Spinal Intradural Arachnoid Cysts Research Articles

Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case.

Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis. The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old. Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.

An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature.

Spinal arachnoid cysts (SACs) arise either intra- or extradurally and are usually solitary, while cases of multiple SACs have been scarcely reported in the literature. Herein, we report on a rare case of multiple and recurring intradural spinal arachnoid cysts (SACs) causing severe spinal cord compression and neuropathic radicular pain, in a 35-year-old female with a 10-year follow-up. Two separate attempts at surgery were performed but only provided temporary relief since the cysts recurred and new ones formed along the entirety of the spinal cord. Finally, a conservative approach with physiotherapy and a combination of analgesic medications was pursued.

Intradural Spinal Arachnoid Cysts in Children: A Collective Experience of 2 Centers

Pediatric intradural spinal arachnoid cysts are rare and can cause spinal cord or nerve root compression. Spinal arachnoid cysts can cause pain, motor/sensory neurological impairments, gait disturbances, spasticity, and bladder problems depending on their location. This study discusses the clinical aspects, management, surgical nuances, and postoperative clinical outcomes of symptomatic congenital intradural spinal arachnoid cysts, which are rarely seen in the pediatric population. Our study involves a retrospective evaluation of 8 pediatric patients who underwent surgery for spinal intradural arachnoid cysts at the Department of Neurosurgery, Kocaeli University School of Medicine, and the Department of Neurosurgery, Selros University School of Medicine. The demographic data of all patients, preoperative/postoperative clinical findings, surgical procedures, surgical complications, and radiological imaging were evaluated. The average age of the patients was 8.7 uated. surgicrange:1-17).The female to male ratio was 4:4. The most common complaint was weakness in the lower extremities (87.5%). Urinary problems (50%) and sensory disturbances (50%) were less frequently observed. All patients had dorsal localization of the cysts. Cyst excision was performed in 7 out of 8 patients, and cyst fenestration was performed in 1 patient. Postoperatively, 7 patients showed complete symptom resolution, while one patient had partial improvement. The success of surgical treatment depends on cyst location, neural tissue compression, and duration of symptoms. Complete removal or fenestration is determined by cyst location and accessibility. Intracystic shunts may be used in certain cases. Timely diagnosis and surgical intervention are crucial for improving neurological function in these rare cases.

Surgical Treatment of Post-Traumatic Symptomatic Thoracolomber Intradural Spinal Arachnoid Cyst

Surgical Treatment of Post-Traumatic Symptomatic Thoracolomber Intradural Spinal Arachnoid Cyst

Systematic Review of Surgical Management of Spinal Intradural Arachnoid Cysts

Spinal intradural arachnoid cysts (SIACs) are rare pathological lesions that can arise via outpouchings of the arachnoid layer in the spinal canal that can result in neurological deficits. We performed a systematic literature review regarding the current surgical techniques used in the management of SIACs and discussed the prevailing hypotheses surrounding the etiology of SIACs. A systematic search of the literature was performed in December 2020 using EMBASE and MEDLINE for reports regarding the surgical management of SIACs. Data were collected regarding the demographics of the patients, classification system used, presence or absence of syrinxes, preoperative imaging modality, surgical approach and extent of resection, and postoperative outcomes and follow-up. Our search yielded 19 reports for inclusion in the present study. The 19 studies included a total of 414 cases, with an overall male/female ratio of 0.93:1. The most common site for the SIACs was the thoracic spinal cord at 77.5%. The symptoms were very similar across the 19 studies. Of the 19 studies, 15 had used resection to manage the SIACs, 10 had used fenestration or marsupialization, and 4 had used cystoarachnoid or cystoperitoneal shunts. SIACs are rare and debilitating spinal pathological lesions, with the etiology of primary SIACs still not fully elucidated. Multiple surgical approaches have been effective, with the optimal operative strategy largely dependent on the individual patient and cyst factors on a case-by-case basis.

Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres.

Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC). Cases were identified from electronic records of two major neurosurgical centres in London over the last 10years (October 2009-October 2019) that have been surgically treated in both institutions. Clinical findings, surgical technique, and recurrence by procedure were statistically analysed. Statistical analysis was performed with STATA 13.1 Software. A total of 42 patients with SIAC were identified for this study with a mean age at the time of surgery of 53.6years and a male:female ratio of 8:13. There were 31 patients with primary SIACs and 11 with secondary SIACs. The most common presenting symptom was paraesthesia (n = 27). The most common location of the cyst was in the thoracic region (n = 33). Syrinx was present in 26.2% of SIACs (n = 11). Resection was associated with significantly better postoperative pain compared to other surgical techniques (p = 0.01), significantly poorer postoperative urinary function (p = 0.029), and lower rates of sensory recovery in patients who presented preoperatively with sensory deficit (p = 0.041). No significant difference was seen in symptomatic outcomes between patients with primary and secondary SIACs. Resection and drainage are both effective methods of managing SIACs. In this observational study, resection was associated with significantly reduced pain postoperatively when compared with drainage, however also with significantly less improvement in postoperative urinary function. Therefore, resection should be the gold standard management option for SIACs, with drainage as an option where resection is unsafe, and drainage should also be considered in patients presenting with urinary dysfunction.

