Intradural Arachnoid Cyst Research Articles

Long segment dorsolumbar spinal arachnoid cyst: a case report

Abstract Congenital spinal intradural arachnoid cyst involving almost the entire spine is very rare. We report a case of 15 years old boy, who presented with progressive spastic paraparesis with gait instability for last 4 months. MRI spine revealed thoracolumbar arachnoid cyst extending from D4 to L3 segment. Complete surgical excision of arachnoid cyst and laminoplasty was done. Patient recovered completely and histopathological examination of specimen confirmed the diagnosis of arachnoid cyst.

Intradural arachnoid cyst of the thoracic spine to be distinguished from spinal cord herniation, a case report

Intradural arachnoid cyst of the thoracic spine to be distinguished from spinal cord herniation, a case report

Cervical spinal intradural arachnoid cysts in related, young pugs

Seven related young pugs were diagnosed with cervical spinal intradural arachnoid cysts by magnetic resonance imaging (n = 6) and myelography (n = 1). All dogs were presented with skin abrasions on their thoracic limbs and non-painful neurological deficits, indicating a C1-T2 myelopathy. In all six dogs examined by magnetic resonance imaging not only the spinal arachnoid cyst but also a concomitant, most likely secondary, syringohydromyelia was confirmed. Pedigree analysis suggested a genetic predisposition for spinal arachnoid cysts in this family of pugs. Generalised proprioceptive deficits more pronounced in the thoracic limbs suggesting a focal cervical spinal cord lesion, with concomitant skin abrasions on the dorsal aspect of the thoracic limbs in a young pug, should alert veterinarians to the possibility of cervical spinal arachnoid cysts.

Progressive growth of arachnoid cysts with cauda equina syndrome after lumbar spine surgery

Intradural arachnoid cysts are a rare cause of spinal cord compression. In symptomatic cases neuropathic pain, gait disturbance, and paraparesis or quadriparesis are often present. Postoperative arachnoid cysts have rarely been reported. We describe a 56-year-old male who developed progressively enlarging arachnoid cysts with cauda equina syndrome and vertebral body erosion after lumbar surgery. The clinical presentation of the patient, the possible mechanisms of cyst formation, and the management of the disease are discussed with regard to previous literature.

Anterior Cervical Arachnoid Cyst

This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome.

Occurrence of a spinal intradural arachnoid cyst after epiduroscopic neural decompression

Epiduroscopy is a relatively new technique that enables visualization of structures directly within the epidural space to detect pathology, improve adhesion, and to administer local anesthetics and steroids to affected nerve roots [1,2]. However, several complications such as visual impairment, epidural abscess, and encephalopathy with rhabdomyolysis have been reported. We report a case of a symptomatic spinal intradural arachnoid cyst induced by an accidental dural tear during epiduro scopy in a patient with failed back surgery syndrome (FBSS). A 65-year-old woman presented with chronic low back pain and radiating leg pain. She complained of hip and thigh pain, and claudication improved with rest. She had undergone a discectomy and laminectomy twice at L4, L5, and S1 2 years ago. On exami nation, the straight leg raising test was positive bilaterally. The Patrick test was negative, and no vascular abnormalities were observed. Magnetic resonance imaging (MRI) revealed an epidural adhesion with postoperative changes, degenerative changes of the L4-5 disc, and a laminectomy state at L5 and S1. A variety of pain therapies were ineffective. Her illness was diag nosed as FBSS, and our plan was epiduroscopic neural decom pression. She was placed in the prone position with routine moni toring in the operating room. An 18.5-G Tuohy needle was introduced into the epidural space through the sacral hiatus under aseptic conditions and with local anesthesia. An intro ducer sheath was advanced into the sacral epidural space. A 0.9 mm flexible endoscope (3000E, Myelotec, Roswell, GA, USA), covered with a 2.9 mm steering catheter (2000, Myelotec), was introduced through the sheath and advanced cephalad into the epidural space under fluoroscopic guidance. Adhesions in the epidural space were mobilized with the tip of the instrument under careful direct vision. However, sufficient epidural adhesiolysis could not be achieved above the S1 level due to the dense adhesions and scar tissue. Epidural fat and scars were visualized, but the image was fuzzy. Further adhesiolysis was attempted. Despite slow advancement of the endoscope, there was a sudden loss of resistance at the level of L5-S1. The S1 nerve roots appeared with small blood vessels, but they were unclear. Iohexol contrast (IOBRIX 300 Ⓡ , 640 mg/ml, Accuzen) instillation under fluoroscopy demonstrated a myelogram, which confirmed that the endoscope had entered the subara chnoid space. The endoscope was retracted from the hole in the dura, and a catheter was placed into the ventrolateral aspect of the left L5-S1 intervertebral foramen under fluoroscopy via the epiduroscope working channel. Contrast agent administration revealed good ventrolateral epidural spread along the L5 nerve roots without connection to the subarachnoid space after negative aspiration of cerebrospinal fluid and blood. A test dose of 2 ml 0.4% lidocaine with 5 mg triamcinolone was injected. The patient had no adverse hemodynamic or neurologic sequelae. Thirty ml of 0.4% lidocaine and 30 mg of triamcinolone were injected into the epidural space at the end of the epiduroscopy. The total volume of saline used for epidural irrigation was 200 ml. The operation was terminated after 40 min due to her frequent complaints of low back pain and movement during the procedure. No complications developed, and the patient was

