Spinal Arachnoid Cyst Research Articles

In Reply to the Letter to the Editor Regarding “Bibliometric Evaluation of U.S. Neurosurgery Subspecialties and Academic Rank Using RCR Index”

Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.

Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports

Abstract Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs. Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome. Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome. Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome.

Extradural spinal arachnoid cysts: Management and outcome in five children

Abstract Background: Spinal extradural arachnoid cysts (SEACs) are rare lesions, which may become symptomatic due to mass effect or nerve root compression. They are discrete pockets of cerebrospinal fluid (CSF) communicating with subarachnoid space. These cysts may be single or multiple. Multiple cysts in the pediatric population are very rare, of which a few are reported to date. Materials and Methods: Here, we present a case series of five pediatric patients diagnosed with symptomatic SEACs and operated in our institute between the period of October 2017 and January 2021. The patients underwent surgery for excision of the cysts and closure of dural defects. The results were analyzed in terms of the clinical symptoms, location of cyst, surgical procedure performed, and outcome after surgery. Result: The mean age of presentation was 12 years. Common presenting complaints were lower limb weakness, pain, and bladder involvement. The median duration of symptoms before surgery was 7.8 months (mean 3 ± 12 months). Excision of cyst wall with closure of dural defect was done in all cases except one, in which the dural defect was not found. All cases gained near-normal muscle strength of lower extremities over a variable period of time after surgery. Conclusion: Pathogenesis of SEAC is not completely understood. Intraoperative localization and closure of the dural defect is the single most important step for excellent outcome.

Surgical Treatment of Spinal Arachnoid Cysts: Cyst Excision or Fenestration?

Arachnoid cysts in the spinal canal account for 1%-3% of all spinal canal lesions. There is no consensus on surgical treatment yet. Dural defect repair is crucial in surgical treatment patients with an extradural component. Fenestration or total resection of the spinal arachnoid cyst is among the preferred methods. This study aimed to examine a series of surgically treated spinal arachnoid cysts in light of the literature. This was a retrospective study of patients treated in the Istanbul Umraniye Training and Research Hospital Neurosurgery Clinic. A total of 18 patients with spinal arachnoid cysts underwent surgical treatment between 2012 and 2021. All patients were assessed before and after surgery for muscle strength, pain, sensory changes, and bowel-bladder symptoms. All patients underwent magnetic resonance imaging and computed tomography for diagnosis and treatment. Among the 18 patients, 8 were men and 10 were women, with a mean age of 43.7 (25-66) years. Congenital conditions were discovered in 15 of the patients, 2 after lumbar drainage and 1 after spinal anesthesia. Intradural extramedullary and intra-extradural cysts were found in 17 patients and 1 patient, respectively. The cyst was smaller than level 3 in 14 patients and greater than level 3 in 4 patients. Cyst excision and cyst fenestration were performed in 11 and 7 patients, respectively. Cyst excision was performed in four of the patients who underwent cyst fenestration because their complaints did not improve. Surgery should be considered in patients with symptomatic spinal arachnoid cysts. Fenestration may be a suitable alternative, especially if magnetic resonance imaging reveals no intracystic adhesion or trabeculation. Residual and recurrence rates are high in patients with a history of intradural intervention, adhesions, or trabeculation. When there is trabeculation, the best option is cyst removal.

Spinal Extradural Arachnoid Cyst: Minimally Invasive Surgical Treatment after Localization of Dural Defect Using Magnetic Resonance Myelogram

Spinal Extradural Arachnoid Cyst: Minimally Invasive Surgical Treatment after Localization of Dural Defect Using Magnetic Resonance Myelogram

Ultrafine Flexible Endoscope Visualization to Assist in the Removal of a Huge Spinal Extradural Arachnoid Cyst: Case Report and Literature Review

Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.

