Spinal Extradural Cyst Research Articles

Evaluation and Treatment of Lumbar Spine Extradural Cysts: A Narrative Review.

The main objective was to describe the different types and characteristics of lumbar spine extradural cysts and their optimal treatment options with a focus on endoscopic technique.We searched Pubmed, EMBASE, Medline, and Google Scholar for articles published between 1967 and 2020 using the keywords "Spinal Cyst,""Extradural Cyst," and "Lumbar Cyst."The various anatomical and histological types of the extradural cysts with their presentations, etiologies, imaging, and optimal treatment with a focus on endoscopic techniques were reviewed from the articles. Lumbar spinal cysts are relatively rare pathologies that might cause radicular symptoms similar to lumbar disc herniation. Spinal extradural cysts are classified either histologically based on the cyst lining tissues (synovial cysts or non-synovial, ganglion cysts) or anatomicallybased on the structure of origin (epidural cysts, ligamentum flavum cysts, discal cysts, post-discectomy pseudocysts, posterior longitudinal ligament cysts, facet cysts). Surgical excision is the recommended treatment of symptomatic cysts with endoscopic techniques being a viable option. Extradural lumbar cysts can be identified based on their histological structure or depending on their structure of origin. Regardless of their classification, they could all give similar clinical findings, and the optimal treatment would be surgical excision with endoscopic technique being a viable option with a satisfactory outcome.

Location Distribution of Fistulas and Surgical Strategies for Spinal Extradural Meningeal Cysts: A Retrospective Analysis of 30 Cases at a Single Center.

ObjectiveThis study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs). MethodsThe authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up. ResultsThirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84%±26.63%. ConclusionMost fistulas were always located at the T12–L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.

A Single Vertebral Surgical Approach for Spinal Extradural Meningeal Cysts Spanning Multiple Vertebral Segments by Auxiliary Neuroendoscope

Spinal extradural meningeal cysts (SEMCs) are rare lesions, especially those spanning multiple vertebral segments, and the surgical strategy has remained controversial. In the present study, we have described the outcomes of 4 patients with SEMCs treated with dural defect repair alone assisted by neuroendoscopy. From January 2018 to January 2020, 4 patients with SEMCs spanning multiple vertebral segments had undergone single-vertebral laminectomy or hemilaminectomy. The SEMCs in all 4 patients had spanned multiple vertebral segments, from T11 to L2. Using magnetic resonance imaging, the location of the dural defect was predicted correctly for 3 patients. Single-vertebral laminectomy was used in 2 patients and single-vertebral hemilaminectomy in 2 patients. Intraoperatively, the entire cyst, including the upper pole, lower pole, and middle segment of the cyst, was explored using neuroendoscopy. In each patient, only 1 dural defect was found, which had been located in the middle segment of the cyst (T12-L1). All cyst dural defects had been sutured under a microscope. In all cases, the cyst wall was not removed. Postoperatively, the symptoms for all the patients had improved significantly, andsubsequent magnetic resonance imaging studies showed obvious cyst regression. During the follow-up period of 15-44 months, no recurrence was observed. For SEMCs spanning multiple vertebral segments, dural defect repair without cyst wall resection through single-vertebral hemilaminectomy or laminectomy can be effective. Intraoperative neuroendoscopy can assist, not only in finding the dural defect, but also in avoiding the omission of multiple dural defects as much as possible.

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine.

ObjectiveTo retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making. MethodsTen adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded. ResultsClinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up. ConclusionSEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.

Clinical outcomes with endoscopic resection of lumbar extradural cysts.