Craniocervical arachnoid cyst in a patient with Klippel-Feil syndrome: a unique case

Klippel-Feil syndrome, or brevicollis, is a complex congenital disorder caused by the improper segmentation of the cervical vertebrae. The authors present the very rare case of a patient with Klippel-Feil syndrome who presented with an intradural arachnoid cyst at the craniocervical junction. They also examine possible factors contributing to this association. A 46-year-old woman presented with complaints of progressively worsening headaches and dizziness of 18 months' duration. She also demonstrated mild bilateral upper-extremity weakness. Magnetic resonance imaging revealed fused cervical vertebrae and a dorsal intradural arachnoid cyst at the craniocervical junction, extending down to the fourth cervical level. Because of worsening myelopathy and the presence of brainstem compression, the patient underwent surgical excision of the arachnoid cyst, which was approached via a midline posterior suboccipital/upper cervical route. An endoscope was introduced through a gap between the occiput and fused upper cervical vertebrae, and the arachnoid cyst was widely fenestrated. Postoperatively, the patient has remained symptom free for more than 2 years with evidence of good radiological decompression. The authors report a unique association between craniocervical arachnoid cyst and Klippel-Feil syndrome. To their knowledge, no other cases of this association have been reported in the literature. Arachnoid cysts should be part of the differential diagnosis in the presence of worsening myelopathic symptoms or pain in patients with Klippel-Feil syndrome.

Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review

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.

Imaging is not everything: thoracic intradural arachnoid cyst with severe spinal cord compression in an asymptomatic patient

Imaging is not everything: thoracic intradural arachnoid cyst with severe spinal cord compression in an asymptomatic patient

Disproportionately Large Communicating Fourth Ventricle Associated With Syringomyelia and Intradural Arachnoid Cyst in the Spinal Cord Successfully Treated With Additional Shunting

A 44-year-old woman presented with a rare case of disproportionately large communicating fourth ventricle (DLCFV) associated with syringomyelia and intradural arachnoid cyst in the spinal cord. Ventriculoperitoneal shunt operation was performed for hydrocephalus after subarachnoid hemorrhage. She developed DLCFV, which was then associated with syringomyelia and spinal intradural arachnoid cyst. Shunting of the fourth ventricle improved DLCFV, and then the syringomyelia and arachnoid cyst. Although the aqueduct was patent, independent pressure control of the fourth ventricle and the other ventricles was necessary to improve the symptoms. Shunting of the fourth ventricle should be considered for patients with DLCFV when the symptoms persist despite adequate pressure control of the other ventricles.

Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst

A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management.

Spinal arachnoid cyst

Preoperative, operative and postoperative radiological examinations and operative notes of 31 patients with spinal arachnoid cyst operated on during 2002–2009 at the Institute of Medical Sciences, Banaras Hindu University, were evaluated. Sixteen patients were male and 15 were female. All patients were managed surgically: extradural arachnoid cysts were managed by excision and intradural arachnoid cysts were managed by marsupialization. There was no recurrence in the 4 years of follow up.

