Spinal Extradural Arachnoid Cyst Research Articles

Multiple spinal extradural arachnoid cysts occurring in a child

Symptomatic multiple extradural arachnoid cysts of the spine are extremely uncommon in children and have only rarely been reported. The authors report a case of multiple extradural spinal arachnoid cysts in a 14-year-old child who presented with signs of spinal cord compression. The disease affected the thoracic spine and extended from T-5 to T-10 with an underlying defect in the dura of the spinal canal that was predisposed to the formation of cysts. The authors describe the imaging examination, surgical planning, and surgical technique, and they review the literature. They also discuss the possible mechanisms of cyst formation.

Multiple spinal extradural arachnoid cysts occurring in a child

✓Symptomatic multiple extradural arachnoid cysts of the spine are extremely uncommon in children and have only rarely been reported. The authors report a case of multiple extradural spinal arachnoid cysts in a 14-year-old child who presented with signs of spinal cord compression. The disease affected the thoracic spine and extended from T-5 to T-10 with an underlying defect in the dura of the spinal canal that was predisposed to the formation of cysts. The authors describe the imaging examination, surgical planning, and surgical technique, and they review the literature. They also discuss the possible mechanisms of cyst formation.

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.

Spinal extradural arachnoid cyst

Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. They usually present with progressive signs and symptoms caused by spinal cord compression if they enlarge. A comprehensive review about spinal extradural arachnoid cyst is made including the author's own case of a 59-year-old woman with a 6-month history of progressive back pain radiating to both legs. Key points concerning the possible pathogenesis including symptomatology, diagnosis, and the implications for treatment are highlighted. Surgical treatment is curative and this rare clinical entity should be considered in the differential diagnosis of spinal extradural lesions.

Expansive duraplasty for the treatment of spinal extradural arachnoid cysts

The authors report the case of a 25-year-old man with a thoracolumbar extradural arachnoid cyst who underwent expansive duraplasty. Symptoms, preoperative magnetic resonance imaging features, and intraoperative findings suggested the involvement of entrapment neuropathy in the manifestation of symptoms. To the authors' knowledge, this case represents the first evidence that expansive duraplasty can achieve complete resolution of the symptoms in a patient with a spinal extradural arachnoid cyst. The results indicate that duraplasty may be an alternative option in cases in which complete resection of the lesion is difficult and widening of the dural sac is necessary at surgery.

Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report

The authors describe the case of a fifteen-year-old girl with progressive paraparesis of the lower limbs that was caused by an intraspinal extradural dorsal arachnoid cyst at the level of Th 3-6. Diagnosis was established with MRI and MRI myelography. The latter revealed the CSF-like content of the cyst. The patient underwent laminotomy and en bloc resection of the cyst. Ligation of the pedicle of the cyst was done with laminoplasty. Quick and complete recovery was observed after surgery.

Extradural spinal arachnoid cysts associated with spina bifida occulta

Spinal extradural arachnoid cysts are an uncommon cause of neural compression in children. Even more uncommon is the association of such cysts with spina bifida occulta. Two girls, 12 and 8-years-old, presented with left leg pain, deteriorating gait, clinical signs of left L5 and S1 root compression, without bladder or bowel symptoms. The first patient had left foot drop. The second patient had muscle wasting and smaller left foot with pes cavus. Radiographs showed spina bifida occulta of S1 in both. MRI revealed an extradural cyst at the S1 level, indenting the thecal sac and the L5 and S1 roots. At operation in both patients a large arachnoid cyst arising from a small dural defect in the axilla of the left S1 root was compressing and displacing it and the dural sac. It was removed and the defect was repaired. The first patient improved with complete recovery of the foot drop. An MRI at 12 months showed no cyst recurrence. The second patient made good recovery initially, but at 10 months developed recurrent symptoms. An MRI scan showed recurrence of the cyst with root compression. On repeat exploration a different dural defect was identified in a more anterior position and was repaired. The coexistence of extradural arachnoid cyst and corresponding bifid spinal segment has not been described previously. It raises the suspicion that the dural defect giving rise to the arachnoid cyst may be due to segmental dural dysgenesis in the context of the dysrhaphic neuroectodermal malformation.

