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Baig Mirza A, Bartram J, Vastani A, Gebreyohanes A, Al Banna Q, Lavrador JP, Vasan AK, Grahovac G. Systematic Review of Surgical Management of Spinal Intradural Arachnoid Cysts. World Neurosurg 2021; 158:e298-e309. [PMID: 34728397 DOI: 10.1016/j.wneu.2021.10.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Spinal intradural arachnoid cysts (SIACs) are rare pathological lesions that can arise via outpouchings of the arachnoid layer in the spinal canal that can result in neurological deficits. We performed a systematic literature review regarding the current surgical techniques used in the management of SIACs and discussed the prevailing hypotheses surrounding the etiology of SIACs. METHODS A systematic search of the literature was performed in December 2020 using EMBASE and MEDLINE for reports regarding the surgical management of SIACs. Data were collected regarding the demographics of the patients, classification system used, presence or absence of syrinxes, preoperative imaging modality, surgical approach and extent of resection, and postoperative outcomes and follow-up. RESULTS Our search yielded 19 reports for inclusion in the present study. The 19 studies included a total of 414 cases, with an overall male/female ratio of 0.93:1. The most common site for the SIACs was the thoracic spinal cord at 77.5%. The symptoms were very similar across the 19 studies. Of the 19 studies, 15 had used resection to manage the SIACs, 10 had used fenestration or marsupialization, and 4 had used cystoarachnoid or cystoperitoneal shunts. CONCLUSIONS SIACs are rare and debilitating spinal pathological lesions, with the etiology of primary SIACs still not fully elucidated. Multiple surgical approaches have been effective, with the optimal operative strategy largely dependent on the individual patient and cyst factors on a case-by-case basis.
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Affiliation(s)
- Asfand Baig Mirza
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom.
| | - James Bartram
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amisha Vastani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Axumawi Gebreyohanes
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Qusai Al Banna
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahilan Kailaya Vasan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Tauro A, Rusbridge C. Syringopleural shunt placement in a pug with a cervical spinal diverticulum and associated syringomyelia. Clin Case Rep 2020; 8:1142-1148. [PMID: 32695345 PMCID: PMC7364096 DOI: 10.1002/ccr3.2845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 01/12/2023] Open
Abstract
We report persistence of associated syringomyelia and formation of newly caudal spinal arachnoid diverticulum, following marsupialization surgery. We describe syringopleural shunt placement as a novel approach to treat both conditions in a Pug dog.
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Affiliation(s)
- Anna Tauro
- ChesterGates Veterinary SpecialistsChesterUK
| | - Clare Rusbridge
- School of Veterinary MedicineGuildfordUK
- Fitzpatrick ReferralsEashingUK
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El Ouadih Y, Coll G, Haro Y, Chaix R. Resolution of isolated syringomyelia after removing thoracic disc herniation. Br J Neurosurg 2020; 34:196-199. [DOI: 10.1080/02688697.2018.1424321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Guillaume Coll
- Neurosurgery, Hopital Gabriel Montpied, Clermont-Ferrand, France
- Image-Guided Clinical Neurosciences and Connectomics (IGCNC), Axe thérapies guidées par l'image (TGI), CNRS, Sigma, Institut Pascal, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Yakouba Haro
- Neurosurgery, Hopital Gabriel Montpied, Clermont-Ferrand, France
| | - Remi Chaix
- Neurosurgery, Hopital Gabriel Montpied, Clermont-Ferrand, France
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Cine balanced fast field echo magnetic resonance imaging of canine spinal arachnoid diverticulae pulsation. Vet J 2019; 248:86-90. [PMID: 31113570 DOI: 10.1016/j.tvjl.2019.04.014] [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: 07/27/2018] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/24/2022]
