pediatric AFP and an approach to investigations are discussed.
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Klekamp J. A New Classification for Pathologies of Spinal Meninges—Part 2: Primary and Secondary Intradural Arachnoid Cysts. Neurosurgery 2017; 81:217-229. [DOI: 10.1093/neuros/nyx050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Spinal intradural arachnoid cysts are rare causes of radiculopathy or myelopathy. Treatment options include resection, fenestration, or cyst drainage.
OBJECTIVE: To classify intradural spinal arachnoid cysts and present results of their treatment.
METHODS: Among 1519 patients with spinal space occupying lesions, 130 patients demonstrated intradural arachnoid cysts. Neuroradiological and surgical features were reviewed and clinical data analyzed.
RESULTS: Twenty-one patients presented arachnoid cysts as a result of an inflammatory leptomeningeal reaction related to meningitis, subarachnoid hemorrhage, intrathecal injections, intradural surgery, or trauma, ie, secondary cysts. For the remaining 109 patients, no such history could be elucidated, ie, primary cysts. Forty-six percent of primary and 86% of secondary cysts were associated with syringomyelia. Patients presented after an average history of 53 ± 88 months. There were 122 thoracic and 7 lumbar cysts plus 1 cervical cyst. Fifty-nine patients with primary and 15 patients with secondary cysts underwent laminotomies with complete or partial cyst resection and duraplasty. Mean follow-up was 57 ± 52 months. In the first postoperative year, profound improvements for primary cysts were noted, in contrast to marginal changes for secondary cysts. Progression-free survival for 10 years following surgery was determined as 83% for primary compared to 15% for secondary cysts. Despite differences in clinical presentation, progression-free survival was almost identical for patients with or without syringomyelia.
CONCLUSIONS: Complete or partial resection leads to favorable short- and long-term results for primary arachnoid cysts. For secondary cysts, surgery can only provide clinical stabilization for a limited time due to the often extensive arachnoiditis.
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Affiliation(s)
- Jörg Klekamp
- Department of Neurosurgery, Christlich-es Krankenhaus Quakenbrück, Quaken-brück, Germany
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De Novo Intraneural Arachnoid Cyst Presenting with Complete Third Nerve Palsy: Case Report and Literature Review. World Neurosurg 2017; 98:873.e27-873.e31. [DOI: 10.1016/j.wneu.2016.11.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022]
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Two Different Life-Threatening Cases: Presenting with Torticollis. Case Rep Pediatr 2016; 2016:7808734. [PMID: 27957374 PMCID: PMC5124474 DOI: 10.1155/2016/7808734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/12/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022] Open
Abstract
Acquired torticollis can be the result of several different pathological mechanisms. It is generally related to trauma, tumors, and inflammatory processes of the cervical muscles, nerves, and vertebral synovia. Although upper respiratory tract and neck inflammation are common causes of acute febrile torticollis in children, diseases with as yet undefined relationships may also result in torticollis. This is the case of spinal arachnoid cyst and pneumonia.
