Extradural Arachnoid Cyst Research Articles

Surgical Management of Thoracic Spinal Extradural Arachnoid Cysts: A Case Report

Spinal extradural arachnoid cysts (SEACs) are exceptionally rare and require advanced imaging for an accurate diagnosis and surgical planning. Magnetic resonance imaging and computed tomography myelography play a pivotal role in delineating cyst characteristics and guiding effective interventions. Laminectomy, coupled with laminoplasty, has emerged as a strategic approach to decompress the spinal cord while preserving spinal alignment. This technique mitigates the risk of postoperative complications and facilitates reoperations if recurrence takes place. The integration of a detailed radiological assessment with meticulous surgical planning is crucial for managing SEACs and optimizing outcomes. This paper presents a case of a 33-year-old man with multiple SEACs at the thoracic level who was successfully treated with a surgical intervention, exemplifying the discussed approach.

Successful detection of multiple communicating holes in multiple spinal extradural arachnoid cysts by using time-spatial labeling inversion pulse magnetic resonance imaging: illustrative case.

Spinal extradural arachnoid cysts (SEACs) communicate with the subarachnoid space through small communicating dural holes. The precise preoperative detection of all communicating holes, followed by minimally invasive dural closure, is the ideal treatment to prevent postoperative spinal deformities, especially in cases of multiple SEACs. However, standard imaging methods often fail to detect communicating hole locations. Although a few cases of successful single-hole detection via cinematic magnetic resonance imaging (MRI) have been reported, this modality's ability to detect multiple holes has not been demonstrated. The authors describe the case of a 14-year-old male with myelopathy due to multiple SEACs at T5-8 and T8-12. Myelography revealed a complete block at the T8 level; no cephalic cyst or communicating holes were identified. Time-spatial labeling inversion pulse (T-SLIP) MRI revealed cerebrospinal fluid flow into the cyst at T10 and T7. A limited laminectomy or hemilaminectomy was performed at T7 and T10, and two dural holes were closed without a total cystectomy. The patient's gait disturbance and rectal disorder disappeared. The cysts were confirmed to have completely disappeared on conventional MRI at 1 year postoperatively. T-SLIP MRI, a cinematic MRI, is useful for detecting multiple communicating holes in SEACs.

Symptomatic Long-segment Extradural Arachnoid Cyst: An Interesting Case Report with Literature Review

Abstract Extradural spinal arachnoid cysts are rare lesions which when become symptomatic lead to progressive neurological signs and symptoms. The spectrum of presentation is myriad and surgical intervention is reserved for symptomatic patients. A 17-year-old boy presented with features of progressive spastic paraparesis for the last 5 months. Initial radiological work-up was suggestive of thoracolumbar extradural cystic lesion. Computed tomography myelography was not able to detect the dural defect. He underwent surgical excision of the cyst under intraoperative neuromonitoring. The lesion was excised in single piece and the intradural communication was noticed along an exiting nerve root. The dural defect at the mid-length of the lesion was identified and closed watertight. Significant improvement in the sensory-motor complaints was noted in the postoperative period. The identification of the dural defect and ensuring its closure along with the complete removal of the cyst is the key to avoid recurrence and is the standard procedure of choice.

Preoperative examination and intraoperative cerebrospinal fluid leakage test for minimally invasive surgery of spinal extradural arachnoid cysts: illustrative case.