Lumbar extradural cysts may be associated with sciatica-type back and leg pain. The symptoms of clinical pain syndrome from synovial cysts are sometimes difficult to differentiate from those of lumbar disc herniation or spinal canal stenosis and may be identified to be a pain source when visualized endoscopically. The authors analyzed the clinical outcomes with their endoscopic resection to better establish clinical indications and prognosticators of favorable results. Two-year Macnab outcomes, VAS scores, and complications were analyzed in a series of 48 patients treated with the endoscopic removal of extradural cyst encountered during routine transforaminal and interlaminar decompression for foraminal and lateral recess stenosis causing lumbar radiculopathy. There were 26 female and 22 male patients. The extradural cysts were most commonly encountered at L4/5 level in 26 patients (72.2%) followed by the L5/S1 level in 8 patients (22.2%), and in 2 patients (5.6%) at the L3/4 level, respectively. One patient underwent T9/10 decompression. At minimum 2-year follow-up, all patients were improved. Excellent results according to the Macnab criteria were obtained in 19/48 (39.6%) patients, good in 18/48 (37.5%), and fair in 11/48 (22.9%), respectively. The average preoperative VAS score for leg pain was 8.06±1.57 and reduced at a statistically significant level (P<0.000) postoperatively to 1.92±1.49, and 1.77±1.32 at final follow-up, respectively. The percentage of patients with unlimited walking endurance had improved at a statistically significant level (P<0.0001) from 33.3% preoperatively (16/48) to 81.3% (39/48) postoperatively. One patient had a recurrent disc herniation, and another patient did not improve. Two patients underwent fusion during the follow-up period. Patients with Fair outcomes had a statistically significant association (P<0.001) with facet instability as suggested by axial T2-weighted magnetic resonance imaging (MRI) findings of thickened ligamentum flavum, facet joint hypertrophy, and bright white fluid-filled joint gap of >2 mm. Endoscopic resection of extradural spinal cysts during routine decompression for symptomatic foraminal and lateral recess stenosis is feasible with favorable clinical outcomes in the majority of patients. Fair outcomes were associated with advanced instability of the involved lumbar facet joint complex.

Caudal lumbar spinal cysts in two French Bulldogs

BackgroundSpinal cysts are rare findings in veterinary medicine, but they are increasingly recognized due to the availability of advanced imaging techniques. Extradural meningeal cysts in French Bulldogs have not been reported previously and arachnoid cysts (diverticula) have not been reported at the caudal lumbar (L6–L7) region in dogs.Case presentationTwo French Bulldogs, aged 5 and 8 years, were referred for evaluation of lower back pain and bilateral hind limb neurological deficits. Neurologic examination revealed ataxia and postural deficits in both dogs. Magnetic resonance imaging (MRI) showed cauda equina compression due to a cyst-like lesion at the level of L6–L7 in both cases. The dogs underwent dorsal laminectomy and the meningeal cyst was completely removed in one dog and in the other dog the spinal arachnoid diverticula was marsupialized. In Case 1, histopathology of the cysts was performed and MRI was repeated. Both dogs were pain free during follow-up evaluations.ConclusionsBased on radiological, intra-operative and histopathological findings, the first case was diagnosed as a meningocele connected by a pedicle to the caudal tip of the dural sac forming a dural diverticulum categorized as an extradural spinal cyst type Ib, and Case 2 as a type III intradural arachnoid diverticula. It is concluded that spinal cysts should be included in the differential diagnosis of cauda equina syndrome and lower back pain in French Bulldogs. Results of these cases may be useful for diagnostic and treatment management.

Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl

The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of “halo-vest” system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of “halo-vest” traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department.

Dural Dissection Cyst: a More Accurate Term for Extradural Meningeal Cyst

Spinal extradural meningeal cyst (EMC) aetiology remains unclear. Based on our in-depth analysis of EMC clinical characters, we propose the alternative term 'dural dissection cyst' (DDC), which is more consistent with its aetiology and pathological manifestations. We examined the clinical, imaging and operative findings of four patients with spinal EMC (type I A) and analysed the aetiology and treatment of the cyst. Spinal DDC was observed between T10 and L3 in our series. Patients presented with low back pain, lower extremity numbness and weakness, and segmental muscle atrophy. Small clefts were found on the inner wall of all cysts. Microscopic suture of the cleft successfully improved patient's symptoms and neurological deficits. Spinal EMC (type I A) is characterized by dural dissection, so the term DDC can best reflect its aetiology. Because it is a dissection cyst, the most reasonable treatment is to suture the fistula.

