Multiple lumbar spinal inter-dural cysts

Abstract

Abstract Introduction: Cysts of the spinal canal may be located in the extradural or intradural space. Distinct from these cysts, inter-dural spinal cysts form between the two layers of the spinal dura and contain fluid, including cerebrospinal fluid (CSF) and blood. Inter-dural spinal cysts are extremely rare. We recently encountered a patient presenting with a multiple lumbar spinal inter-dural cysts. Patient concerns: A 58-year-old woman presented with an acute onset of back pain radiating to her left leg. She had no history of surgery or trauma and no other medical illness. Her pain was not relieved by considerable attempts to control it through medication or physical therapy Diagnosis: The magnetic resonance imaging indicated multiple cystic lesions ventral and dorsal to the thecal sac at L2/3 which were compressing the roots of the cauda equina. The contents of the ventral lesion were relatively high signal on T2-weighted images and low-signal on T1-weighted images, suggesting a CSF. Additional magnetic resonsnce myelography was highly suggestive of multiple isolated cysts located in the inter-dural space, with a thin wall separated from the CSF. Interventions: The patient underwent total laminectomy of the 2nd to 3rd lumbar vertebral to expose the cyst. After midline dural incision, inner dural leaflet was found and we could have confirmed the exact position of the cyst was interdural space, and the inner dura was excised. We then retracted the rootlets to find another ventral cyst. A small incision was made in the inner dura overlying the ventral cyst and yellowish fluid was drained. Complete cyst fenestration and excision of the inner dural leaflet was performed. Outcomes: A histopathology report confirmed the cyst to be dura. The patient had complete resolution of symptoms and was asymptomatic 3 years after surgery. Conclusions: Inter-dural cysts occur very rarely. We report the first case of multiple lumbar spinal inter-dural cysts. Acknowledging inter-dural spinal cysts as a type of spinal meningeal cyst is imperative, as this will allow surgeons to avoid unnecessary dural breaches and associated complications.