Surgical outcome of primary intradural spinal arachnoid cysts: a series of 10 cases

BackgroundPrimary intradural spinal arachnoid cysts are rare pathologies of uncertain etiology and variable presentation from no symptoms to myelopathy or radiculopathy according to cord or root compression. MRI with diffusion and contrast differentiates them from many pathologies. There is a lot of debate regarding when to treat and how to treat such rare pathologies.ObjectiveWe present a series of 10 primary intradural arachnoid cysts and evaluate outcome after surgery.MethodsThis retrospective study includes patients having primary intradural spinal arachnoid cysts operated in two tertiary care centers from October 2012 till October 2019. Symptomatic cysts were subjected to microsurgical resection or outer wall excision and inner wall marsupialization under neurophysiological monitoring. The Japanese Orthopedic Association Score was used for clinical evaluation while MRI with contrast and diffusion was used for radiological evaluation before and after surgery.ResultsThis series included 10 patients, 4 males and 6 females, with mean age of 40 years. Pain was the most common presentation. The most common location was dorsal thoracic region. Total excision was achieved in 2 cases and marsupialization in 8 cases.All symptoms improved either completely or partially after surgery. No neurological deterioration or recurrence was reported during the follow-up period in this series.ConclusionTreatment of symptomatic primary intradural spinal arachnoid cysts should be microsurgical resection, when the cyst is adherent to the cord, microscopic fenestration can be safe and effective.

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

AbstractThe present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

Spinal intradural arachnoid cysts - A multicentre case series assessing management and outcomes

Spinal intradural arachnoid cysts - A multicentre case series assessing management and outcomes

Surgical treatment with dye injection for symptomatic spinal intradural arachnoid cysts

Surgical treatment with dye injection for symptomatic spinal intradural arachnoid cysts

Hydrocephalus following surgery of thoracic intradural arachnoid cyst: a case report

Spinal intradural arachnoid cysts (SIACs) are cerebrospinal fluid (CSF) sacs formed by arachnoid membranes. They may be idiopathic or acquired. Treatment is resection, fenestration, or cyst drainage. A 41-year-old female patient presented with myelopathy symptoms and complaints. Magnetic resonance imaging (MRI) revealed a T6-T10 dorsal intradural arachnoid cyst. A T6-T10 laminectomy was performed and an arachnoid cyst was excised under surgical microscope. The cyst contained a clear liquid that was surrounded by a transparent membrane. At 7 weeks postoperatively, the patient experienced severe headache, excessive sleepiness, vomiting, loss of coordination, difficulty walking, and difficulty concentrating. A head computed tomography (CT) scan showed marked ventricular dilation that was diagnosed as delayed hydrocephalus. The patient underwent ventriculoperitoneal shunt (VPS) placement one day after admission. This is a rare condition of hydrocephalus that develops due to CSF leakage after SIAC surgery.

Spinal arachnoid cysts in adults: diagnosis and management. A single-center experience.

OBJECTIVEAdult spinal arachnoid cysts (SACs) are rare entities of indistinct etiology that present with pain or myelopathy. Diagnosis is made on imaging studies with varying degrees of specificity. In symptomatic cases, the standard treatment involves surgical exploration and relief of neural tissue compression. The aim of this study was to illustrate features of SACs in adults, surgical management, and outcomes.METHODSThe authors searched medical records for all SACs in adults in the 10-year period ending in December 2016. Radiology and pathology reports were reviewed to exclude other spine cystic disorders. Recurrent or previously treated patients were excluded. Demographic variables (age, sex) and clinical presentation (symptoms, duration, history of infection or trauma, and examination findings) were extracted. Radiological features were collected from radiology reports and direct interpretation of imaging studies. Operative reports and media were reviewed to accurately describe the surgical technique. Finally, patient-reported outcomes were collected at every clinic visit using the SF-36.RESULTSThe authors' search identified 22 patients with SACs (mean age at presentation 53.5 years). Seventeen patients were women, representing an almost 3:1 sex distribution. Symptoms comprised back pain (n = 16, 73%), weakness (n = 10, 45%), gait ataxia (n = 11, 50%), and sphincter dysfunction (n = 4, 18%). The mean duration of symptoms was 15 months. Seven patients (32%) exhibited signs of myelopathy. All patients underwent preoperative MRI; in addition, 6 underwent CT myelography. SACs were located in the thoracic spine (n = 17, 77%), and less commonly in the lumbar spine (n = 3, 14%) and cervical/cervicothoracolumbar region (n = 2, 9%). Based on imaging findings, the cysts were interpreted as intradural SACs (n = 11, 50%), extradural SACs (n = 6, 27%), or ventral spinal cord herniation (n = 2, 9%); findings in 3 patients (14%) were inconclusive. Nineteen patients underwent surgical treatment consisting of laminoplasty in addition to cyst resection (n = 13, 68%), ligation of the connecting pedicle (n = 4, 21%), or fenestration/marsupialization (n = 2, 11%). Postoperatively, patients were followed up for an average of 8.2 months (range 2-30 months). Postoperative MRI showed complete resolution of the SAC in 14 of 16 patients. Patient-reported outcomes showed improvement in SF-36 parameters. One patient suffered a delayed wound infection.CONCLUSIONSIn symptomatic patients with imaging findings suggestive of spinal arachnoid cyst, surgical exploration and complete resection is the treatment of choice. Treatment is usually well tolerated, carries low risks, and provides the best chances for optimal recovery.

