Epidural Arachnoid Cyst Research Articles

An exceptional presentation of Charcot–Marie‐tooth 1C disease: Case report of a diagnostic dilemma

AbstractCharcot–Marie‐Tooth (CMT) disease is the commonest form of hereditary sensorimotor neuropathy and presents with a vast plethora of phenotypes and genetic mutations. CMT1C is a rarer variant presenting with lower limb predominant sensorimotor involvement, associated with LITAF/SIMPLE gene mutation. We describe a case of an 18‐year‐old male with progressive asymmetrical upper limb weakness and atrophy with an extensive epidural arachnoid cyst in cervicothoracic spine. Nerve conduction study and genetic analysis aided the diagnosis of CMIT1C. This is the first case reported with the coexistence of the two pathologies that may turn out to be a phenotype of the same disease spectrum in future research.

Extradural Arachnoid Cyst: An Uncommon Cause of Spinal Cord Compression in Children: A Case Report

The objective of this work is to highlight and discuss a rare cause of curable spinal cord compression with a favourable evolution, through the case of a posterior thoracic epidural arachnoid cyst for which we will discuss its clinical, paraclinical, therapeutic and evolutionary characteristics, with review of the literature. The patient was a six and a half year old boy with no previous pathological history. He was admitted for progressive gait problems with myalgia. MRI showed an extradural cystic lesion in the thoracic spinal cord opposite D5-D10 with a signal similar to that of the CSF. A laminectomy followed by evacuation of the cyst with partial removal of the wall was performed. Pathological examination confirmed the diagnosis. The evolution was marked by a total disappearance of the initial clinical symptomatology in the patient. Although rare, the extradural arachnoid cyst is a potential cause of reversible spinal cord compression for which surgical resection is the treatment of choice.

Idiopathic thoracolumbar spinal epidural arachnoid cysts: A case report and systematic review.

Idiopathic spinal epidural arachnoid cysts (SEACs) are rare and may cause myelopathy and cord compression. They typically arise from a congenital defect in the dura that communicates with the intrathecal subarachnoid space. Although the ideal treatment of SEACs is direct dural repair and cyst excision, there is as yet no clear standard of care for the management of these lesions. A 47-year-old female presented with myelopathy attributed to an magnetic resonance imaging-documented posterior epidural T12-L2 cyst (i.e., 1.1 × 6 × 3.3 cm) lesion. The patient underwent a direct dural repair of the fistulous communication between the subarachnoid space and the cyst, along with cyst drainage/ excision through a right-sided laminotomy. Postoperatively, the patient was asymptomatic. We additionally reviewed the literature regarding the management of SEACs. Our review yielded 14 articles involving 18 patients with predominantly thoracolumbar (57%) SEACs that were either communicating (61%) or not communicating (39%) with the subarachnoid space. They averaged 35.5 years of age and exhibited a male preponderance (66%). Symptoms typically included pain (78%), followed by weakness/myelopathy (42%). Surgery frequently included bilateral laminectomies (57%) followed by unilateral laminectomies (50%) that typically resulted in symptom resolution. SEACs are rare typically thoracolumbar lesions that may cause myelopathy which resolves following direct dural closure/subarachnoid fistulous occlusion.

Surgical treatment of epidural arachnoid cyst type II of the thoracic and lumbar spine: case report

Background. Spinal epidural arachnoid cysts are the protrusion of the arachnoid membrane through an existing defect in the dural, functioning as a valve. Literature data on diagnosis and surgical treatment are presented by descriptions of clinical cases and there is no consensus on the optimal approach to solving this problem.Aim. To present a clinical case of surgical treatment of epidural arachnoid cyst type II of the thoracic and lumbar spine; to analyze methods of diagnosis and surgical treatment of such cysts.Materials and methods. All cases of diagnosis and treatment of spinal epidural arachnoid cysts in adults published in the PubMed search engine by 2021 have been analyzed. A clinical case of successful surgical treatment of an epidural arachnoid cyst of the thoracic and lumbar spine of type II on the basis of the Almazov National Medical Research Centre (Saint Petersburg, Russia) is presented.Results. Analysis of the published results of treatment of patients with epidural arachnoid cysts showed that the main task facing the surgeon is to identify and close the communication between the cyst and the subdural space. To accurately determine the localization of the dura mater defect and minimize operative access, many authors consider computed tomography myelography to be effective.Conclusion. Despite the variety of existing diagnostic methods, a specific and accurate way to visualize the defect has not been found to date. Based on the analysis of the literature, it can be said that the rarity of publications on this topic makes even individual reports relevant, and today there is no way to propose a specific strategy for the diagnosis and surgical treatment of such cysts.

Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports

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.

THORACOLUMBAR EPIDURAL ARACHNOID CYST OF DIFFICULT CLINICAL MANAGEMENT: CASE REPORT

ABSTRACT Introduction: Among the primary lesions occupying the spinal space, only 1% corresponds to the epidural arachnoid cyst (EAC). This condition is usually asymptomatic, and identified accidentally in imaging tests. In symptomatic cases, total surgical resection is recommended. Objective: To describe a case of EAC refractory to clinical treatment. Methods: A 45-year-old woman had lumbar pain for six years and increased pain in the last months, with irradiation to the left lower limb (corresponding to L1). No other alterations found in the physical examination. Magnetic resonance imaging (MRI) of the spine revealed an intravertebral cystic lesion at T12-L1 level, in the left posterolateral position, causing enlargement of the foramen, and suggesting an epidural arachnoid cyst. Results: Due to failure of the initial clinical treatment, the patient underwent left T12-L1 hemilaminectomy, resection of the cyst and correction of dural failure. The patient progressed with effective pain control and MRI confirmed absence of residual lesion. Conclusion: EAC is more common in men (4:1) and may be congenital or acquired. The most common topography is thoracic (65%). Its clinical presentation is low back pain, lower limb pain and paresthesia. MRI is the method of choice for diagnosis and surgical intervention is restricted to cases that are symptomatic or refractory to clinical treatment, and the prognosis tends to be excellent. We conclude that, in addition to being a rare and commonly asymptomatic condition, an adequate therapeutic approach is essential for complete cure, avoiding intense pain and manifestations that bring about a drastic reduction of functional capacity. Level of evidence: IV. Type of study: Case series.

Clinical presentation of a dorsal epidural arachnoid cyst after an epidural anaesthesia

Abstract Background Arachnoid cysts are dural diverticula with liquid content similar to cerebrospinal fluid, with 1% occurring in the spinal cord. They locate mainly in the dorsal region of the thoracic spine, and are unusual causes of spinal cord compression. Clinical case The case is presented of a previously healthy 15-year-old boy, with a 20-month history of spastic paraparesis that started apparently after epidural block for ankle osteosynthesis. There was decreased sensitivity and strength of the pelvic limbs and gradually presented with anaesthesia from T12 to L4 dermatomes, L5 and S1 bilateral hypoaesthesia and 4+/5 bilateral strength, in the L2 root and 2+/5 in L3, L4, L5, S1, hyperreflexia, Babinski and clonus, but with no alteration in the sacral reflexes. In the magnetic resonance it was diagnosed as an extradural arachnoid cyst from T6 to T9. The patient underwent a T6 to T10 laminotomy, cyst resection, dural defect suture, and laminoplasty. One year after surgery, the patient had recovered sensitivity, improvement of muscle strength up to 4+/5 in L2 to S1, and normal reflexes. Conclusions After the anaesthetic procedure, increased pressure and volume changes within the cyst could cause compression of the spinal cord, leading to symptoms. Despite being a long-term compression, the patient showed noticeable improvement.

KYSTE ARACHNOIDIEN EXTRA DURAL SPINAL DORSAL : A PROPOS D’UN CAS

The arachnoid cyst spinal epidural is a rare desease. Its pathogenesis remains unknown. We report the case of a young boy of 14, without contributory medical history, admitted to the neurosurgery department of the Fann National University Hospital in Dakar for a dorsal spinal cord compression syndrome, stage of spastic paraplegia. MRI objectified posterior thoracic cystic lesion next to T5-T8 extradural pace. The cyst was removed piece by posterior approach. Histological examination concluded an arachnoid cyst. The postoperative course was marked by a gradual recovery of the neurological deficit. Despite its rarity, the thoracic epidural arachnoid cyst is among the etiologies of spinal cord compression syndrome which he must think his diagnosis allows for constant healing radical surgical treatment. Keywords: arachnoidcyst, extradural cyst, MRI, surgery

A symptomatic spinal extradural arachnoid cyst with lumbar disc herniation.

Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

Clinical characteristics and treatment strategies for idiopathic spinal extradural arachnoid cysts: a single-center experience.

