Intradural Arachnoid Cyst Research Articles

Spontaneous Repeated Disappearance and Recurrence of Multiple Spinal Intradural Arachnoid Cysts in a Child

Spinal intradural arachnoid cysts are rare in the pediatric population. We present a rare case of intradural spinal arachnoid cysts that spontaneously and repeatedly disappeared and reoccurred. A 2-year-and-8-months-old boy presenting with lower extremity weakness was found to have spinal intradural arachnoid cysts in cervical and thoracolumbar regions at separate times. Although spontaneous disappearance of both lesions was observed, surgical treatment was finally performed for the symptomatic recurrent thoracolumbar lesion. To the best of our knowledge, this is the first report of spontaneously disappearing and recurring spinal arachnoid cysts.

Intraoperative Visualization of a Spinal Arachnoid Cyst Using Pyoktanin Blue.

Spinal arachnoid cysts (SACs) are filled with cerebrospinal fluid, and they include the arachnoid membrane, making it difficult to distinguish the walls of the cyst from the arachnoid membrane and excise the cyst as a lump. Here we report a technique for the intraoperative visualization of SACs, involving the use of pyoktanin blue. Four patients with spinal intradural arachnoid cysts underwent total excision of the cysts between October 2016 and April 2017. In 1 case, magnetic resonance imaging revealed the cyst clearly, but in the other cases, the cysts were unclear. All cysts were injected with 1% pyoktanin blue (Wako Pure Chemical Industries, Osaka, Japan) diluted 500 times with physiological saline before excision. When it was difficult to distinguish the cyst from the normal arachnoid membrane, 1% pyoktanin blue diluted 1000 times with physiological saline was injected into both the cyst and the subarachnoid space, and the spread of the stain was observed. The cysts were better visualized after pyoktanin blue injection than before injection. When it was difficult to distinguish the cyst from the normal arachnoid space, pyoktanin blue injection was useful for judging the cyst space. There were no perioperative complications, and the patients' symptoms improved partially or completely after treatment. Our technique of pyoktanin blue injection into SACs could make their excision easy and safe.

A New Classification for Pathologies of Spinal Meninges-Part 2: Primary and Secondary Intradural Arachnoid Cysts.

Spinal intradural arachnoid cysts are rare causes of radiculopathy or myelopathy. Treatment options include resection, fenestration, or cyst drainage. To classify intradural spinal arachnoid cysts and present results of their treatment. Among 1519 patients with spinal space occupying lesions, 130 patients demonstrated intradural arachnoid cysts. Neuroradiological and surgical features were reviewed and clinical data analyzed. Twenty-one patients presented arachnoid cysts as a result of an inflammatory leptomeningeal reaction related to meningitis, subarachnoid hemorrhage, intrathecal injections, intradural surgery, or trauma, ie, secondary cysts. For the remaining 109 patients, no such history could be elucidated, ie, primary cysts. Forty-six percent of primary and 86% of secondary cysts were associated with syringomyelia. Patients presented after an average history of 53 ± 88 months. There were 122 thoracic and 7 lumbar cysts plus 1 cervical cyst. Fifty-nine patients with primary and 15 patients with secondary cysts underwent laminotomies with complete or partial cyst resection and duraplasty. Mean follow-up was 57 ± 52 months. In the first postoperative year, profound improvements for primary cysts were noted, in contrast to marginal changes for secondary cysts. Progression-free survival for 10 years following surgery was determined as 83% for primary compared to 15% for secondary cysts. Despite differences in clinical presentation, progression-free survival was almost identical for patients with or without syringomyelia. Complete or partial resection leads to favorable short- and long-term results for primary arachnoid cysts. For secondary cysts, surgery can only provide clinical stabilization for a limited time due to the often extensive arachnoiditis.

Cervical arachnoid cyst mimicking the cause of cervical radiculopathy: A case report

Abstract We herein present a case involving an asymptomatic cervical intradural arachnoid cyst that was suspected to be the cause of the patient's radicular pain. Magnetic resonance imaging showed a small, round intradural mass beside the cervical nerve root. An arachnoid cyst of this shape has not been previously reported. Intraoperative examination revealed that the cyst was not compressing the nerve root and was asymptomatic. Intradural spinal surgery is sometimes associated with serious complications. The knowledge that arachnoid cysts of this shape are asymptomatic can help to avoid unnecessary surgery.