Idiopathic Thoracic Intradural Spinal Arachnoid Cyst Associated with Syringomyelia: a casereport and Literature reviewarticle

Idiopathic Thoracic Intradural Spinal Arachnoid Cyst Associated with Syringomyelia: a casereport and Literature reviewarticle

Intradural spinal arachnoid cyst resection: implications of duraplasty in a large case series

OBJECTIVE Optimal diagnosis and management strategies for intradural spinal arachnoid cysts (SACs) are still unresolved given the rare nature of this entity, with few large case series and virtually no statistical analyses of patient characteristics in the literature. Here, the authors studied a large patient cohort with these lesions to determine whether pre- or postoperative attributes could be used to aid in either diagnosis or prognosis. METHODS A chart review was completed at a single institution for the period from 2002 to 2016 to determine the preoperative characteristics and postoperative outcomes of 21 patients with exclusively intradural SACs. Patients were assessed for symptoms such as weakness, pain, sensory changes, bowel and/or bladder dysfunction, and gait changes. Postoperatively, patients were analyzed for symptom improvement, complication occurrence, and duration of follow-up. RESULTS Approximately two-thirds of the patients in this series had developed SACs idiopathically, and the mean duration of symptoms prior to diagnosis was 15 months among all patients. A slight majority (57%) underwent CT myelography in the course of diagnosis, and a quarter of the patients had a syrinx. There was a statistically significant association between location of the SAC and number of presenting signs and symptoms; that is, patients with cysts in the lumbosacral region had more symptoms than those with cysts at the cervical or thoracic levels (p = 0.031). Overall, outcomes were largely positive, with approximately 60%-70% of patients experiencing postoperative improvement in symptoms, with motor weakness showing the highest response rate (71%) and pain symptoms the least likely to subside (50%). In the cohort with preoperative pain, those who had undergone expansile duraplasty were significantly more likely to experience relief of their pain symptoms (p = 0.028), which may have been a result of the superior restoration of cerebrospinal fluid pathways allowing for more adequate reduction in compression. CONCLUSIONS In this large case series on intradural SACs, new light has been shed on aspects of both pre- and postoperative care for patients with these rare lesions. Specifically, the authors revealed that lumbosacral intradural SACs may be associated with a higher disease burden and that patients who undergo expansile duraplasty may have an increased likelihood of experiencing postoperative pain relief.

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.

Clinical and Radiologic Outcomes After Fenestration and Partial Wall Excision of Idiopathic Intradural Spinal Arachnoid Cysts Presenting with Myelopathy.

Intradural spinal arachnoid cysts (ISACs) with associated neurologic deficits are encountered infrequently. Various management strategies have been proposed with minimal data on comparative outcomes. We describe the clinical and radiologic presentation as well as the outcomes of 14 surgically managed patients who presented with an ISAC and associated myelopathy. We retrospectively reviewed the clinical course of consecutive patients presenting with neurologic deficits associated with idiopathic ISACs at our institution. The diagnoses were based on preoperative magnetic resonance imaging studies followed by intraoperative and histopathological confirmation. A total of 14 consecutive patients with ISACs (1 cervicothoracic, 12 thoracic, and 1 thoracolumbar) and associated myelopathy were identified. Syringomyelia was noted in 8 patients. All ISACs were treated with cyst fenestration and partial wall resection through a posterior approach. Preoperative neurologic symptoms were noted to be stable or improved in all patients starting at 6-week postoperative follow-up. The median (interquartile range) preoperative mJOA score was 13 (12.0-14.8), whereas the postoperative median score at a mean follow-up of 22 months (range 6-50 months) was 16 (14.0-17.0), which represents a median improvement (ΔmJOA) of 2.0 (1.3-3.0) (P < 0.001). Comparison of ΔmJOA scores between cases without and with associated syrinxes did not reveal a significant difference (P = 0.23). Postoperative magnetic resonance imaging scans revealed spinal cord re-expansion at the level of the ISAC in all cases and either complete or partial syrinx resolution in 7 of 8 cases. Early treatment with fenestration and partial wall resection allows for cord decompression, syrinx resolution, and gradual resolution of myelopathic symptoms in most cases.

Anterior thoracic intradural spinal arachnoid cyst- A rare cause of spinal cord compression in a Two-Year old child

Anterior thoracic intradural spinal arachnoid cyst- A rare cause of spinal cord compression in a Two-Year old child

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.