Abstract
Canine spinal arachnoid diverticulae (SAD) are characterised by focal cerebrospinal fluid dilatations within the subarachnoid space, most commonly associated with nonpainful paresis and ataxia secondary to chronic compressive myelopathy. Numerous imaging techniques have been described for diagnosis of this condition, including myelography, computed tomography myelography, and magnetic resonance imaging (MRI). The present retrospective study investigated the utility of cine balanced fast field echo (cine bFFE) MRI sequences in measuring pulsatile flow in 12 dogs with SAD. The secondary aim was to determine the prevalence and location of syringes in relation to SAD, as the co-occurrence of these conditions has not been previously reported. The degree of SAD pulsation was calculated as the change in area per cardiac cycle on sagittal (n = 12/12) and transverse (n = 7/12) cardiac-gated cine bFFE MRI sequences. Pulsation was identified on all sequences, with a median ratio of change in SAD area of 0.14 (range, 0.10-0.27; n = 12) on sagittal cine bFFE and 0.23 (range, 0.05-0.53; n = 7) on transverse cine bFFE sequences. Significant differences between minimum and maximum SAD dimensions were identified on sagittal (P = 0.002) and transverse measurements (P = 0.018). A moderate prevalence of syringomyelia was identified (n = 6/12; 50%) on T2W sequences, occurring both cranial (n = 4/12; 33%) and caudal (n = 2/12; 17%) to the SAD. These results support the ability of cine bFFE sequences to identify dynamic pulsation of canine SAD. This technique is currently limited by banding artifacts and its inability to quantify flow velocity and abnormal flow jets.
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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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Nuances in Localization and Surgical Treatment of Syringomyelia Associated with Fenestrated and Webbed Intradural Spinal Arachnoid Cyst: A Retrospective Analysis. World Neurosurg 2016; 87:176-86. [DOI: 10.1016/j.wneu.2015.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 11/22/2022]
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Zhang C, Morozova AY, Abakumov MA, Gubsky IL, Douglas P, Feng S, Bryukhovetskiy AS, Chekhonin VP. Precise Delivery Into Chronic Spinal Cord Injury Syringomyelic Cysts with Magnetic Nanoparticles MRI Visualization. Med Sci Monit 2015; 21:3179-85. [PMID: 26486048 PMCID: PMC4621156 DOI: 10.12659/msm.895624] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/02/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury (SCI) often results in the deficiency of glia and neurons in cystic cavities. These syringomyelic cysts can prevent axonal regeneration and sprouting. Details of the mechanism of syringomyelic cyst formation are unknown and an effective treatment for overcoming syringomyelic cysts is not available. MATERIAL AND METHODS Ten adult female Wistar rats underwent contusion SCI modeling resulting in syringomyelic cyst formation. A novel method for locating the cysts was developed and employed. MRI safe silver needles were inserted through the erector spinae of anesthetized rats to create a stable reference point. MRI images of the rodent spine were taken with the needles in situ. This information was used to accurately locate the cyst and determine the 3-dimensional entry point coordinates for nanoparticle delivery. Nanoparticles were injected into the cyst during a primary injection of 8 ul and a secondary injection of 8 ul, to prove the procedure can be accurately repeated. RESULTS None of the rats died intra- or post-operatively. The syringomyelic cysts were accurately located with the 3-dimensional entry point coordinates. After nanoparticle delivery twice into each rat, the visualized syringomyelic cyst volume significantly decreased from 5.71±0.21 mm3 to 3.23±0.364 mm3 and to 1.48±0.722 mm3. CONCLUSIONS The present study describes a novel strategy for precise nanoparticle delivery into a syringomyelic cyst, using measurements obtained from MRI images. This strategy may aid in developing a new method for studying chronic spinal cord injury and a novel treatment for syringomyelic cysts.