Idiopathic intradural dorsal thoracic arachnoid cysts: A case series and review of the literature

BackgroundSpinal intradural arachnoid cysts (SIAC) are cerebrospinal fluid (CSF) filled sacs formed by arachnoid membranes and may be either idiopathic or acquired. Idiopathic cysts represent a separate entity and their aetiology remains uncertain. By far the most difficult differential diagnosis is distinguishing between idiopathic anterior spinal cord herniation (IASCH) and dorsal thoracic intradural arachnoid cysts (TIAC), due to their similarity in radiological appearance. Cine-mode (SSFP) is emerging as a novel technique in the diagnosis and operative planning of SIAC. MethodRetrospective analysis of patients with idiopathic TIACs that were surgically managed at Royal North Shore Hospital and North Shore Private Hospital between November 2000 and November 2015. ResultsTen patients were included in this study. Age ranged from 20 to 77years with a mean age of 60years and a female preponderance. The most common clinical features were progressive gait ataxia and lower limb myelopathy. Radicular pain tends to improve following surgery, however gait ataxia may not. DiscussionWhile there are circumstances in which the distinction between dorsal thoracic intradural arachnoid cysts and idiopathic anterior spinal cord herniation are radiologically obvious, in cases where the appearances are less clear, cine-mode SSFP MRI imaging can provide an invaluable tool to differentiate these pathologies and lead the clinician towards the correct diagnosis and management. The mainstay of surgical management for dorsal TIACs is laminectomy and cyst excision or fenestration. Surgery for gait ataxia should be aimed towards preventing deterioration, while maintaining the potential for symptomatic improvement, whereas surgery for radicular pain should be curative.

Spinal intradural arachnoid cyst in an adult with spinal dysraphism

Spinal arachnoid cyst is an uncommon cause of spinal cord compression and rarelycan complicate congenital cord malformations. We report a 48 year gentleman presented withprogressive spastic paraparesis of 6 months duration associated with difficulty in walking;now he was able to walk with support. MRI dorsal spine showed hypo-intense lesion on T1Wimages, becoming hyper-intense on T2W images extending from D 5-8 level. The patientunderwent D-5 to D-8 laminectomy, during surgery after opening the dura there was CSFfilled cyst. Histopathological examination confirmed the diagnosis of an arachnoid cyst. Aswas seen in present case, excision of thearachnoid cyst is associated with immediateimprovement of motor functions, particularly if the operation is performed prior to development of neurological deficits.

Rapid Progression of Extensive Arachnoid Adhesion Longer Than Twelve Segments and Cysts Formation after Posterior Lumbar Interbody Fusion: Case Report

Arachnoid cysts and intradural adhesion are uncommon in postoperative complication rather than congenital condition. The adhesion and cysts are usually around surgical site but some extend to a distant place. The authors report a case of formation of arachnoid cysts and adhesion far away from original surgical site with signifi cant clinical manifestations after posterior lumbar interbody fusion (PLIF).A 55-year-old woman accepted PLIF and got a good recovery but her dura mater was torn and sutured during procedure. Six months after her 1st surgery, she felt rapid progressing numbness from foot to belly and weakness of both lower limbs. On Examination bilateral deep tendon refl exes were hyperactive. Magnetic resonance imaging (MRI) showed intradural adhesion formed from T4 to sacral canal. Cerebrospinal fluid terminated at T4 level and there exactly the arachnoid cyst was formed. The long intradural adhesion and distant cyst formation made this case unique and the cause of neurological manifestations. Then the patient underwent intradural exploratory surgery and cyst-abdominal shunting. The cyst was actually found to be the terminal part of remaining subarachnoid space. Patient’s numbness stopped advancing upward and the strength of both lower limbs gradually improved after surgery. Therefore, arachnoid cyst and adhesion might appear at any place after spine surgery with dural rupture. Exploratory surgery and timely decompression can effectively slow down the progression of disease.Spinal meningeal cysts are rare and have been described as “arachnoid cysts,” “pouches”, or “diverticula”.7 Most spinal intradural arachnoid cysts are thought to be congenital but still some acquired arachnoid cysts were reported as to be the results of trauma, hemorrhage or infection.8 Even fewer were caused by intradural infl ammation after invasive diagnostic test and treatment. Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 94-98

