Intradural Arachnoid Cyst Research Articles

Extensive intradural arachnoid cyst of the lumbar spinal canal: case report

Background Spinal intradural arachnoid cysts are rare outpouchings of arachnoid lining occurring mainly in the thoracic and cervical regions. MRI is considered the diagnostic procedure of choice; however, some arachnoid cysts have been reported to elude diagnosis by MRI due to the similar signal intensity of the cyst and the subarachnoid space. Case description We present a case of a 41-year-old woman with an intradural arachnoid cyst of the lumbar spinal canal. Diagnostic studies demonstrated a herniated L4-5 disk, which led to two operations. Despite intractable pain postoperatively, the MRI failed to reveal further focal compression of the nerve root. A myelogram suggested compression of the thecal sac by a dorsal mass lesion. The patient underwent a midline durotomy that revealed two large arachnoid cysts with the nerve roots beneath them pushed ventrally and to the right. Removal of the arachnoid layer resulted in complete fenestration of the cyst and allowed the nerve roots to freely float in the spinal fluid. Conclusion In retrospect, the abnormality could be appreciated on multiple prior scans performed at another institution, demonstrating that in the patient with low back pain, degenerative disc disease is not the only diagnosis to consider.

脊柱管内くも膜嚢腫手術例の検討

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.

Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery

A case report with long-term follow after a surgical procedure. To describe a case of intradural arachnoid cyst secondary to a compression fracture in the thoracic spine and to report long-term results after surgical treatment with hemilaminectomy. Osaka, Japan. A 68-year-old man who had a traumatic intradural arachnoid cyst following an adjacent compression fracture of T5 underwent surgery. Intraoperatively, after recognition of intradural arachnoid cyst with an echogram following hemilaminectomy, the dural sac was incised and the arachnoid cyst was resected under microscopic observation. At 7 years after the operation, the low intensity within the vertebral body of the compression fracture had resolved and the spinal cord remained in its normal shape and position. No progression of kyphotic deformity was detected. A compression fracture of the thoracic spine can be associated with an intradural arachnoid cyst. Microscopic resection via hemilaminectomy for the cyst showed a good result in a 7-year follow up.

Aracnoidite constritiva causada por pantopaque resultando em siringomielia e paraparesia: relato de caso

We present an unusual case of thoracic constrictive arachnoiditis after pantopaque myelography, used 10 years before in the diagnosis of intradural arachnoid cyst.

Quiste aracnoideo espinal intradural relacionado con síndrome de Noonan

Intradural spinal arachnoid cysts are collections of liquid similar to CSF, caused by a disorder of the arachnoid trabeculae. Noonan s syndrome is a condition involving multiple malformations, with autosomal dominant inheritance, variable penetration and expression and a phenotype similar to that of Turner s syndrome. We describe the case of a girl with Noonan s syndrome who presented with progressive scoliosis and signs and symptoms of a disorder of the spine related to an intradural spinal arachnoid cyst. A four year old girl with no significant previous clinical history was seen for slow growth (in size and weight), progressive scoliosis and urinary sphincter dysfunction. On physical examination there were features of polymalformation compatible with Noonan s syndrome and thoracic scoliosis. In view of this a spinal MR study was done. This showed an intradural arachnoid cyst from segment T4 to T11, with displacement and spinal narrowing which required a cyst-peritoneal shunt. Intradural spinal arachnoid cysts are collections of liquid produced due to arachnoid trabeculae. Noonan s syndrome is a condition involving multiple malformations with a phenotype which is very similar to that of Turner s syndrome. It is linked to alterations of tissue elastin which favor the appearance of arachnoid cysts. Arachnoid cysts are an uncommon cause of spinal compression and/or progressive scoliosis. Although this association has not been described previously, in the case of a patient with Noonan s syndrome, with clinical features of a spinal disorder and/or progressive scoliosis, the presence of a spinal arachnoid cyst should be considered.

Symptomatic sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst

A case of sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst in a 35-year-old male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and dysuria for several months. Computed tomographic (CT) myelograms and magnetic resonance imaging (MRI) scans showed a huge sacral cyst without neural components. A favorable outcome could be achieved by decompression of the cyst, obliteration of the fistulous channel between the cyst and the thecal sac, and fenestration of the arachnoid cyst into the subarachnoid space. The relevant literatures are also reviewed.