Early microsurgery on thoracolumbar spinal extradural arachnoid cysts: Analysis of a series of 41 patients

BackgroundWe designed this study to share our management experiences on spinal extradural arachnoid cysts (SEACs) to add more to the body of evidence for their treatment. MethodsWe retrospectively reviewed 41 patients who underwent microsurgery for thoracolumbar SEACs at our hospital from June 2009 to June 2019. All clinical data, including medical history, clinical features, imaging manifestation, operative findings, and prognosis, were extracted from medical records and databases. Perioperative differences of the Visual Analogue Scale (VAS), the Oswestry disability index (ODI) score, and postoperative Odom’s criteria were used to assess the surgical outcome. ResultsThe most common and very first clinical symptom in the 41 patients was pain (VAS = 2.82 ± 0.89), and the mean ODI value was 61.7 ± 8.9%. Imaging revealed that the cystic lesions in the thoracolumbar spine involved an average of 2.85 segments. Of the 41 patients, 39 underwent total cyst excisions, and 36 had their dural defect repaired by one of three methods. The mean postoperative follow-up time was 52.3 months. Postoperatively, one case developed kyphoscoliosis and two cases experienced a recurrence. The majority of patients showed excellent outcomes according to Odom’s criteria, the postoperative VAS (0.80 ± 1.08), and the ODI (15.4 ± 9.3%). ConclusionsThemost commonclinicalsymptoms of thoracolumbar SEACs included progressive discomfort and pain around the involved spinal segments. Early surgical intervention relieved the patients from their symptoms. Microsurgery was recommended to resect the complete cyst and to repair the dural defect, but resection of the complete cyst is more necessary than just repairment of the dural defect for providing promising outcomes.

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.

Case of Endoscopic Surgical Treatment of Thoracic Arachnoid Cyst

Spinal arachnoid cysts are the benign intradural extramedullary lesions that usually occur at the thoracic region. Such cysts can cause compression of spinal cord with symptoms of myelopathy. The diagnosis is clinical and radiological with the use of MRI. Nowadays there are some surgical options to eliminate compression of spinal cord: laminectomy and total removal of the arachnoid cyst, puncture aspiration, cyst fenestration, cystoperitoneal shunting.

Microsurgical treatment of symptomatic spinal extradural arachnoid cyst: a consecutive case series of 34 patients and literature review

PurposeA spinal extradural arachnoid cyst (SEAC) is a rare condition with unclear etiology. Herein, we report a series of symptomatic SEACs to illustrate features of SEACs in adults, surgical management, and outcomes. MethodsA total of 34 consecutive patients who underwent microsurgical treatment were retrospectively reviewed. Patient characteristics were recorded in each case, including presenting symptoms, imaging findings, neurologic status, a surgical procedure performed and follow-up. ResultsThere were 19 (56%) male and 15 (44%) female patients, with the ages ranging from 16 to 71 years (average 45 years). The lesions were located in the cervical segment (n = 4, 12%), thoracic segment (n = 6, 18%), thoracolumbar segment (n = 10, 29%) and lumbar segment (n = 14, 41%). Clinical presentations included back pain (n = 18, 53%), sensory deficits (n = 14, 41%), weakness (n = 4, 12%) and gait ataxia (n = 4, 12%), with a mean duration of symptoms of 17 months. The lesion was hypointense with the spinal cord on T1-weighted images and hyperintense on T2-weighted images and showed no homogeneous enhancement after contrast medium injection. Communication between the cyst and subarachnoid space was found in 23 patients and the cyst was resected after fistula ligation. Postoperatively, patients were followed up for an average of 80 months. The patients’ symptoms dramatically improved and follow-up radiological images showed a complete disappearance of the cyst in all patients. No recurrence was observed in the dural repair group. ConclusionPatients with symptomatic SEAC present with obvious and persistent symptoms. Complete microsurgical cyst removal with the closure of the dural defect is the standard treatment procedure with good results and a low recurrence rate.

Spinal extradural arachnoid cyst: An uncommon cause of thoracic spine compression

Spinal extradural arachnoid cysts are unusual causes of symptomatic spinal cord compression. They represent expanding diverticula of the subarachnoid space herniating through a dural defect into the extradural space. The pathogenesis of this entity is still unclear.