Mediastinal Hydatid Cyst Mimicking Malignant Mediastinal Neurogenic Tumor

Hydatid disease is caused by Echinococcus granulosus parasite. It is an endemic disease; particularly in many Mediterranean countries. The liver and the lungs are most frequently involved. Bone involvement is reported in 1% - 2% of the cases and about 50% of those are seen in the spine. Herein we report a case of primary spinal extradural hydatid cyst that caused paraplegia due to compression of the dorsal spinal cord and was diagnosed initially as case of lumber prolapsed intervertebral disc. The cyst was only discovered when the patient had progressive paraplegia and the preoperative provisional diagnosis was posterior mediastinal neurogenic tumor causing destruction of the pedicle and lamina of the fifth thoracic vertebra. Fortunately, she regained near full power after surgical treatment of her spinal cyst.

Primary posterior mediastinal hydatid cyst mimicking malignant mediastinal neurogenic tumor

Introduction: Hydatid disease is caused by Echinococcus granulosus parasite. It is an endemic disease; particularly in many Mediterranean countries. bone involvement is reported in 1-2% of the cases and about 50% of those are seen in the spine. Herein we report a case of primary spinal extradural hydatid cyst that caused paraplegia due to compression of the dorsal spinal cord and was diagnosed initially as case of lumbar prolapsed intervertebral disc. case report: A 40-year-old female referred to us suffering from painful spastic weakness of lower limbs, her condition started six months earlier to admission and she became paraplegic for last four months with loss of bladder and bowel control. she had L4, L5 lumbar laminectomy four months earlier as she was diagnosed as lumbar prolapsed intervertebral disc. After a thorough diagnostic workup, it was provisionally found that she has a malignant posterior mediastinal mass, but

Diagnosis and surgical treatment of spinal extradural meningeal cysts at throco - lumbar spine

Objective To summarize the clinical manifestation,imaging characteristic and experience of surgical treatment of extradural meningeal cyst at thoraco - lumbar spine.Methods The authors retrospectively analyzed a series of 10 patients with extradural meningeal cyst at thoraco - lumbar spine surgically treated under microscope from 2001to 2011.There were 4 males and 6 fameles with average age of 26.5 yaers ( rang from 7 to 54 years old ).The weakness of lower extremities,bowl and bladder dysfunction were the main clinical manifestation.MRI inmaging showed the cyst located dorsal to the spinal cord and extending to the neural formen with lower signal in T1and higher signal in T2 seriers without enhancement.The lesions located at thoraco - lumbar spine range from T10 and L3.10 operations had been performed with the cyst resection and fistula repairment under microscope. The patients remained prone position until 7 days post - operition.Results The meningeal cyst had been gross total or subtotal resected and histological examination showed typical meningeal cyst tissue in all cases. There was no operative complication happened.The lower limbs weakness or bowel and bladder dysfunction were gradually relieved post-operation.The period of follow- up was ranged from 3 months to 10 years (average 4.1years).All the patients with neurological intact,there were no recurrence of the cyst and the alignment and lordosis of spine were kept evaluated with MRI investigation during follow - up period.Conclusions The extradural meningeal cyst at thoraco - lumbar spine are rare found and characterized by chronic decompression of spinal cord and nerve,the manifestation in MRI imaging is cystolic CSF signal both in T1and T2 series without enhancement.The surgical treatment including dissection of the wall of the cyst,find and repair the CSF leakage under microscope,the outcome of surgical treatment is satisfactory. Key words: Spine; Microsurgery; Meningeal cyst

Spinal extradural meningeal cyst and Scheuermann’s disease: coincidence or causative factor?