Spinal extradural arachnoid cysts (SEACs) are rare and can cause spinal dysfunction. Total cyst removal and duraplasty via multiple laminectomies are commonly performed. However, to avoid postoperative spinal deformity and axial pain, a minimally invasive surgery via selective laminectomy may be optimal. Therefore, preoperative detection of the dural fistula site is required. A 25-year-old male presented with a 2-month history of progressive gait disturbance and back pain. Conventional magnetic resonance imaging (MRI) revealed SEACs at the T9 to L2 level but did not reveal the dural fistula. Further examinations were performed using sagittal time-spatial labeling inversion pulse MRI and cone-beam computed tomography myelography with a spinal intrathecal catheter, which indicated a dural fistula on the left side at the T12 level. On the basis of these results, dural repair was performed via selective laminectomy. Furthermore, an intraoperative cerebrospinal fluid leakage test by intrathecally injecting saline via a spinal catheter confirmed complete closure of the dural fistula, with no other fistulas. These comprehensive pre and intraoperative examinations may be useful for minimally invasive and selective surgeries in patients with SEACs.

A case study and review of the literature regardingextradural spinalarachnoid cyst

Arachnoid cysts are spaces containing cerebrospinal fluid partitioned into an arachnoid-formed sheath and are a rare cause of symptomatic spinal cord compression. This case study examined a patient with spastic paraparesis who underwent surgery to remove the cystic lesion and push back the marrow. Post-op control spinal MRI showed total excision of the cyst, and the patient has progressed well and has fully recovered from his deficit. Nabors divides extradural arachnoid cysts into three types: type 1, type 2, and type 3. Type 1 is essentially thoracic, extending over several vertebrae with a peak of greater frequency around the eighth dorsal vertebra. Symptoms are generally slowly progressive, but rapid revelation or decompensation are possible. Treatment options include marsupialization, wide resection, and total excision. For symptomatic cases, total excision is the reference treatment. For painful cases, complete excision, tied off the intradural communication pedicle, and reshaping the dura is the primary surgical goal.

How to locate the fistula orifice of spinal extradural arachnoid cyst: Surgical experience and clinical outcome

BackgroundIn clinical practice, spinal extradural arachnoid cysts (SEAC) are relatively rare. The key to the treatment of SEAC is recognize and close the dural defects (fistula orifice), but there is currently no convenient method to locate and identify the fistula. We propose a method for predicting the location of lumbar/thoracolumbar SEAC fistula based on surgical experience, subsequently closing the fistula through posterior unilateral interlaminar fenestration. Evaluating its surgical efficacy and investigated its effect on patient prognosis.MethodsA stepped approach based on clinical experience is proposed. A retrospective analysis was performed on 6 patients diagnosed with thoracolumbar SEAC disease and treated with posterior unilateral interlaminar fenestration through the position by pre-estimated fistula orifice in our hospital’s Department of Neurosurgery between January 2017 and January 2022.ResultsAll patients who received this treatment experienced significantly lower postoperative VAS pain scores and ODI index compared to their corresponding preoperative values (P < 0.01). During the ongoing follow-up after surgery, no unstable vertebral column, adverse effects, or complications were reported.ConclusionsThe use of posterior unilateral interlaminar fenestration for the treatment of large SEAC in the adult lumbar/thoracolumbar segment can reduce spinal cord manipulation and enhance spine stability. The disease can be treated by sealing the fistula orifice through a small fenestra, the position of which is assessed before surgery. This surgical method reduces trauma and improves the prognosis of patients with large SEAC.

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.

Diagnosis and treatment of spinal extradural arachnoid cysts: A chronic traumatic case report with review of the literature

Arachnoid cysts are formed by duplication of the arachnoid membrane between the arachnoid and the pia mater. Although it is very common in intracranial localization, those with spinal location are rare. Extradural arachnoid cysts of the spinal canal are extremely rare pathologies regarded as either congenital or acquired. These cysts, which can develop idiopathic, post-traumatic, and after arachnoiditis, are often detected incidentally. They present with weakness in the extremities, neuropathic pain, paresthesia, or myelopathy. Here we describe the case of a 17-year-old male patient with a history of chronic spinal trauma who attended our clinic with severe low back pain for 7 months.

Three-dimensional phase-contrast magnetic resonance imaging for the detention of a small communicating defect in a patient with a spinal extradural arachnoid cyst: illustrative case.

