Symptomatic lumbar intradural arachnoid cyst: A case report

Spinal arachnoid cysts are a relatively uncommon lesion that may be either intra- or extradural, and intradural spinal arachnoid cysts are even less common. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. We present three cases in the pediatric age group with spinal intradural arachnoid cysts without a preceding history of trauma. Three patients with symptomatic intradural arachnoid cysts were investigated with conventional T1- and T2-weighted magnetic resonance imaging (MRI). The MRI scans demonstrated the intradural arachnoid cysts with slightly lower CSF signal intensity on the gradient echo images and slightly higher signal intensity on T1-weighted images. The first cyst was located at the level T12–L1 and compressed the conus medullaris, with neurogenic bladder and cauda equina syndrome for 2 months. The second was located at the level C5–T1 ventrally, with spastic gait and neurogenic bladder for 4 years. The other was located at T2–3 ventrally, with sudden onset of quadriplegia after jumping rope. The combined treatment of total resection and wide fenestration in our three patients produced an excellent return of neurologic function in each one, except for residual urinary disturbance in case 2. Intradural spinal arachnoid cysts appear to result from an alteration of the arachnoid trabeculae; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and congenital. The majority of intradural spinal arachnoid cysts occur in the thoracic region and most are dorsal to the neural elements. Only 10 cases have been reported in which the intradural arachnoid cysts were located anterior to the cervical spinal cord, of which 8 were in the pediatric age group, like our case 2. Myelography, postcontrast CT myelography and MRI have been demonstrated as useful for the diagnosis of intradural arachnoid cysts. MRI is the imaging modality of choice, and the extent, size and nature of the lesion in our cases were well demonstrated by MRI. Surgical treatment is necessary if progressive neurological dysfunction appears in the course of spinal cord compression. Complete surgical excision of the cysts is the best choice of treatment, and wide fenestration and shunting of the cyst to the peritoneum, pleural cavity or right atrium were the modalities of choice. MRI offers a noninvasive and effective means to make the diagnosis of arachnoid cysts easier. Intradural arachnoid cysts may cause progressive myelopathy; however, the postoperative prognosis is good if the operation is performed prior to neurologic deficits.

Intradural Spinal Arachnoid Cyst: A Long-Term Postlaminectomy Complication: A Case Report and Review of the Literature

Spinal arachnoid cysts are rare intradural spinal canal collections of cerebrospinal fluid enclosed by an arachnoid membrane, often associated with congenital or acquired dural defects, most frequently located in the thoracic spine, although they may also occur at lumbar or cervical levels. Symptomatic arachnoid cysts typically cause progressive neurological deficits secondary to spinal cord or nerve root compression. We report the case of a 29-year-old woman presenting with a 1-year history of progressive low back pain, lower limb weakness, and persistent pain unresponsive to conservative management. Magnetic resonance imaging (MRI) demonstrated an extramedullary, extradural cystic lesion extending from T9 to L2, causing significant spinal cord displacement, consistent with an arachnoid cyst. The patient underwent microsurgical decompression consisting of a laminectomy and cyst fenestration under microscopic visualization, resulting in symptomatic relief. Postoperative imaging confirmed resolution of the spinal cord compression. This case underscores the necessity of timely diagnosis and surgical intervention in symptomatic spinal arachnoid cysts to prevent permanent neurological sequelae. MRI remains essential for accurate diagnosis, and early surgical treatment offers a favorable prognosis with low recurrence risk.

Secondary intradural arachnoid cyst involving the spine is uncommon. It is usually secondary to trauma, haemorrhage, surgery or inflammation. We present two cases of treated tuberculous meningitis, which presented with gradual onset of quadriplegia and paraplegia, respectively. MRI revealed intradural (cervical and thoracic) arachnoid cysts (ventral and dorsal to the spinal cord) with myelomalacic cord changes. Ventral location of such spinal arachnoid cysts, and being secondary to tuberculous arachnoiditis are distinctively uncommon features. The rarity of this condition and the relevance of MRI in the accurate diagnosis have been discussed here.

Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare. We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts. In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %). Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.