Idiopathic spinal epidural arachnoid cysts (SEACs) are relatively rare lesions with diverse clinical manifestations depending on the affected spinal region and nerve roots. To assess the relationship between clinical presentation and surgical outcome, we conducted a retrospective review of medical records and neuroimages from idiopathic SEAC patients. Of 15 consecutive patients with idiopathic SEACs, 14 underwent surgical treatment at the Beijing Tiantan Hospital between January 2008 and July 2013. Case histories, clinical presentations, imaging findings, operative findings, and surgical outcomes were reviewed. Of the 15 patients, 5 were children (median age, 13 years) and 10 were adults (median age, 35 years). The male-to-female ratio was 4:1. The median disease duration was 1 year in children and 4 years in adults. The most common manifestations were progressive paraparesis (73.3 %) and radiculopathy (66.7 %). All pediatric lesions affected thoracic segments, while 80 % of adult lesions affected lumbar segments. Fourteen patients underwent microsurgical treatment, with cyst excision in nine (combined with fistula closure in four) and partial cyst excision in five (with fistula closure in three). No recurrences were observed during follow-up (average of 23 months). Excellent outcome was achieved in six cases, good outcome in four, fair in two, and poor in two. Idiopathic SEAC mainly affect the thoracic segments in children and the lumbar segments in adults, and often results in progressive paraparesis and radiculopathy. Early surgical intervention is suggested for progressive symptomatic patients to restore neurological function.

Spinal Cord Injury Secondary to Hereditary Spinal Arachnoid Cysts

Spinal arachnoid cysts are benign and uncommon in children. The etiology may be congenital or traumatic. Despite the development of magnetic resonance in recent years, its findings are generally accidental. The most common symptoms are pain and progressive paraparesis, asymmetrical. Its appearance may be part of lymphedema distichiasis syndrome to be motivated by mutations in the FOXC2 gene transmitted as an autosomal dominant. A case of a girl with D3 ASIA C paraplegia is reported. The spine magnetic resonance revealed two posterior epidural spinal arachnoid cysts from D1-D2 to D8-D9 and from D12 to L2 and D6 and D8 myelopathy. Rehabilitation treatment program as well as surgical to evacuation of the cysts. Reviewing the clinical history, by the father, grandmother and cousin had spinal arachnoid cysts and lymphedema distichiasis syndrome respectively. A genetic study of girl, her brother and father confirms the FOXC2 gene mutation.

What is a reasonable surgical procedure for spinal extradural arachnoid cysts: is cyst removal mandatory? Eight consecutive cases and a review of the literature

Spinal epidural arachnoid cysts (EAC) are rare and may present with myelopathy, which can be completely curable with surgery. The majority of investigators believe that the repairment of dural defect is important to treat EAC. However, the necessity of excising EACs remains controversial. The purpose of this study was to find a reasonable surgical technique for treatment of EACs after considering the clinical outcome, recurrence, and complications. The data from 44 operations in the literature and eight cases from our own experience were analyzed. This data included the surgical method, patient characteristics, level and size of the EAC, global assessment of the clinical outcomes, and the incidence of recurrence. The recurrence rate was 2.0 % and 66.7 % in the patients who underwent repair of the dural defect and in those failed to repair of the dural defect, respectively (p = 0.007). The recurrence rate was 8.3 % and 3.6 % in patients who underwent complete EAC excision totally, and those who underwent EAC fenestration only, respectively (p = 0.590). The clinical outcome in patients with repaired dural defects was significantly better than that in patients with unrepaired dural defects (2.61 vs.1.67) (p = 0.027). The clinical outcome score was 2.42 and 2.68 in patients who underwent complete EAC excision and those who underwent EAC fenestration only, respectively (p = 0.158). The mean EAC length was 5.04 vertebral body levels (range, 2-13). Six of the 51 patients (11.7 %) had multiple EACs. Total excision of EACs may have little benefit in terms of cyst recurrence and clinical outcome. The procedure for EAC resection carries a risk of complications such as kyphosis. If EAC resection is performed, we suggest that a tailored short-level laminotomy be used to allow for the repair of dural defects. Particularly in patients with small EAC, a partial hemilaminectomy with dural defect repair may be a possible method to reduce complications.

Quiste aracnoideo espinal epidural postraumático: presentación de un caso

Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases. The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma. Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.

Cystothecostomy: a new technique to treat long segment spinal extradural arachnoid cyst

Pathogenesis and treatment of the spinal arachnoid cyst has not been well established. A novel method of treatment of a long segment spinal arachnoid cyst is being presented in a 9-year-old boy. He presented to us with a slowly progressive spastic paraparesis. MRI revealed dorsal epidural arachnoid cyst extending from T7 vertebral body to L1 body producing marked cord compression. In order to save the child from a long segment laminectomy or laminoplasty, a new minimally invasive technique was devised. In this technique L1 laminectomy was performed under local anaesthesia, and the cyst was communicated to thecal sac by making an interconnecting stoma. We named this procedure as cystothecostomy. There was gradual neurological recovery after the procedure.