Sacral extradural arachnoid cyst in association with split cord malformation

Background ContextSplit cord malformation (SCM) is a congenital disease that can be associated with other spinal anomalies. Few cases of concurrent intradural arachnoid cyst and SCM have been sporadically reported; however, sacral extradural arachnoid cyst (SEAC) with SCM is very rare. PurposeThe report describes our experience with simultaneous surgery in patients with concurrent SEAC and SCM in an effort to document the treatment of the rare spinal concomitant anomalies. Study DesignThe present study is designed as a case series. Patient SampleThis is a continuous series of patients with coexisting SCM and SEAC who were presented to our institution. Outcome MeasuresThe lower extremities weakness and deformity, radiological imaging, urodynamic tests, and surgical aspects of the patient population are documented. MethodsCases with concomitant anomalies were consecutively enrolled among 73 patients who were operated on for SCM between 2008 and 2014. Clinical data and surgical findings were prospectively filed and retrospectively evaluated. ResultsThere were seven patients (2 boys and 5 girls), with age ranging from 18 to 119 months (mean: 56.71±39.49). Type I SCM was detected in six cases, and type II SCM was detected in one case. Tethering of the cord was detected in all seven patients, and six patients (85.7%) had syrinx formation rostral to the level of SCM. All patients had at least one kind of urological dysfunctions manifesting as neurogenic bladder. On surgery, fistulous orifice of the meningeal cyst was found and ligated in six cases, and the other one was repaired via sealing the cyst walls as near as possible to the thecal sac. ConclusionsIn patients with symptomatic SCM, the signs of concurrent SEAC may be masqueraded by the former condition. It would be impossible to attribute a given sign, particularly urological signs, to either SCM or SEAC. Whatever the sign and nature, both conditions are better to be managed surgically in one session under a single anesthesia to prevent duplicate complications of further anesthesia and interventions in scar tissue.

Atypical cause of radiculopathy – Intradural spinal arachnoid cyst

Intradural spinal arachnoid cysts are a relatively uncommon lesion that may be either intra, or extradural, and intradural spinal arachnoid cysts are even less common. Arachnoid cysts are cerebrospinal fluid collections in the spine that can present with neurological symptoms. The objective of this paper is to describe a rare case of radicular pain due to a spinal arachnoid cyst.

Cervicothoracic intradural arachnoid cyst with scoliosis and brachial plexopathy

A 23-year-old woman presented with neck, back, and left arm pain with left shoulder weakness. Her medical history was unremarkable for cervical trauma. Neurologic examination showed hypoesthesia and hypoalgesia in the C5–C8 dermatomes, with hypoactivity of deep tendon reflexes at the left upper extremity. Magnetic resonance imaging revealed scoliosis associated with an intradural left anterolateral arachnoid cyst at the C3–T1 levels, compressing the spinal cord, scalloping the posterior surfaces of vertebral bodies, and expanding the left neural foramina (Fig. 1). There was fatty atrophy of the left shoulder muscles due to brachial plexopathy (Fig. 2). Fig. 2Coronal fat-saturated T2-weighted (Left) and coronal T1-weighted (Right) magnetic resonance images of cervicothoracic spine revealed scoliosis and fatty atrophy of the left shoulder muscles due to brachial plexopathy (arrows). View Large Image Figure Viewer Download Hi-res image

Spinal intradural arachnoid cyst in an adult with spinal dysraphism

Spinal intradural arachnoid cyst in an adult with spinal dysraphism

診断にcine mode MRIが有用であった脊髄空洞症を合併した脊髄硬膜内くも膜囊胞の1例

63歳, 男性. 進行する両下肢しびれと右下肢不全麻痺による歩行障害を主訴に来院した. 脊髄MRIにてTh4-5に脊髄空洞症を認め, cine mode MRIを施行したところTh5-6レベルに膜様構造物を認め, 脊髄空洞症を合併した脊髄くも膜囊胞と診断した. 手術はTh5-6レベルの椎弓切除を行い, くも膜囊胞を大きく開放した. 術後MRIでは空洞は速やかに縮小しており, 運動麻痺は軽快した. 本症例ではcine mode MRIを用いることにより硬膜内の膜様物を同定できたため, 脊髄くも膜囊胞の診断に至った. 脊髄空洞症の原因として脊髄くも膜囊胞を鑑別診断として念頭に置き, cine mode MRIはその診断に有用であると考えられる.