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Garg K, Borkar SA, Kale SS, Sharma BS. Spinal arachnoid cysts – our experience and review of literature. Br J Neurosurg 2016; 31:172-178. [DOI: 10.1080/02688697.2016.1229747] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin Anil Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Jin B, Zhao JZ, Wang HB, Wang KD, Liu LQ, Su YB. Laminectomy by craniotome for huge spinal extradural arachnoid cyst: a case report. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0034-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Ros López B, Martín Gallego Á, Iglesias Moroño S. Quistes aracnoideos del sistema nervioso central. Algoritmos y recomendaciones generales de manejo. Neurocirugia (Astur) 2016; 27:67-74. [DOI: 10.1016/j.neucir.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/07/2015] [Indexed: 12/14/2022]
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Glenn CA, Bonney P, Cheema AA, Conner AK, Gross NL, Yaun AL. Iatrogenic intradural arachnoid cyst following tethered cord release in a child. J Clin Neurosci 2016; 24:163-4. [DOI: 10.1016/j.jocn.2015.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/21/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
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Ishibe T, Senzoku F, Kamba Y, Ikeda N, Mikawa Y. Time-Spatial Labeling Inversion Pulse Magnetic Resonance Imaging of Cystic Lesions of the Spinal Cord. World Neurosurg 2015; 88:693.e13-693.e21. [PMID: 26732971 DOI: 10.1016/j.wneu.2015.12.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cystic lesions of the spinal cord such as spinal intradural arachnoid cysts (SIACs) and spinal extradural arachnoid cysts (SEACs) contain cerebrospinal fluid (CSF). The pathology of these lesions is often difficult to understand because it is difficult to detect abnormal CSF flow by conventional magnetic resonance imaging (MRI) or myelography. We preliminarily evaluated the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) of cystic lesions of the spinal cord. METHODS T-SLIP MRI was applied to the following 6 consecutive cystic lesions of the spinal cord: 3 SEACs, 1 SIAC, 1 spinal intramedullary cyst associated with adhesive arachnoiditis, and 1 chronic pseudomeningocele. Information obtained by T-SLIP MRI was evaluated with regard to the following: 1) whether exclusive pathologic information was obtained, 2) whether this information affected the therapeutic strategy, and 3) the time required for T-SLIP MRI. RESULTS Exclusive information was obtained in all 6 cases. In SEACs and the intramedullary cyst, pathologic CSF flow into the cyst was directly visualized, enabling us to narrow the therapeutic intervention targets. In SIAC, exclusive information involved detection of the cystic cranial wall and the absence of the caudal wall, enabling us to omit the exploration of the caudal wall. The examination required as long as 80 minutes for SIAC and <30 minutes for the other cases. CONCLUSIONS T-SLIP MRI is useful for obtaining pathologic information about cystic lesions of the spinal cord.
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Affiliation(s)
- Tatsuya Ishibe
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan.
| | - Fukuji Senzoku
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Yusuke Kamba
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Noboru Ikeda
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
| | - Yoshihiro Mikawa
- Center for Spine Surgery, Japan Community Healthcare Organization Tamatsukuri Hospital, Tamayu-cho, Matsue-shi, Shimane, Japan
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Kerr JM, Ukpeh H, Steinbok P. Spinal extradural arachnoid cyst presenting as recurrent abdominal pain. Childs Nerv Syst 2015; 31:965-9. [PMID: 25822934 DOI: 10.1007/s00381-015-2688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Spinal arachnoid cysts are an infrequently reported cause of abdominal pain in children. In this report, we describe the unusual case of an extradural arachnoid cyst presenting as recurrent abdominal pain in a pediatric patient without any signs of cord or nerve root compression. CASE REPORT A 14-year-old girl with recurrent abdominal pain as the only symptom of a spinal extradural arachnoid cyst is reported. The patient was incidentally diagnosed with an intraspinal mass on abdominal computed tomography (CT) during the course of investigating her abdominal pain. Magnetic resonance (MR) imaging confirmed the diagnosis of a T11-L2 extradural arachnoid cyst. After resection of the T11-L2 arachnoid cyst, the patient's abdominal pain resolved. To our knowledge, this is the first report describing abdominal pain as the sole presenting feature of a spinal arachnoid cyst in the pediatric population. CONCLUSION This case illustrates that abdominal pain may be the first and only presentation of spinal arachnoid cysts in children. Spinal pathology should be considered in the differential diagnosis of unexplained abdominal pain, even when there are no other symptoms of spinal disease.
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Affiliation(s)
- John M Kerr
- Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia, 4480 Oak St, #K3-159, Vancouver, BC, V6H 3V4, Canada
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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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Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl. Case Rep Orthop 2015; 2015:627502. [PMID: 26543656 PMCID: PMC4620383 DOI: 10.1155/2015/627502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022] Open
Abstract
The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of “halo-vest” system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of “halo-vest” traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.