Sacral epidural noncommunicating arachnoid cyst

The authors examine the natural history of a spinal epidural arachnoid cyst and present their experience with its treatment in a 25-year-old man who presented with progressive cauda equina syndrome. Neuroimaging revealed two neighboring sacral epidural cysts. The cysts were completely removed via a sacral S1-4 laminectomy; no communication with the subarachnoid space could be found. The patient's postoperative course was uneventful. He experienced progressive improvement and, finally, complete resolution of symptoms and no recurrence of the cyst. Nabors Type I sacral epidural arachnoid cysts are rare; in some cases their origins and the mechanism by which they cause deterioration in the patients' clinical condition are debatable. Findings in the present case support the idea that some of these cysts are noncommunicating but progressive in their clinical presentation. This lesion type is also known to occur intracranially. A brief review of the literature is provided.

Utility of Preoperative Magnetic Resonance Imaging Myelography for Identifying Dural Defects in Patients with Spinal Extradural Arachnoid Cysts: Case Report

Preoperative magnetic resonance imaging (MRI) myelography scans demonstrated a dural defect in a 50-year-old man with an epidural arachnoid cyst who had a 29-year history of untreated weakness and numbness both lower limbs. MRI scans showed a dorsal intraspinal extradural cystic lesion at the level from Th11 to L1. Although preoperative cine-MRI scans failed to display the dural defect, an MRI myelography scan showed cerebrospinal fluid in the subarachnoid space containing a cyst. The site of shunting between the subarachnoid space and the cyst was visualized as a pulsating flow void to the right of Th12. We removed the cyst wall and closed the dural defect via laminectomy. Because the preoperative MRI myelography scan correctly identified the existence and location of the dural defect, we conclude that MRI myelography is helpful for detecting dural defects in patients with epidural arachnoid cysts.

Cervicothoracic Extradural Arachnoid Cyst: Possible Association With Obstetric Brachial Plexus Palsy

The association of cervicothoracic extradural arachnoid cysts and obstetric brachial plexus palsy has not previously been reported. We report two patients with this association. The first patient is a 9-month-old boy with left obstetric brachial plexus palsy that developed bilateral leg weakness at 6 months of age owing to compression of the spinal cord by a C6 to T8 left cervicothoracic extradural arachnoid cyst. The second patient is a 3-year-old girl with bilateral brachial plexus palsy and spastic paraparesis who had magnetic resonance imaging at 3 days of age that showed intraspinal cord injury and a cervicothoracic extradural arachnoid cyst compressing the spinal cord. We believe that the association of cervicothoracic epidural arachnoid cysts and obstetric brachial plexus palsy in these patients was causal and recommend that the possibility of a cervicothoracic epidural arachnoid cyst be considered in patients with brachial plexus palsy and evidence of spinal cord injury.

Idiopathic spinal cord herniation

The authors describe two occurrences of idiopathic spinal cord herniation, an entity that has been reported previously in only 11 cases. The patients described in this report presented in midlife with Brown-Séquard syndrome. Computerized tomography myelography and magnetic resonance (MR) imaging showed ventral displacement of the spinal cord with no apparent dorsal mass. Intraspinal cerebrospinal fluid (CSF) flow studies in which phase-contrast pulse sequence cine MR imaging was used displayed a normal pattern dorsal to the spinal cord. Percutaneous intrathecal endoscopic observation did not disclose dorsal intradural cysts, but ventral adhesions were seen between the spinal cord and the dura. Microsurgical intradural exploration revealed ventrolateral herniation of the cord and a ventral root through a dural defect into an epidural arachnoid cyst. The adhesions were released, the cord was repositioned intradurally, and the dural defect was patched. The patients showed gradual improvement postsurgery, as did most of the patients in the previously reported cases. The CSF flow and endoscopic studies were found to be particularly informative, and dural patching with surgical membrane is recommended.

Magnetic Resonance Imaging of an Epidural Spinal Arachnoid Cyst

The myelography, CT and MR imaging findings in a patient with an epidural spinal arachnoid cyst are discussed. MR imaging excellently demonstrated cyst size, cyst location and cord compression, and should be the method of choice in these cases.

Posttraumatic arachnoid cyst at the cranial base with unusual manifestations

A posttraumatic epidural arachnoid cyst embedded within the left petrous bone of a 25-year-old woman is reported. The lesion produced clinical manifestations of cerebrospinal fluid rhinorrhea, recurrent meningitides, and neuropathy affecting all divisions of the fifth cranial nerve as well as the eighth cranial nerve on the left side. The location of posttraumatic arachnoid cyst is rare at the cranial base, and the described clinical manifestations are unique.