Scalpel Sign in Spine Pathology: Presentation in 3 Different Rare Diagnoses

The scalpel sign is a radiological finding observed on sagittal magnetic resonance imaging and computed tomography myelography corresponding to an indentation in the dorsal aspect of the spinal cord resembling a surgical scalpel blade. It is said to be a pathognomonic imaging discovery linked to dorsal arachnoid webs. However, other spine-related conditions may mimic dorsal arachnoid webs on magnetic resonance imaging, such as spinal arachnoid cysts or ventral spinal cord herniation, leading to misdiagnosis. A retrospective review was performed of cases involving 3 different diagnoses at our institution in the last 5 years that shared in common the characteristic focal dorsal indentation of the spinal cord. Of 7 cases identified, all but 1 were treated and confirmed intraoperatively. All lesions were located at the dorsal spinal cord. Magnetic resonance imaging was the study of choice for evaluation. Clinical manifestations included back pain and lower extremity numbness and weakness together with compressive myelopathy signs and urinary symptoms. Mean follow-up was 16.8 months with satisfactory postoperative results. Isolated radiological presentation of the scalpel sign is not sufficient to distinguish between dorsal arachnoid webs, arachnoid cysts, and ventral herniation of the spine. However, awareness of its importance is relevant for accurate curative surgical planning.

English

BACKGROUND Arachnoid cyst of spinal cord (ACS) is a very uncommon lesion of the spinal cord. The problem with these lesions is that they can stimulate the pain of prolapsed intervertebral disc pathology and patient may be misdiagnosed for the same. In this study we wanted to diagnose and establish a surgical treatment in such patients. METHODS This study is a case series and comprised of 12 patients which was conducted in Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, in which all patients having arachnoid cyst of spinal cord were operated and follow-up for reliving of symptoms or development of new symptoms. RESULTS Our study demonstrates that surgical result is good when spinal arachnoid cyst is better. All patients who underwent surgery were having significant improvement in symptoms and quality of life. CONCLUSIONS Surgical management is primary treatment modality in patients of arachnoid cyst of spinal cord and the results of surgery in such patients are good. KEYWORDS Spinal Arachnoid Cyst, Lumber Pain, Radiculopathy

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.

Multiple extradural spinal arachnoid cysts: A case report

Background: Extradural spinal arachnoid cysts (SACs) rarely cause neural compression and disability.Case Description: A 38-year-old female presented with a history of two episodes of falling due to transient weakness in the lower limbs. The neurological examination showed normal motor and sensory function, but hyperreflexia. The thoracic magnetic resonance imaging revealed multiple extradural SACs between the T3-L1 levels. Following complete surgical resection of the most symptomatic cyst, she did well. The histopathological examination confirmed a Type I extradural SAC.Conclusion: Here, we discussed one case and reviewed the literature on the diagnosis and treatment of multiple extradural SACs.

Spondylotic and Other Structural Myelopathies.

This article highlights both common structural causes of myelopathy, such as spondylotic disease, and infrequent but treatable causes, such as syringomyelia, spinal cord herniation, arachnoid cyst, arachnoid band and web, epidural lipomatosis, Hirayama disease, and arachnoiditis. Neuroimaging improvements and availability have uncovered many structural abnormalities in the spines and spinal cords of patients who were asymptomatic or minimally symptomatic. Recent published clinical series have improved our knowledge of the natural history of structural abnormalities and the risks of intervention versus conservative management. Myelopathy from a suspected structural cause is a common reason for neurologic consultation. Correlation between the history, examination, and imaging are especially important to determine whether intervention is necessary or conservative management is the best option.

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.

A Rare Case Report of Spinal Cord Compression by multiple extra Dural Arachnoid Cyst at Thoracic Level

The patient was a 18 year young male with chief complaint of difficulty in walking & progressive weakness in left lower limb was diagnosed as having space occupying lesion causing cord compression leading to muscular weakness. There was drastic & immediate recovery after excision of extradural mass from D3 to D9. A spinal extradural arachnoid cyst is a relatively rare disease.

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

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