Anterior thoracic intradural arachnoid cysts

Anterior thoracic intradural arachnoid cysts (ATIACs) are a rare cause of spinal cord and nerve root compression, for which different treatment strategies have been proposed. Although ATIAC represents a well-known clinical entity, the choice of surgical method has not been uniform, and no study has been specifically designed to compare the results of the different treatment options adopted. The authors report the case of a 40-year old man with a 1-year history of dorsal pain, weakness in the lower extremities, gait disturbance, and mild sexual and urinary dysfunction. On neurological examination spastic paraparesis, lower-extremity hypertonia, and hypesthesia below T-2 were demonstrated. Magnetic resonance imaging revealed the presence of an ATIAC at the T-2 level. The patient underwent complete microsurgical removal of the cyst. The authors conducted a Medline search of the relevant literature from 1966 to 1998 and also obtained data on other cases in which patients underwent surgical treatment of ATIAC. The literature search yielded five such cases. Treatment strategies were complete excision and fenestration followed by placement of a shunt. In addition, one case was characterized by intraoperative cyst rupture during retraction of the spinal cord. Correct preoperative workup coupled with microneurosurgical technique allow for successful removal of the lesion and excellent outcome. Based on the literature review and the results in our case, the complete excision of ATIAC is associated with an excellent outcome, which is different from results achieved using other surgical strategies.

Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT.

Imaging studies in eight patients with surgically-confirmed spinal arachnoid cysts were analyzed retrospectively. All patients had preoperative MRI of the spine and seven preoperative myelography with postmyelographic CT. In all cases the correct diagnosis could be made preoperatively on the basis solely of MRI. The diagnosis could also be established from myelography and postmyelographic CT in six of the seven cases. In one case myelography and CT simply demonstrated an intradural extramedullary mass.

脊髄くも膜嚢胞の臨床的検討

The clinical findings in five intradural and two extradural arachnoid cysts were discussed. All patients of intradural arachnoid cyst were female, and their lesions were located at the upper or mid thoracic level. Three patients showed sensory disturbance and five showed motor weakness of the lower extremities. MRI and CTM showed enlargement of the subarachnoid space and displacement of the spinal cord. One patient had syringomyelia, two had cervical disc disease, and two had spinal cord herniation at the thoracic level. During the operation, the cyst walls were removed in all patients. Simaltaneously, herniated spinal cords were replaced intradurally. Later, cervical anterior fusion was performed in one patient, but another patient was follow-up without recourse to an operation. Syringomyelia disappeared without any direct treatment. The patients showed good recovery after operation, but the patients of extradural arachnoid cyst showed weakness and sensory disturbance of the lower extremities. Their dural defects were located at the thoracic level. MRI and CTM showed large cysts and bone erosion. After removal of the cyst wall and closure of the dural defect, each patient made a good recovery. Although MRI and CTM were helpful both for diagnosis and operation, 3D MR myelography would have been helpful to show the three dimentional relationship of the cyst and the subarachnoid space, as well as the pathogenesis of the arachnoid cyst and/or spinal cord herniation.

Cine magnetic resonance imaging of spinal intradural arachnoid cysts.

The diagnostic value of cine magnetic resonance imaging (CMRI) that visualizes fluid and tissue movement was evaluated in patients with spinal intradural arachnoid cysts, a rare but increasingly detected cause of spinal cord dysfunction. Four patients with thoracic spinal intradural arachnoid cysts were investigated with conventional T1- and T2-weighted and cardiac-gated CMRI. Four normal volunteers also underwent CMRI for comparison. Sagittal T1- and T2-weighted imaging showed lesions as an abnormal widening of the posterior spinal subarachnoid space, but mixed high- and low-signal intensities on T2-weighted imaging suggested cystic lesions. CMRI, using 16 to 20 sagittal gradient echo images during the cardiac cycle of normal volunteers, indicated synchronous signal changes along the subarachnoid space, suggesting a smooth cerebrospinal fluid flow. CMRI of patients detected that the caudal or cranial direction of the high-signal propagation suddenly reversed at some locations (as if rebounding) in an asynchronous fashion along the lesion (asynchronous rebound phenomenon), which was well demonstrated by the closed-loop video mode. Cystectomy revealed that the cysts consisted of multiple lobules and that the asynchronous rebound phenomenon corresponded with some boundaries of cyst lobules. CMRI also visualized dynamic spinal cord compression by the cyst. CMRI can demonstrate abnormal fluid flow and spinal cord compression caused by a spinal intradural arachnoid cyst.