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Detection of the communicating hole(s) of spinal extradural arachnoid cysts using time-spatial labeling inversion pulse magnetic resonance imaging. Spine (Phila Pa 1976) 2014; 39:E1394-7. [PMID: 25202934 DOI: 10.1097/brs.0000000000000591] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Report of 2 cases. OBJECTIVE To report the usefulness of time-spatial labeling inversion pulse magnetic resonance imaging (T-SLIP MRI) for detection of the communicating hole(s) of spinal extradural arachnoid cysts (SEACs). SUMMARY OF BACKGROUND DATA SEACs normally communicate with the subarachnoid space via small communicating hole(s) in the dura. It is necessary to identify the accurate locations of these communicating hole(s) before attempting to close them through limited laminotomy/laminectomy. Myelocomputed tomography or conventional MRI may fail to detect the locations of the hole(s) because they comprise small dural defects. METHODS Case 1: A 33-year-old female presented with an SEAC at the T11–L2 vertebral level. Case 2: An 82-year-old female presented with an SEAC at T12–L4 vertebral level. RESULTS Case 1: T-SLIP MR image of the left parasagittal plane (not the midsagittal or right parasagittal plane) revealed cerebrospinal fluid flow from the subarachnoid space into the cyst at L1. After limited laminotomy at T12–L1 and partial cyst resection, we identified 2 contiguous dural holes immediately medial to the left L1 pedicle; this corroborated the preoperative T-SLIP MRI findings. The holes were sutured. Postoperative conventional MR image confirmed significant cyst shrinkage. Case 2: T-SLIP MR image revealed a curved line at the L1 pedicle in the right parasagittal plane. After L1 laminectomy and partial cyst resection, a dural hole was identified L1 pedicle, which was in agreement with the preoperative T-SLIP MRI findings. After surgery, the lower extremity pain disappeared. Postoperative conventional MR image revealed significant cyst shrinkage. CONCLUSION T-SLIP MRI is useful for detection of the communicating hole(s) of SEACs. LEVEL OF EVIDENCE N/A.
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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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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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Haber MD, Nguyen DD, Li S. Differentiation of Idiopathic Spinal Cord Herniation from CSF-isointense Intraspinal Extramedullary Lesions Displacing the Cord. Radiographics 2014; 34:313-29. [DOI: 10.1148/rg.342125136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lohani S, Rodriguez DP, Lidov HGW, Scott RM, Proctor MR. Intrasacral meningocele in the pediatric population. J Neurosurg Pediatr 2013; 11:615-22. [PMID: 23601014 DOI: 10.3171/2013.3.peds12519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intrasacral meningoceles are rare cystic lesions that can cause focal compression within the bony sacral canal. Their mechanisms are poorly understood, but most intrasacral meningoceles appear to be intrasacral extradural cysts caused by arachnoid herniating through a small dural defect in the caudal end of the thecal sac. As opposed to perineural cysts, they are not associated with an exiting nerve root. When symptomatic, they can cause sacral pain or sacral nerve root dysfunction due to local compression. METHODS This is a retrospective series from Boston Children's Hospital. All patients in whom symptomatic intrasacral meningocele that required surgical treatment was diagnosed between May 1994 and March 2011 were included in the study. Spine MRI was the diagnostic modality of choice. All patients underwent sacral exploration, with ligation and obliteration of the cyst. Resected cyst wall was subjected to pathological examination. RESULTS There were 13 patients (11 boys and 2 girls) who underwent operation for intrasacral meningocele. The median age was 8 years (range 5 months-16 years). The most common presenting symptom was back pain (in 5) often described as deep tail bone pain, followed by urinary incontinence (3) and constipation (2). Three patients had evidence of associated tethered cord on MRI studies. Four patients were asymptomatic and their diagnosis was made following imaging for other reasons; they were surgically treated because of the increasing size of the lesion or association with other congenital lesions. Most patients had symptomatic improvement after surgery. CONCLUSIONS Intrasacral meningoceles are rare lesions that may result from a congenital dural weakness and a resultant arachnoid diverticulum. They present in childhood either incidentally or with symptoms secondary to nerve root compression. Identification of the point of herniation through the dura mater and ligation of the lesion provides cyst cure and resolution of symptoms in most patients.
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Affiliation(s)
- Subash Lohani
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
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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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