Spinal extradural meningeal cyst with spinal stenosis

Case report. To present a rare pathology causing a common disease. Spine unit of the orthopaedic surgery department of a university hospital in Berlin/Germany. A 39-year-old female with an intraspinal extradural arachnoid cyst of the lumbar spine presented with intermittent radiating lumbar pain. The magnetic resonance imaging (MRI) showed a dorsal spinal extradural arachnoid cyst at L3/4. After wide laminotomy L3, operative cyst resection and stabilisation at L3/4 by posterior lumbar interbody fusion (PLIF), major symptom relief occurred. Spinal extradural arachnoid cysts are a rare entity causing low back pain and intermittent radicular syndromes. They can be caused by arachnoid herniation through dural weak spots which are hereditary or occur after trauma. A ball-valve mechanism promotes growth. The main diagnostic tool for spinal extradural cysts is the MRI scan. Additionally, myelography is helpful to demonstrate fluid communication. Complete surgical removal of the cyst should be attempted to reduce risk of recurrence. If extensive decompression is needed for the surgical approach causing segmental instability, interbody fusion is recommended. The outcome depends on age, duration and degree of neurological damage.

Noncommunicating spinal extradural arachnoid cyst causing spinal cord compression in a child

Extradural arachnoid cysts in the spine are relatively uncommon causes of spinal cord compression in the pediatric population that are thought to arise from congenital defects in the dura mater. Most reports describe such cysts communicating with the intrathecal subarachnoid space through a small defect in the dura. The authors describe the case of a child who presented with spinal cord compression caused by a large spinal extradural arachnoid cyst that did not communicate with the intradural subarachnoid space. An 11-year-old girl presented with urinary urgency, progressive lower-extremity weakness, myelopathy, and severe gait ataxia. Magnetic resonance imaging of the spine demonstrated a large extradural arachnoid cyst extending from T-8 to T-12. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cyst. Intraoperatively, the dura was intact and there was no evidence of communication into the intradural subarachnoid space. Postoperatively, the patient's motor strength and ambulation improved immediately, and no subsequent cerebrospinal fluid leak occurred. Noncommunicating spinal extradural arachnoid cysts are extremely rare lesions that can cause spinal cord compression in children. Because the dura remains intact, they can be removed entirely without subsequent dural repair. The authors review the literature and discuss the proposed underlying mechanisms of formation of these arachnoid cysts.

Usefulness of Constructive Interference in Steady State (CISS) Imaging for the Diagnosis and Treatment of a Large Extradural Spinal Arachnoid Cyst

We present a rare case of a symptomatic large extradural arachnoid cyst extending from the lower thoracic to sacral region in a 12-year-old boy, who presented with the signs and symptoms of spinal cord compression over 4 years. Since the pedicle of the cyst could not be delineated using conventional magnetic resonance imaging (MRI), cine-mode MRI, and computed tomography scan, partial resection of the cyst was initially performed, which significantly improved motor function. After the first operation, a single pedicle was clearly demonstrated by 3D constructive interference in steady state (CISS) MRI. Thus, additional surgery aimed at closing the dural defect was performed to prevent future enlargement of the cyst. The operative findings were consistent with those of 3D CISS imaging. Clinical and radiological features of this lesion are discussed, focusing on the usefulness of 3D CISS MRI for preoperative evaluation, and especially for delineating the pedicle in cases of large extradural spinal arachnoid cysts.

Effectiveness of a transforaminal surgical procedure for spinal extradural arachnoid cyst in the upper lumbar spine

Spinal extradural arachnoid cysts are relatively rare, and the pathogenesis is still unclear. Here, we report a 24-year-old woman with a Type I lesion by Nabors' classification (extradural arachnoid cyst without spinal nerve root fiber involvements), who complained of low back pain and right thigh pain, treated surgically using a transforaminal approach. Magnetic resonance imaging (MRI) and myelography showed a large extradural cystic lesion close to the L1 nerve root sleeve, accompanied by moderate L1 nerve root compression and a communication between the extradural cyst and the subarachnoid space. Resection of the cyst wall and closure of the ostium were easily performed by this approach. This procedure resulted in the relief of both low back pain and right thigh pain. Histological examination showed clusters of meningothelial cells, which was a typical feature of arachnoid cysts. Postoperative MRI demonstrated that both the cystic lesion and nerve root compression had disappeared. This transforaminal procedure proved useful for the treatment of a lesion located around a lumbar spinal nerve root.