Spinal arachnoid cyst as a cause of isolated, progressive, bilateral C5–C6 radiculopathy

A 41-year-old man presented with bilateral shoulder weakness and pain. The symptoms had been present for 5 years on the left side and for 3 years on the right. His medical history was remarkable for cervical trauma related to a fall 8 years earlier. Neurologic examination showed severe bilateral weakness of shoulder abduction, with atrophy of the deltoid, supraspinatus, and infraspinatus muscles (Fig. 1). Biceps tendon reflexes were decreased bilaterally. Electromyography findings were consistent with bilateral C5–C6 radiculopathy. Magnetic resonance imaging revealed a spinal intradural arachnoid cyst extending from the level of C2 to L3 (Fig. 2), displacing the spinal cord posteriorly. Computed tomography-myelography showed early filling of this cyst with contrast material, suggesting a large communication with the subarachnoid space. The patient underwent an L2–L3 laminotomy with cyst fenestration and shunting. Three months after surgery, a slight improvement of strength was noticed. Radiculopathy or myelopathy resulting from compression by a spinal cyst is rare. Nabors et al. classified spinal cysts as extradural without spinal nerve root involvement (Type I), extradural with spinal nerve root involvement (Type II), and intradural (Type III) [1]. Arachnoid cysts, the most common spinal intradural cysts, are either congenital or acquired. The majority of acquired arachnoid cysts develop after spinal cord trauma, subarachnoid hemorrhage, or infection [2]. These lesions are usually posterior to the spinal cord in the thoracic region. Subarachnoid cysts anterior to the spinal cord, which are less common, generally have greater craniocaudal extension and are often associated with previous trauma [2]. The extensive subarachnoid cyst in this case is very likely related to the reported previous trauma. It is possible that the findings were the result of stretch or compression injuries to the nerve roots.

Iatrogenic intradural arachnoid cyst following tethered cord release in a child

Iatrogenic arachnoid cysts represent uncommon complications of intradural spinal procedures. Here we present the case of a 7-year-old girl who was found to have a symptomatic, pathologically proven, intradural arachnoid cyst 3years following tethered cord release. The patient originally presented with abnormal urodynamics testing and was found to have fatty infiltration in her filum terminale. She underwent sectioning of the filum terminale without complications. The patient presented 3years later with pain and neurogenic claudication. The patient was successfully treated with subarachnoid cyst fenestration with resolution of her bilateral lower extremity pain. Spinal intradural arachnoid cysts represent an important, though rare, postoperative complication of dural opening.

Klippel-Feil syndrome with upper cervical intradural arachnoid cyst

Klippel-Feil syndrome can be seen with bony anomalies of the craniocervical junction and syringomyelia. However, association of Klippel-Feil syndrome with upper cervical arachnoid cyst has not been reported previously. This report demonstrates clinical and radiological features of a case of Klippel-Feil syndrome complicated by Chiari I malformation, upper cervical arachnoid cyst and syringomyelia. A 7-year-old girl was evaluated due to headache, neck pain and restricted cervical movements. Craniocervical evaluation of the case demonstrated Chiari I malformation, partial fusion defect at C2-C3, C5-C6 vertebrae, upper cervical arachnoid cyst and cervicothoracal syringomyelia. Suboccipital craniectomy, C1 laminectomy, arachnoid cyst excision, and duraplasty with autologous fascia lata were performed. The headache and the neck pain of the patient improved after the operation. The arachnoid cyst did not recur.

Spinal intradural arachnoid cyst with spinal dysraphism

Spinal arachnoid cysts are relatively uncommon, they may be either intra- or extradural, among them the intradural spinal arachnoid cysts are less common. The authors report a patient with this rare lesion, in whom an anterior spinal intradural arachnoid cyst was associated with thoracic split cord malformation type I (diastematomyelia) and tethering of cord. The cyst was located anterior to the thoracic spinal cord. Our patient was an 8-year-old child who presented with progressive paraparesia. The presence of an intradural anterior arachnoid cyst was detected on magnetic resonance imaging. Surgical treatment was performed on all three lesions during the same sitting. Complete surgical excision of the cyst was the best choice of treatment with simultaneous treatment of the associated anomalies. The most important advantage of handling all three distinct lesions in one sitting, is that he was operated during a single exposure anaesthesia, which remains an important consideration in a child. The surgical treatment carried out and review of pertinent literature is being presented here. (J Pediatr Neurol 2004; 2(4): 235-239).