Background: Spinal arachnoid cysts (SACs) are rare benign lesions arising from the arachnoid membrane containing cerebrospinal fluid (CSF). They are usually solitary and asymptomatic and are often discovered incidentally. Symptomatic patient may develop progressive neurological deficits due to spinal cord or nerve root compression. The presence of multiple intradural arachnoid cysts is an exceptional finding, and with very few have been reported in the literature. These lesions pose diagnostic and therapeutic challenges, particularly when they extend over several vertebral levels. MRI is the gold standard for their identification, as it allows precise assessment of their number, size, location, and impact on adjacent neural structures. Case Presentation: A 34-year-old woman with no relevant medical history developed sudden-onset paraplegia associated with urinary retention and sensory disturbances. Clinical examination confirmed thoracic sensory level and flaccid paraplegia. MRI of the spinal cord demonstrated multiple intradural extramedullary arachnoid cysts spanning several thoracic levels, causing significant spinal cordcompression, with no associated hemorrhage or neoplastic lesion. There was no evidence of prior trauma, surgery, or infection. Conclusion: Multiple intradural spinal arachnoid cysts are an uncommon but important differential diagnosis in patients with acute myelopathy. MRI plays a central role in their diagnosis, enabling not only detection but also differentiation from other cystic or neoplastic lesions. Recognizing this rare entity is essential for timely management and preventing unnecessary or inappropriate interventions.

Spinal intradural arachnoid cysts are a rare cause of spinal cord compression. Since 2000, the authors have treated patients using 2- or 3-level hemilaminectomy or laminectomy followed by partial cyst wall resection as well as endoscopic inspection and fenestration of the cyst wall. They evaluated the usefulness and reliability of endoscopic treatment for this clinical entity based on long-term follow-up results. Between 1997 and 2003, 11 patients (3 males and 8 females) with spinal intradural arachnoid cysts were treated, and the authors conducted a retrospective review of these cases. Before 2000, 5 patients were surgically treated without the use of endoscopic techniques. During that time, more than 4 levels of hemilaminectomy were performed to expose and remove cyst walls that extended longitudinally over the spinal axis. Beginning in 2000, endoscopy was used in all 6 cases. Up to 3 levels of hemilaminectomy or 2 levels of laminectomy were performed, and the cyst wall was resected through the bone window. An endoscope was inserted into the cyst cavity and moved in the cranial and caudal direction to fenestrate the cyst wall, resulting in communication of the cyst cavity with the subarachnoid space. Postoperatively, the neurological symptoms of all patients improved. During long-term follow-up (mean 114.8 months), none of the patients treated with or without endoscopy experienced recurrent cyst formation. Endoscopic techniques allow neurosurgeons to treat spinal intradural arachnoid cysts less invasively than with standard surgical approaches. Although the number of cases reviewed in this report is small, the data suggest that the use of endoscopy can be an important option in the surgical treatment of spinal arachnoid cysts.

Six patients with spinal arachnoid cyst were treated at the Ryukyu University Hospital from 1990 to 2001. We evaluated the operative results retrospectively. The mean age of these six patients was 48 years (range : 13 to 72 years). They were consisted of one male and five females. All cysts occurred at the dorsal side of the spinal cord. Three cases had extradural arachnoid cyst, and the other three had intradural arachnoid cyst. All patients underwent surgery for cyst excision. For extradural arachnoid cyst, we recognized a stalk between the cyst wall and dura in all cases. Total excision was performed on two cases with tying of the stalk. Partial excision was performed in one case because of adhesion. For intradural arachnoid cyst, one case was treated with laminoplasty and total resection of the cyst, the other two cases were treated with laminectomy and partial cyst wall resection. After surgery, three cases of extradural arachnoid cyst and one case of intradural cyst treated with total resection showed no recurrence and recovered satisfactory. Whereas, the other two cases of intradural arachnoid cyst treated with partial cyst wall resection showed recurrence of cyst and one became worse at follow-up.

Spinal intradural arachnoid cysts (SIACs) are cerebrospinal fluid (CSF) sacs formed by arachnoid membranes. They may be idiopathic or acquired. Treatment is resection, fenestration, or cyst drainage. A 41-year-old female patient presented with myelopathy symptoms and complaints. Magnetic resonance imaging (MRI) revealed a T6-T10 dorsal intradural arachnoid cyst. A T6-T10 laminectomy was performed and an arachnoid cyst was excised under surgical microscope. The cyst contained a clear liquid that was surrounded by a transparent membrane. At 7 weeks postoperatively, the patient experienced severe headache, excessive sleepiness, vomiting, loss of coordination, difficulty walking, and difficulty concentrating. A head computed tomography (CT) scan showed marked ventricular dilation that was diagnosed as delayed hydrocephalus. The patient underwent ventriculoperitoneal shunt (VPS) placement one day after admission. This is a rare condition of hydrocephalus that develops due to CSF leakage after SIAC surgery.