Spinal extradural arachnoid cysts are thought to be pouches that communicate with the intraspinal subarachnoid space through a dural defect. The treatment for these cysts is resection of the cyst wall followed by obliteration of the communicating defect, which is often elusive. The authors report the case of a 22-year-old man with an extradural arachnoid cyst with claudication and progressive motor weakness. Regular magnetic resonance imaging (MRI) and computed tomography did not reveal the location of the defect in the cyst. However, three-dimensional (3D) phase-contrast MRI clearly indicated the location of the defect and the flow of cerebrospinal fluid into the cyst. These findings allowed the authors to perform the least invasive surgery; the patient recovered motor function and could walk more smoothly. 3D phase-contrast MRI can reveal a subtle dural defect in patients with spinal extradural arachnoid cysts.

Spinal extradural arachnoid cysts: A novel formation mechanism and dural defect location technology

PurposeThe formation mechanism of spinal extradural arachnoid cysts (SEACs) remains unclear. There are several hypotheses for the formation of SEACs, but none of them can fully explain its pathological findings and surgical procedures. In this study, we retrospectively analyzed the cases of SEACs, aiming to clarify the formation mechanism of SEACs. In addition, we summarize a concise method for locating dural defects preoperatively and formulate a putative explanation of this method. MethodsThe clinical data of 14 patients with SEACs underwent surgery in our hospital from January 2017 to December 2021 were retrospectively analyzed. ResultsFourteen patients were identified during the study period. The cysts all spanned the T12/L1 segment, and dural defects were also located at the T12/L1 level (2 cases not recorded) as well as the middle or the upper-middle level of the cysts. Nine cases were treated with total cyst excision, 2 cases were treated with dural defect closure only, and 3 cases were treated with total cyst excision and dural defect closure. Histopathological examination demonstrated that the cyst wall contained both the arachnoid epithelial and compact fibrous connective tissue. The symptoms were relieved in all patients, and no recurrence was observed. ConclusionsAccording to intraoperative and pathological findings, the dural outer layer cyst (DOLC) is a more reasonable hypothesis about SEACs formation. When CT myelography or cinematic MRI cannot determine the location of the dural defect preoperatively, it can be located according to the middle level of the SEACs with high accuracy.

Clinical and imaging features of spinal extradural arachnoid cysts: a retrospective study of 50 cases.

Spinal extradural arachnoid cysts (SEDACs) are thought to arise from leakage of CSF through a spinal dural defect. This study investigates the demographics and imaging spectrum of SEDACs at our academic institution and compares them with those reported in the literature. Fifty cases with documented MRI diagnosis of SEDAC, Nabors criteria type I meningeal cyst (MC), were identified from retrospective review of imaging records between 1999 and 2020. Patient demographics, presenting symptoms, cyst characteristics, and management outcomes were studied. Statistical analysis was performed to determine associations between maximum cyst size and presenting symptoms along with other imaging findings. In all 50 subjects, SEDACs were solitary (single) and sporadic (non-familial). The majority were incidental (62%), located posteriorly (92%) and laterally (80%) in the thoracic and thoracolumbar regions (34%, 30%). They were associated with mild mass effect upon the thecal sac (50%) and bone remodeling (92%). Among symptomatic SEDACs, back pain and radiculopathy were the most reported (68%). Larger cysts were located caudally in the spinal canal, and were associated with greater thecal mass effect, bone remodeling, and septations. Four out of six subjects who underwent surgical management had complete or partial remission. One had cyst recurrence. In this largest series of SEDACs, most were discovered incidentally, stable over time, and located in the thoracic spine dorsal to the thecal sac. When symptomatic, back pain and radiculopathy were the most common presenting symptoms. Treatment with complete surgical excision may yield the best results for symptomatic lesions.

Gluteus Maximus Muscle Flap in Tongue in Groove and Wrap Around Pattern for Refractory CSF Leakage in Extradural Cyst Patient.