Cine-mode magnetic resonance imaging of a thoracic intradural arachnoid cyst: Case report

We report the appearance of a thoracic intradural arachnoid cyst on cine-mode magnetic resonance imaging (MRI). Based on the operative findings, cine-mode MRI was more sensitive for identifying the intradural location of arachnoid cysts than was conventional MRI. The value of cine-mode MRI in diagnosing this rare entity is discussed.

An unusual spinal intradural arachnoid cyst

Spinal intradural arachnoid cysts are seen most frequently in the thoracic region, particularly near the midline posteriorly. A thoracic intradural arachnoid cyst in this typical location is reported, with the additional unusual finding of herniation of the spinal cord through an anterior defect in the dura matter. The MRI findings are described.

最近経験した胸髄硬膜内嚢腫の１例

A case of intradural arachnoid cyst is reported. The patient, a 14-year-old boy complained of severe back pain and gait disturbance. MRI showed wide-spread cyst in the subarachnoid space. MRI is very useful for the diagnosis of spinal a rachnoid cysts.

Spinal Cord Herniation Associated with an Intradural Spinal Arachnoid Cyst Diagnosed by Magnetic Resonance Imaging

Abstract Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst. (Neurosurgery 29:137-139, 1991)

Spinal cord herniation associated with an intradural spinal arachnoid cyst diagnosed by magnetic resonance imaging

Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst.

くも膜嚢腫と二重硬膜とを伴った特発性脊髄ヘルニアの一例

Idiopathic spinal cord herniation is very rare, 5 cases being so far reported in the literature. A 71-year-old-woman with a gradual loss of power in her left leg and with a sensory disturbance in the lateral side of her right leg was admmited. MRI showed that from Th4 to Th5, the spinal cord was shifted ventrally and disappeared, and a dilated subarachnoid space was noticed dorsally. She was diagnosed spinal cord herniation associated with an arachnoid cyst, and the operation was done. During operation, not only an intradural arachnoid cyst was obsreved dorsally, but was duplicated dura mater ventrally. In the ventral lesion, the spinal cord was herniated through a defect of the inner layer of the dura mater. This dural inner layer as well as the arachnoid cyst was resected. Her clinical symptoms were not progressed.When the spinal cord is shifted or disappeared in an image, we should precisely determine the relationship between the spinal cord and the dura mater during operation with consideration of a possibility of the presence of idiopathic spinal cord herniation.

Thoracic intradural arachnoid cyst: possible pitfalls with myelo-CT and MR

A thoracic intradural arachnoid cyst presenting as an intradural extramedullary mass highly suggestive of psammoma on myelogram and myelo-CT is reported in a 34-year-old female. High densities of the cyst were related to collection of contrast media within the cyst. However MR examination of the thoracic spinal cord including sagittal T1 (without and with contrast) and T2 studies failed to demonstrate the mass. Lack of MR changes were related on one hand to the small size of the cyst and to the absence of mass effect on the spinal cord, and on the other hand to a CSF-like signal of the contents of the cyst. Only combination of myelography, myelo-CT and MR allows precise diagnosis of small intradural arachnoid cyst; however MR is the method of choice for evaluation of large intradural subarachnoid cysts.

A variant of the syndrome of spinal arachnoid cysts with multiple congential defects

We report an apparently unique case of multiple spinal intradural arachnoid cysts in association with distichiasis, late onset lower limb lymphoedema, and previously unrecognized features of associated bilateral megaureters, Arnold Chiari malformation with hydrocephalus and syringomyelia. The literature on this unusual group of congenital malformations is reviewed.

胸髄くも膜のう腫の２例 ＭＲＩの有用性について

We reported two cases of an intradural arachnoid cyst in the thoracic spine.Case 1 was a 53-year-old man and case 2 was a 41-year-old man. Both had neurological deficits. Supine myelogram and MCT showed wide-spread subarachnoid space.MRI also showed same findinds.Laminectomy was performed for both cases and the subarachoid cyst was resected.At three months sfter surgery. MRI showed that the decompression of the spinal cord had been obtained.It may be useful for the early diagnosis of the subarachnoid cyst.

Intradural spinal arachnoid cyst case report

An intradural spinal arachnoid cyst presenting with spinal cord compression is discussed. This case illustrates the value of magnetic resonance imaging in the diagnosis and follow-up of intradural spinal arachnoid cysts.