Symptomatic Idiopathic Noncommunicating Intradural Arachnoid Cyst of the S1 Nerve Root

A case report of a rare symptomatic, idiopathic, noncommunicating intradural arachnoid cyst (IAC) of the proximal part of the S1 nerve root (NR). To discuss the possible pathophysiology, clinical and magnetic resonance imaging (MRI) presentation, intraoperative findings, and follow-up of IAC of the proximal part of the S1 NR. Rare variety of the Nabors's Type 3 spinal IAC. The etiopathogenesis are uncertain. Surgical NR decompression with extirpation of the cyst is the treatment of choice. A 37-year-old woman clinically presented as monoradiculopathy with a 9-month history of progressive, posture-dependent radicular pain, paresthesia and hypoesthesia in the right S1 dermatome, and mild weakness of the ipsilateral plantar flexors. Magnetic resonance imaging (MRI) showed a noncommunicating IAC of the proximal part of the S1 NR on the right side. Surgical exploration through the ipsilateral L5-S1 hemilaminectomy was performed with microsurgical arachnolysis of the compressed and stretched S1 NR fascicles that surrounded the cyst, during which the cyst spontaneously collapsed. The remnant of the cyst wall was extirpated and histopathology confirmed the diagnosis. After surgery an excellent clinical outcome was archived: the leg pain was no longer present and the paraesthesia, hypoesthesia, and motor weakness were resolved within 3 months. At 12 months of follow-up, the patient continues to be completely asymptomatic with no evidence of recurrence on MRI. A rare case of symptomatic, idiopathic, noncommunicating IAC of the proximal part of the S1 NR has been presented. Early recognition and treatment resulted in complete symptom resolution, with preservation of the full working capacity and good quality of life. Isolated monoradiculopathy with progressive, posture-dependent radicular pain seem to be typical clinical findings for such a lesion. Attending physicians should always be mindful of this fact in the total clinical evaluation of such cases.

Lumbar intraspinal arachnoid cyst superimposed by hyperacute spinal subdural hematoma: an unusual case

Background context Lumbar intradural arachnoid cyst (AC) concomitant with hyperacute spinal subdural hematoma (SSDH) has never been reported in the literature. Purpose To report a case of lumbar AC superimposed by hyperacute SSDH, which was difficult to diagnose preoperatively using magnetic resonance imaging. Herein, we describe diagrams showing the proposed mechanisms underlying the formation of a symptomatic AC. Study design/setting The study was designed to be a case report and literature review. Methods A 65-year-old man presented with acute onset of low back pain, followed by 5-day history of numbness and weakness in both legs before admission. Magnetic resonance imaging of the lumbosacral spine revealed an intradural extramedullary biconvex lesion at the L3–L4 level; the lesion compressed the cauda equina posteriorly. The lesion mainly appeared as hyperintense on T2-weighted images and hypointense on T1-weighted images. On the basis of these findings, the lesion was preoperatively diagnosed as a symptomatic lumbar subdural AC that compressed the cauda equina. Results The patient underwent laminectomy from L2 to L4. After a dura incision, a partially organized subdural hematoma was noted. Beneath the subdural hematoma was an AC compressing the underlying nerve roots. The patient’s back pain and muscle strength markedly improved after the operation. Conclusions Preoperative diagnosis of concomitant hyperacute SSDH and AC is difficult. In cases of patients who present with intraspinal AC accompanied by an acute onset of clinical presentation, an associated etiology should be considered until proven otherwise.