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Affiliation(s)
- Chao Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Anna Y. Morozova
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
| | - Maxim A. Abakumov
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Ilya L. Gubsky
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Patricia Douglas
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Shiqing Feng
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Andrey S. Bryukhovetskiy
- Center for Biomedical Technologies, Federal Research and Clinical Center for Specialized Types of Medical Assistance and Medical Technologies of The Federal Medical Biological Agency, Moscow, Russian Federation
| | - Vladimir P. Chekhonin
- Department of Medicinal Nanobiotechnology, Pirogov Russian National Research Medical University, Moscow, Russian Federation
- Department of Basic and Applied Neurobiology, Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russian Federation
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Kong WK, Cho KT, Hong SK. Spinal extradural arachnoid cyst: a case report. KOREAN JOURNAL OF SPINE 2014; 10:32-4. [PMID: 24757455 PMCID: PMC3941728 DOI: 10.14245/kjs.2013.10.1.32] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 02/23/2013] [Accepted: 03/12/2013] [Indexed: 12/19/2022]
Abstract
Spinal arachnoid cyst is a rare cause of myelopathy secondary to spinal cord compression. We report a case presenting extradural arachnoid cyst of probable traumatic origin leading to irreversible neurological deficits including paraparesis and neurogenic bladder. The patient presented progressive paraparesis and voiding difficulty. Magnetic resonance imaging (MRI) of the spine revealed long segmental cystic lesion of cerebrospinal fluid (CSF) signal intensity at dorsal extramedullary space of T11 to L3 level suggesting arachnoid cyst with diffuse cord compression. On the operation, an ovoid shaped dural defect was identified at right sided dorsolateral aspect of the dura mater between nerve root sleeves at T11 and T12 level. The patient was treated by microsurgical repair of the dural defect and intraoperative findings revealed no further leakage of CSF. The neurological status of the patient was stationary on follow-up examination postoperatively. We postulate that delayed-onset post-traumatic extradural arachnoid cyst should be taken into consideration on the differential diagnosis of intrapinal cysts.
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Affiliation(s)
- Woo-Keun Kong
- Department of Neurosurgery, College of Medicine, Dongguk University, Ilsan Hospital, Goyang, Korea
| | - Keun-Tae Cho
- Department of Neurosurgery, College of Medicine, Dongguk University, Ilsan Hospital, Goyang, Korea
| | - Seung-Koan Hong
- Department of Neurosurgery, College of Medicine, Dongguk University, Ilsan Hospital, Goyang, Korea
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Yamashita T, Hiramatsu H, Kitahama Y, Tokuyama T, Sugiyama K, Namba H. Disproportionately large communicating fourth ventricle associated with syringomyelia and intradural arachnoid cyst in the spinal cord successfully treated with additional shunting. Case report. Neurol Med Chir (Tokyo) 2013; 52:231-4. [PMID: 22522338 DOI: 10.2176/nmc.52.231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 44-year-old woman presented with a rare case of disproportionately large communicating fourth ventricle (DLCFV) associated with syringomyelia and intradural arachnoid cyst in the spinal cord. Ventriculoperitoneal shunt operation was performed for hydrocephalus after subarachnoid hemorrhage. She developed DLCFV, which was then associated with syringomyelia and spinal intradural arachnoid cyst. Shunting of the fourth ventricle improved DLCFV, and then the syringomyelia and arachnoid cyst. Although the aqueduct was patent, independent pressure control of the fourth ventricle and the other ventricles was necessary to improve the symptoms. Shunting of the fourth ventricle should be considered for patients with DLCFV when the symptoms persist despite adequate pressure control of the other ventricles.
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Affiliation(s)
- Tae Yamashita
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Walid MS, Sanoufa M, Salvatierra J. Syringomyelia: a complication of an underlying pathology. J Clin Med Res 2010; 2:102-4. [PMID: 21811530 PMCID: PMC3140878 DOI: 10.4021/jocmr2010.04.291w] [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: 04/06/2010] [Indexed: 11/10/2022] Open
Abstract
Patients with syringomyelia may have diverse etiology and experience a variety of symptoms. This report describes two cases of syringomyelia in patients with different profiles, presentations and pathomechanisms.
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