Extensive spinal intradural arachnoid cyst exhibiting a “double cord sign” on magnetic resonance imaging

Study designRetrospective case study. ObjectiveTo report on a case with an extensive intradural arachnoid cyst that caused left hemiparesis. Summary of background dataIntradural arachnoid cysts are not common causes of spinal cord compression and myelopathy. Although arachnoid cysts of the spine have been occasionally reported, cases with extensive intradural arachnoid cysts associated with hemiparesis are rarely reported. MethodThe patient was a 43-year-old woman who had cervical myelopathy symptoms, including radiating pain and left limb hemiparesis with gait disturbance. Magnetic resonance imaging revealed an extensive intradural extramedullary multi-septated cyst from the C6–T12, exhibiting a double cord sign on the T2-weighted axial image of the spine. The mass blocked normal cerebrospinal fluid flow, which led to cord compression. Two stages of operations were planned because of the patient's health status. The patient underwent laminectomy and cyst wall resection on the level of the T5–T7, which had the most compressed lesion. From C6–T2, a right side unilateral laminectomy was performed to resolve the right limb's neurology after the first operation. ResultHypoesthesia and the radiating pain were improved immediately postoperatively; however, motor power at the C8–T1 level of the right unaffected side was impaired and included finger abduction and finger flexion, which decreased to 4/5. During the second operation, the arachnoid cyst was exposed by performing a right unilateral laminectomy. The patient's neurologic symptoms were improved without neurologic sequelae. ConclusionIn the case of an extensive cyst that exhibits a double cord sign, an intradural arachnoid cyst should be suspected as a differential diagnosis. Without radical excision of all lesions, neurologic symptoms can be recovered by performing selective resection and CSF normalization can be achieved even at extensive levels.

An intradural arachnoid cyst of the thoracic spinal cord detected by fast imaging employing steady-state acquisition magnetic resonance imaging

An intradural arachnoid cyst of the thoracic spinal cord detected by fast imaging employing steady-state acquisition magnetic resonance imaging

Paraplegia induced by mild trauma in a child with thoracic spinal arachnoid cyst

Spinal arachnoid cysts are rare entities that often present with progressive myelopathy and are treated via surgical excision and fenestration. The acute onset of symptoms from these lesions is not well described in the literature. We report an 18-month-old child with acute onset of paraplegia following a mild trauma, who was found to have a compressive dorsal thoracic intradural spinal arachnoid cyst and emergently treated via surgical decompression and cyst resection. After several months of physical therapy the child achieved meaningful neurologic recovery. Spinal arachnoid cysts can cause acute decompensation in children with serious neurological injury following mild trauma, this risk should be weighed when managing asymptomatic lesions.

Differentiation of Idiopathic Spinal Cord Herniation from CSF-isointense Intraspinal Extramedullary Lesions Displacing the Cord

Focal spinal cord displacement can be caused by idiopathic spinal cord herniation (ISCH), in which the cord protrudes through a dural defect into the epidural space, causing cord displacement and tethering. ISCH is uncommon and often is misdiagnosed initially, which results in delayed management. ISCH can be mimicked by space-occupying cerebrospinal fluid (CSF)-isointense intraspinal extramedullary lesions, such as epidermoid cysts or teratomas, intradural arachnoid cysts, epidural hematomas or abscesses, cystic nerve sheath tumors, synovial or Tarlov cysts, meningoceles, and pseudomeningoceles. Initial computed tomography (CT) and unenhanced magnetic resonance (MR) imaging studies may depict focal cord displacement and a widened CSF space but often are not sufficient to identify the underlying cause. High-resolution thin-section MR imaging can delineate the exact location of the dural defect and the protrusion of the herniated cord through this defect into the epidural space. At imaging, unimpeded CSF pulsation artifacts seen within a widened CSF space exclude a space-occupying lesion. A filling defect seen at conventional or CT myelography can help confirm a CSF-isointense space-occupying lesion; intravenous contrast agent administration can help exclude a rim-enhancing cystic extramedullary lesion. The clinical presentation usually is nonspecific, but symptom acuity, fever, and trauma can guide the imaging evaluation and help narrow the differential diagnosis. A multimodality imaging approach is essential to differentiate ISCH from space-occupying CSF-isointense intraspinal extramedullary lesions.