Spinal arachnoid cysts are relatively uncommon, they may be either intra- or extradural, among them the intradural spinal arachnoid cysts are less common. The authors report a patient with this rare lesion, in whom an anterior spinal intradural arachnoid cyst was associated with thoracic split cord malformation type I (diastematomyelia) and tethering of cord. The cyst was located anterior to the thoracic spinal cord. Our patient was an 8-year-old child who presented with progressive paraparesia. The presence of an intradural anterior arachnoid cyst was detected on magnetic resonance imaging. Surgical treatment was performed on all three lesions during the same sitting. Complete surgical excision of the cyst was the best choice of treatment with simultaneous treatment of the associated anomalies. The most important advantage of handling all three distinct lesions in one sitting, is that he was operated during a single exposure anaesthesia, which remains an important consideration in a child. The surgical treatment carried out and review of pertinent literature is being presented here. (J Pediatr Neurol 2004; 2(4): 235-239).

This case report describes the unique occurrence of acquired intradural spinal arachnoid cyst after lumbar puncture, which was proven radiographically and surgically. To review and explore complications of lumbar puncture in the context of subsequent cyst development and to review the incidence, presentation, pathogenesis, and management of spinal intradural arachnoid cysts. The etiology of the spinal intradural arachnoid cyst remains obscure; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and assumed by many authors to be congenital. A 20-Year-old woman with back and leg pain underwent lumbar myelography that yielded normal results with no evidence of arachnoid cyst at that time. Within 5 months, clinical symptoms of cauda equina compression and an S1 radiculopathy developed. Subsequent myelography and magnetic resonance imaging revealed a lumbar spinal arachnoid cyst. There was no history of intervening trauma or arachnoiditis. The lumbar puncture was thought to be the cause of the arachnoid cyst. A laminectomy was performed with complete excision of the arachnoid cyst. The patient had an unremarkable postoperative course with excellent relief of her symptoms. This case provides supporting evidence for the traumatic etiology of spinal intradural arachnoid cyst. The development of an intradural spinal arachnoid cyst should be included as a possible complication of lumbar puncture.

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.

Intraoperative Visualization of a Spinal Arachnoid Cyst Using Pyoktanin Blue.

Introduction: Spinal arachnoid cysts are rare fluid-filled sacs that develop within the spine’s protective layer, known as the arachnoid membrane. These cysts were first described by British neurologist George Spiller in 1903. The arachnoid cyst gets its name from the arachnoid membrane, one of the three layers of the meninges that surround and protect the brain and spinal cord. This membrane is responsible for producing cerebrospinal fluid, which acts as a cushion and shock absorber for the brain and spinal cord. Case discussion: A 21-year-old female with no known medical conditions presented with a history of weakness and numbness in both lower limb for the past 1 years. Clinical examination and routine workup done with radiological investigation. An MRI of the spine showed a well-defined cystic lesion in the spinal canal measuring 22cm x 10.7cm x 8.2 cm, extending from the middle of the T11 to L3 vertebrae segment. After careful consideration, it was decided that surgery is necessary to relieve her symptoms and prevent further damage to her spinal cord. Discussion: Spinal arachnoid cysts, although rare, are a fascinating and often misunderstood condition. Usually seen in patients between the ages of 30-50 years with a slight female predominance, their exact cause is still unknown. Diagnosis of spinal arachnoid cysts can be challenging, as the symptoms may mimic those of other spinal conditions. Treatment options for spinal arachnoid cysts depend on the severity of symptoms and the size and location of the cyst. Conclusion: Spinal arachnoid cysts are rare but potentially debilitating conditions that can occur at any age and in any region of the spine. While their exact cause is unknown, advances in imaging technology have made it easier to diagnose and manage these cysts. Keywords: Spinal arachnoid cyst, extradural arachnoid cyst, arachnoid cyst.

The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.