Diagnostic and therapeutic management of spinal arachnoid cysts.

The wide variety of intraspinal cystic lesions necessitates different elaborate diagnostic procedures to choose the right therapeutic management in symptomatic patients. Based on the case reports of seven patients with symptomatic spinal arachnoid cysts we discuss the aetiology, diagnostic procedures and therapeutic management of extra- and intradural spinal cysts. All patients underwent MRI, Myelography and CT-Myelography during diagnostic evaluation. During surgery the cyst was resected and the communication between the cyst and the subarachnoid space was closed. Two patients were identified with intradural, five with extradural spinal arachnoid cysts. Postoperative outcome was favourable in those patients without preoperative cord damage. MRI is the diagnostic procedure of first choice because of its potential to demonstrate the exact localisation, extent and relationship of the arachnoid cyst to the spinal cord. Cord atrophy secondary to compression can be visualised and used for prediction of neurological outcome. Myelography and CT-Myelography (CTM) are still of diagnostic value since they might demonstrate the communication between the subarachnoid space and the cyst, which is important for surgical planning. The aim of surgical treatment is neural decompression and prevention of refilling of the cyst which is best accomplished by complete resection of the cyst and closure of the communication between cyst and subarachnoid space.

Extended extradural spinal arachnoid cyst: an unusual cause of progressive spastic paraparesis

A 15-year old girl presented with a slowly progressive spastic paraparesis since the age of 12. Creatine kinase was slighty increased. Muscle biopsy carried out during tendon surgery for severe toe-walking showed ‘myopathic’ changes. Subsequent neurological evaluation and radiological studies revealed a large extradural arachnoid cyst extending from the 11th thoracic vertebra to the first lumbar vertebra. Her condition improved after operation. The ‘myopathic’ features turned out to be the result of chronic spinal compression. MRI is the method of choice to examine patients with non-hereditary progressive spastic paraparesis. Muscle biopsy and tendon surgery should not be performed, without careful neurological examination.

Myelographic and MRI appearances of a thoracic spinal extradural arachnoid cyst of the spine with extra-and intraspinal extension

An unusual arachnoid cyst of the thoracic spine is reported. The clinical and neuroradiological features are described.

The value of MRI in the study of spinal extradural arachnoid cysts

Two cases of extradural arachnoid cyst in the spinal canal were diagnosed by magnetic resonance imaging (MRI). MRI correctly characterized the extradural location of the cysts as well as the cyst contents as CSF, thus establishing the diagnosis. MRI may be of predictive value in the postoperative prognosis.

Magnetic resonance imaging of a spinal extradural arachnoid cyst

A case of extradural arachnoid cyst in the spinal canal of a 16-year-old male was diagnosed by magnetic resonance imaging. The diagnosis was verified by a metrizamide-enhanced computed tomographic myelogram. An operation with a favorable outcome followed. The noninvasive advantages of magnetic resonance imaging in such a diagnosis are demonstrated by this case.

Communicating spinal arachnoid cysts: Diagnosis by delayed metrizamide computed tomography

A case of an extradural spinal arachnoid cyst is presented with emphasis on the neuroradiologic characteristics of this lesion. The cyst was definitely diagnosed by delayed metrizamide spinal computed tomography. Extradural spinal arachnoid cysts, or diverticula, have been the subject of much discussion in the neuroradiologic and neurosurgical literature. However, the appearance of a communicating arachnoid cyst on delayed spinal computed tomography after metrizamide myelography is heretofore undescribed in the English language neurosurgical literature.

Intrasacral extradural communicating arachnoid cyst

A case of cystic lesion within the sacrum, commonly described as “occult intrasacral meningocele,” is presented. A critical comparison with similar cystic lesions elsewhere in the spinal column suggests that intrasacral meningocele represents a part of a more general disorder, the spinal extradural arachnoid cyst. (Neurosurgery 8:236-240, 1981)

The radiological appearances of spinal extradural arachnoid cysts.

The radiological appearances of spinal extradural arachnoid cysts.