Extradural spinal arachnoid cysts: Management and outcome in five children

Abstract

Abstract Background: Spinal extradural arachnoid cysts (SEACs) are rare lesions, which may become symptomatic due to mass effect or nerve root compression. They are discrete pockets of cerebrospinal fluid (CSF) communicating with subarachnoid space. These cysts may be single or multiple. Multiple cysts in the pediatric population are very rare, of which a few are reported to date. Materials and Methods: Here, we present a case series of five pediatric patients diagnosed with symptomatic SEACs and operated in our institute between the period of October 2017 and January 2021. The patients underwent surgery for excision of the cysts and closure of dural defects. The results were analyzed in terms of the clinical symptoms, location of cyst, surgical procedure performed, and outcome after surgery. Result: The mean age of presentation was 12 years. Common presenting complaints were lower limb weakness, pain, and bladder involvement. The median duration of symptoms before surgery was 7.8 months (mean 3 ± 12 months). Excision of cyst wall with closure of dural defect was done in all cases except one, in which the dural defect was not found. All cases gained near-normal muscle strength of lower extremities over a variable period of time after surgery. Conclusion: Pathogenesis of SEAC is not completely understood. Intraoperative localization and closure of the dural defect is the single most important step for excellent outcome.