Spinal extradural arachnoid cyst (SEAC) is a rare disease and has surgical challenges because of the critical surrounding anatomy. We describe the rare case of a 58-year-old woman who underwent extradural cyst total excision with dural repair and presented with refractory cerebrospinal fluid (CSF) leakage even though two consecutive surgeries including dural defect re-repair and lumbar-peritoneal shunt were performed. The authors covered the sacral defect using bilateral gluteus maximus muscle flap in tongue in groove and wrap around pattern for protection of visible sacral nerve roots and blockage of CSF leakage point. With the flap coverage, the disappearance of cyst and fluid collection was confirmed in the postoperative radiological finding, and the clinical symptoms were significantly improved. By protecting the sacral nerve roots and covering the base of sacral defect, we can minimize the risk of complication and resolve the refractory fluid collection. Our results suggest that the gluteus muscle flap can be a safe and effective option for sacral defect and CSF leakage in extradural cyst or other conditions.

Review/Perspective On the Diagnosis and Surgical Management of Spinal Arachnoid Cysts.

Background: Spinal arachnoid cysts (SAC) are typically congenital, spontaneous, traumatic (i.e., including iatrogenic/surgical), or inflammatory in origin. In descending order, they occur in the thoracic, lumbar, and cervical spine, and originate from focal entrapment of the arachnoid membrane. Arachnoid cysts represent 1–2% of all cystic spinal masses/tumors. The majority are extradural arachnoid cysts (EDAC) while 10% of all arachnoid cysts are intradural (IDAC) including subarachnoid, or extra-arachnoidal/subdural. Only rarely are they intramedullary in location. The clinical symptoms/signs of IDAC/EDAC include; intracranial hypotension (i.e., due to continued cerebrospinal fluid drainage), radiculopathy, and/or myelopathy.Methods: Magnetic Resonance Images (MR) and Myelo-Computed Tomography (Myelo-CT) studies classically document the predominant dorsal location of IDAC/EDAC. They also show their extent and severity contributing to root, cord, and/or cauda equina compression. In the cervical/thoracic spine, MR/Myelo-CT studies classically show the “double cord” or “windsock” signs, while the “fake arachnoiditis sign” may be seen in the lumbar spine. The latter sign signals the presence of a circumferential extra-arachnoidal-subdural cyst that centrally “traps” the cauda equina. Note, that this resembles and is often misinterpreted as adhesive archnoiditis.Results: Patients with significant SAC-related neurological deficits typically warrant early surgery. That surgery includes; partial/total resection/fenestration of cyst walls, and occlusion of communicating fistulas with or without accompanying shunts.Conclusion: It is critical to recognize the clinical (i.e., intracranial hypotension, radiculopathy, and/or myelopathy) and radiographic MR/Myelo-CT signs (i.e., “double cord,” “windsock signs”, or “fake arachnoiditis sign”) of IDAC, EDAC, or intramedullary spinal arachnoid cysts to appropriately offer treatment. For those with significant neurological deficits, early surgery (i.e. optimally 0-< 24 hours after the onset of symptoms/signs consisting of laminectomies, partial/total cyst resection/fenestration, and ligation/occlusion of the subarachnoid-cyst fistula with or without shunt placement), is essential to avoid significant permanent neurological sequelae.

In Reply to the Letter to the Editor Regarding “Bibliometric Evaluation of U.S. Neurosurgery Subspecialties and Academic Rank Using RCR Index”

Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.

Extradural spinal arachnoid cysts: Management and outcome in five children

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.

Spinal Extradural Arachnoid Cyst: Minimally Invasive Surgical Treatment after Localization of Dural Defect Using Magnetic Resonance Myelogram

Spinal Extradural Arachnoid Cyst: Minimally Invasive Surgical Treatment after Localization of Dural Defect Using Magnetic Resonance Myelogram

Ultrafine Flexible Endoscope Visualization to Assist in the Removal of a Huge Spinal Extradural Arachnoid Cyst: Case Report and Literature Review

Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.