IntroductionExtradural meningeal cysts, previously called extraduralarachnoid cysts, are relatively rare lesions of the spinal canaland are uncommon causes of spinal cord compression inchildren and adolescents [4, 15]. They are extradural out-pouchings of arachnoid tissue that communicate with theintraspinal subarachnoid space through a small dural defect[5]. According to the classification system by Nabors et al.[16], spinal meningeal cysts are divided into three majorcategories: extradural cysts without spinal nerve root fibers(type I), extradural cyst with spinal nerve root fibers (typeII),andintradural cysts (typeIII).TypeImeningeal cysts arefurther divided into extradural meningeal cysts (type IA)and sacral meningoceles (type IB).The etiology of spinal extradural meningeal cystsremains unclear. Although some can be acquired from trau-ma, infection, or inflammation, the majority of dural defectsare thought to be congenital in nature [3]. In a few reportedcases, authors suggested that a type IA cyst (extraduralmeningeal cyst) may be combined with Scheuermann'sdisease (kyphosis dorsalis juvenilis) [4, 10]. In this report,we present a rare case of spinal cord compressing type IAspinal extradural meningeal cyst with Scheuermann's dis-ease in an adolescent patient.Case reportA 15-year-old male presented with progressive ataxia andgait disturbance for 15 days. In his past history, the patienthad a small head circumference at birth and had surgery forunilateral cryptorchidism. He also showed a developmentaldelay and mental retardation from the age of two. Fifteendays before admission, gait disturbance developed and hehad also progressive difficulty in defecating 3 days beforeadmission.On physical examination, short stature (<3 %), low bodyweight (25–50 %), small head circumference (<30 %), andtic-like movement were noted in the right hand. On neuro-logical examination, he showed grade 4 spastic paraparesisincluding upper motor neuron signs in both lower extremi-ties. His deep tendon reflexes were hyperactive and his gaitwas severely ataxic. Laboratory tests including completeblood count, serum chemistry profile, electrolyte profile,erythrocyte sedimentation rate, C-reactive protein, and rou-tine urinalysis were normal.On radiologic evaluation, plain spinal X-ray and comput-erized tomography revealed irregular narrowing of the discspaces, irregular endplates, and kyphosis, which are consis-tent with Scheuermann's disease. Whole spine magneticresonance imaging (MRI) revealed a dorsally located14.5×7.4×75-mm-sized cerebrospinal fluid (CSF) intensitycystic mass at the T12–L1 level which was noted to extendfrom the epidural space into both neural foramens. Thecystic lesion had low signal intensity on T1-weightedimages, high signal intensity on T2-weighted images, andno contrast enhancement (Fig. 1a, b). His thecal sac andspinal cord were compressed. Also, mild disc bulging on

Multiple spinal extradural cysts causing progressive paraparesia: case report and review of literature

AbstractMultiple meningeal extradural cysts are extremely rare. The clinical presentation varies from asymptomatic patients to important symptoms due to spinal cord compression. This article reports the case of a girl with multiple meningeal extradural cysts with progressive paraparesis and hypoesthesia on inferior limbs. The MRI showed multiple extradural cysts between C7 and L1. A partial resection was made at the cystis, reflecting a improve at the postoperative follow up of the patient. The management of asymptomatic cases is usually followed up clinical and radiologically. At the management of the symptomatic cases, the resection of the cysts is the most indicated treatment, even for patients with a long-standing history of compression. However the partial removal has as good results as the total one. The authors review the literature and show a subtotal resection of the cysts did not change the evolution of the presentation.

Lymphoedema - distichiasis syndrome with recurrent abortions

Lymphoedema-distichiasis syndrome, a type of familial lymphoedema praecox, is a rare, primary lymphoedema of pubertal onset associated with distichiasis and other associations including congenital heart disease, ptosis, varicose veins, cleft palate, and spinal extradural cysts. We report a case of familial lymphoedema with associated distichiasis, atrial septal defect, varicose veins, and recurrent abortions in a 29-year-old female.

Spinal Extradural Meningeal Cysts

Case series and literature review. To analyze the characteristics of extradural spinal meningeal cysts (SMCs) by magnetic resonance imaging (MRI) and discuss their classifications and etiology, as well as exploring the choice of treatment. Spinal extradural meningeal cysts are a rare type of SMC. They are also known as extradural/epidural spinal arachnoid cysts. According to Nabors' classification, they belong to the category of types I and II meningeal cysts. The etiology of spinal extradural cysts remains unclear. We retrospectively analyzed the MRI scans of 18 cases of extradural arachnoid cyst, which were consecutively treated surgically at our institutions between June 1990 and November 2009. All cases were confirmed by surgery. Disonics 0.35T and Philips Gyroscan Intera 1.5T scanner with surface coils were used for patient scanning. MRI examination included routine sagittal T1-weighted/spin-echo , sagittal, and transverse T2-weighted scanning. The above scans were repeated after the administration of intravenous contrast 3 medium (gadolinium) in 12 patients. Seven of the 18 cases were located in the middle and lower thoracic spine, 3 in the lumbar spine, and 8 in the thoracolumbar junction. All cystic lesions were isointense compared with cerebrospinal fluid on the T1 and T2-weighted images. The lesions showed no enhancement after gadolinium administration. MRI had great sensitivity to and specificity for extradural arachnoid cysts and seemed to be the diagnostic procedure of choice before and after surgery. Accurate understanding of MRI features helps clinicians make preoperative diagnoses and guides the operation. The definitive treatment of SMCs involves total removal of the cyst and repair of the dural defect.