Arachnoscopy: a special application of spinal intradural endoscopy

The microsurgical removal of obstructions to CSF flow is the treatment of choice in the surgical management of intradural arachnoid cysts. Cardiac-gated phase-contrast MR imaging is an effective tool for the primary diagnosis and localization of arachnoid cysts. Microsurgery, however, does not lend itself to assessments of further adhesions beyond the borders of the exposed area. The use of a thin endoscope allows surgeons to assess intraoperatively whether the exposure is wide enough. Between 2006 and 2010, a single neurosurgeon performed 31 consecutive microsurgical procedures with endoscopic assistance in 28 patients with spinal arachnoid adhesions. A MurphyScope endoscope was used for this purpose. The CSF flow was studied before and after surgery in all patients by using phase-contrast MR imaging in the region of the craniocervical junction, the cervical spine, the thoracic spine, and the lumbar spine. In all 31 procedures, CSF flow obstructions were detected at the level identified by phase-contrast MR imaging. In 29 procedures, image quality was sufficient for an inspection of the adjacent subarachnoid space. In 6 cases, the surgeon detected further adhesions that obstructed CSF flow in the adjacent subarachnoid space that were not visualized with the microscope. In all cases, these adhesions were identified and removed during microsurgery. Arachnoscopy is a helpful adjunct to microsurgery and can be performed safely and easily. It allows the surgeon to detect further adhesions in the subarachnoid space that would remain undetected by microscopy alone.

Intra-dural spinal arachnoid cysts: a short series of 10 patients

Objective. To describe intra-dural arachnoid cysts as the cause of compressive myelopathy.Material and methods. A short series of 10 patients harbouring intra-dural arachnoid cysts is described. A detailed description of symptomatology, radiological findings, surgical approach, techniques and outcome is discussed. Microsurgical excision was performed in all patients. In two patients, intra- and extra-spinal communications of cysts were found and were ligated.Results. Good long-term results were achieved in all 10 patients, after surgical intervention.Conclusion. Rarely, intradural, extramedullary lesions like arachnoid cysts may lead on to compressive myelopathy causing spastic paraparesis. Except for the catastrophic complication like intra-cystic haemorrhage or subdural haematoma, the fatal complication is unlikely. The congenital dural defect is considered the cause behind the development of these cysts. Though uncommon, but intradural arachnoid cysts are important cause of compressive myelopathy. These lesions are curative, if excised surgically with precision.

Surgical treatment of spinal intradural arachnoid cysts using endoscopy

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.

Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele in a child

Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele is very rare. We report a case in a 9-year-old Chinese boy who presented with a two-week history of progressive paraparesis and gait ataxia. Magnetic resonance imaging revealed that a dorsal intradural extramedullary cystic lesion extended from T1 to T5 and compressed the spinal cord. A left lateral intrathoracic meningocele pouch was found incidentally at the level of T1. The arachnoid cyst as well as meningocele was removed and the spinal cord compression was relieved. Arachnoid cyst was confirmed by histological examination. The patient recovered well postoperatively. This is the second report of such a case in the world according to the available literature. The take-home message for our case is that the surgical approach should be individualized, depending on the size and location.

脊髄空洞症を伴った特発性胸椎硬膜内クモ膜嚢胞の診断と治療 : 4症例の経験より

脊髄空洞症を生じ,歩行障害を呈した特発性胸椎硬膜内クモ膜嚢胞は,診断が難しく,治療方法も確立されていない.本論文では,MRI診断における要点と,手術方法について考察を行った.われわれが経験した4症例では,MRI T2強調矢状断像において,脊髄空洞症に近接して,脊髄背側部のクモ膜下腔拡大と,脊髄の前方への偏位圧迫を認めた.この脊髄の形と位置の変化が,特に重要な所見である.上記所見により,クモ膜嚢胞の診断はMRIで可能と考える.神経症状が進行する場合は手術が必要と判断される.われわれは全例にクモ膜嚢胞摘出術を行い,うち1例にはシャント術を追加した.術後全例で脊髄空洞症は縮小し,神経症状の改善を認めた.脊髄空洞症を伴った胸椎硬膜内クモ膜嚢胞に対しては,クモ膜嚢胞摘出術を第一選択とし,脊髄への圧迫が除かれたと判断できる場合は,シャント術は不要と考えられる.

Cervicothoracic Intradural Arachnoid Cyst Misdiagnosed as Motor Neuron Disease

Recognizing syndromes which mimic ALS is crucial both to avoid giving this diagnosis erroneously and since there may be appropriate treatments. We report a 63-year-old woman diagnosed with possible ALS five years ago based on upper and lower motor neuron signs with typical electrophysiology and normal cranial MRI. At reassessment, spinal MRI revealed a cervicothoracic cyst with cord compression that was successfully treated neurosurgically. Histopathology confirmed an arachnoid origin as suspected from MRI. Spinal cysts may mimic ALS and need to be thoroughly excluded by appropriate imaging.