Early microsurgery on thoracolumbar spinal extradural arachnoid cysts: Analysis of a series of 41 patients

BackgroundWe designed this study to share our management experiences on spinal extradural arachnoid cysts (SEACs) to add more to the body of evidence for their treatment. MethodsWe retrospectively reviewed 41 patients who underwent microsurgery for thoracolumbar SEACs at our hospital from June 2009 to June 2019. All clinical data, including medical history, clinical features, imaging manifestation, operative findings, and prognosis, were extracted from medical records and databases. Perioperative differences of the Visual Analogue Scale (VAS), the Oswestry disability index (ODI) score, and postoperative Odom’s criteria were used to assess the surgical outcome. ResultsThe most common and very first clinical symptom in the 41 patients was pain (VAS = 2.82 ± 0.89), and the mean ODI value was 61.7 ± 8.9%. Imaging revealed that the cystic lesions in the thoracolumbar spine involved an average of 2.85 segments. Of the 41 patients, 39 underwent total cyst excisions, and 36 had their dural defect repaired by one of three methods. The mean postoperative follow-up time was 52.3 months. Postoperatively, one case developed kyphoscoliosis and two cases experienced a recurrence. The majority of patients showed excellent outcomes according to Odom’s criteria, the postoperative VAS (0.80 ± 1.08), and the ODI (15.4 ± 9.3%). ConclusionsThemost commonclinicalsymptoms of thoracolumbar SEACs included progressive discomfort and pain around the involved spinal segments. Early surgical intervention relieved the patients from their symptoms. Microsurgery was recommended to resect the complete cyst and to repair the dural defect, but resection of the complete cyst is more necessary than just repairment of the dural defect for providing promising outcomes.

Microsurgical treatment of symptomatic spinal extradural arachnoid cyst: a consecutive case series of 34 patients and literature review

PurposeA spinal extradural arachnoid cyst (SEAC) is a rare condition with unclear etiology. Herein, we report a series of symptomatic SEACs to illustrate features of SEACs in adults, surgical management, and outcomes. MethodsA total of 34 consecutive patients who underwent microsurgical treatment were retrospectively reviewed. Patient characteristics were recorded in each case, including presenting symptoms, imaging findings, neurologic status, a surgical procedure performed and follow-up. ResultsThere were 19 (56%) male and 15 (44%) female patients, with the ages ranging from 16 to 71 years (average 45 years). The lesions were located in the cervical segment (n = 4, 12%), thoracic segment (n = 6, 18%), thoracolumbar segment (n = 10, 29%) and lumbar segment (n = 14, 41%). Clinical presentations included back pain (n = 18, 53%), sensory deficits (n = 14, 41%), weakness (n = 4, 12%) and gait ataxia (n = 4, 12%), with a mean duration of symptoms of 17 months. The lesion was hypointense with the spinal cord on T1-weighted images and hyperintense on T2-weighted images and showed no homogeneous enhancement after contrast medium injection. Communication between the cyst and subarachnoid space was found in 23 patients and the cyst was resected after fistula ligation. Postoperatively, patients were followed up for an average of 80 months. The patients’ symptoms dramatically improved and follow-up radiological images showed a complete disappearance of the cyst in all patients. No recurrence was observed in the dural repair group. ConclusionPatients with symptomatic SEAC present with obvious and persistent symptoms. Complete microsurgical cyst removal with the closure of the dural defect is the standard treatment procedure with good results and a low recurrence rate.

Spinal extradural arachnoid cyst: An uncommon cause of thoracic spine compression

Spinal extradural arachnoid cysts are unusual causes of symptomatic spinal cord compression. They represent expanding diverticula of the subarachnoid space herniating through a dural defect into the extradural space. The pathogenesis of this entity is still unclear.