Spinal Extradural Meningeal Cyst in Klippel-Trenaunay Syndrome

A case of a symptomatic spinal extradural meningeal cyst (SEMC) in Klippel-Trenaunay syndrome (KTS) is introduced. A 38-year-old woman presented with right L2 radiculopathy. She underwent operations for varicose veins in both her lower extremities. She had port-wine nevi on her trunk and extremities. The edematous change in both legs had waxed and waned. Magnetic resonance imaging showed an 11.8×13 mm extradural meningeal cyst growing through the intervertebral foramen in L2-3. Multiple meningeal cysts were located in the dorsal aspect of the spinal cord from T3 to T10. A 5.8×6.2 mm cyst was also found in left pleural cavity. The extradural meningeal cyst was completely excised and the preoperative symptom was improved. KTS is a congenital disorder due to a mesodermal abnormality, which may predispose the dura to weakness. The SEMC may occur through the dural defect or weakened point.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

Noncommunicating Spinal Extradural Meningeal Cyst in Thoracolumbar Spine

Spinal extradural meningeal cyst has been rarely reported, whose etiologies are assumed to be the communication of cerebrospinal fluid (CSF) between intradural subarchnoid space and cyst due to the congenital defect in dura mater. Although the CSF communication due to this defect can be found, in most case, few cases in which there is a lack of the communication have also been reported. We report a case of the huge extradural meningeal cyst occurring in the thoracolumbar spine (from T10 to L2) where there was a lack of the communication between the intradural subarachnoid space and cyst in a 46-year-old man who presented with symptoms that were indicative of progressive paraparesis and leg pain. The patient underwent laminectomy and cyst excision. On intraoperative findings, the dura was intact and there was a lack of the communication with intradural subarachnoid space. Immediately after the surgery, weakness and leg pain disappeared shortly.

Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral sciatica and were found to have intraspinal cystic lesions causing lumbar radiculopathy. Magnetic resonance imaging demonstrated rounded, cystic lesions (i.e., hypointense on T1- but hyperintense on T2-weighted images) adjacent to minimally dehydrated, nonherniated disc spaces in both cases. These patients underwent posterior decompression and cysts were excised, and their sciatic symptoms were completely resolved. Histological examination showed typical features of ganglion cysts in these cases.

Multiple Extradural Spinal Arachnoid Cysts Causing Diffuse Myelomalacia of the Spinal Cord

Extradural spinal cyst is a rare cause of compression myelopathy. It is usually solitary and its typical location is posterior to the spinal cord. We present a case of multiple spinal arachnoid cysts causing diffuse myelomalacia secondary to a significant compression of the spinal cord with no symptom relief after surgical decompression. A 35-year-old female patient presented to our hospital complaining of progressive weakness and numbness of both lower extremities for the last 2 months, being more prominent on the right side. Her history was significant for back pain that started after a vaginal delivery 1 year ago. Spinal MRI revealed multiple extradural arachnoid cysts and diffuse myelomalacia. A T4-T6 level laminectomy was performed. The cyst was nearly totally resected. There was partial symptomatic relief after surgery, but 5 months later her symptoms worsened. MRI revealed nodular syringomyelia and atrophy of the thoracic spinal cord. Extradural spinal arachnoid cyst is to be considered in the differential diagnosis of spinal cord compression. Vaginal delivery may accelerate the process and symptoms by a sudden increase in the cyst size. In cases of myelomalacia secondary to cyst pressure postoperative results are quite poor.