Spinal Extradural Cyst Research Articles

Leptomeningeal cysts in congenital ectopia lentis. Case report.

✓ A case of ectopia lentis (Marfan syndrome) with a cerebral subarachnoid cyst, a spinal extradural cyst connected to a lateral intrathoracic meningocele, and perineural cysts is presented. The association of these leptomeningeal cysts in this genetic disorder of connective tissue suggests a common pathogenesis.

Intraspinal dermoid and spinal extradural cyst: pneumomyelographic findings.

Two cases of intraspinal dermoid and spinal extradural cyst are briefly reported, with special reference to the pneumomyelographic picture.

Congenital Cysts of the Spinal Membranes and Roots

One case of leptomeningeal cyst, three cases of spinal extradural cysts and ten cases of perineural cysts, two of which were operated on, are reported. The literature pertaining to these diseases is reviewed and the possibilities of a correct radiological diagnosis are discussed.

Spinal extradural cysts.

Spinal extradural cysts.

Lumbar Extradural Cysts—Congenital

Congenital extradural spinal cysts are exceedingly rare and represent the least common cause of spinal cord pressure. The literature records only 35 cases. This fact, coupled with the satisfying surgical results, dictates the periodic review and discussion of the symptoms and diagnostic features. These extradural cysts have a high predilection for the thoracic region, 29 of the 35 reported cysts occurring entirely within the thoracic region. Six have been reported extending into the lumbar region, and of these only two have occurred isolatedly in the lumbar area. The literature is consistent in reporting the symptomatology and signs of spinal extradural cysts as being compatible with an expanding lesion in the thoracic area. This description was initiated by Elsberg, in 1934, and has been quoted verbatim in several of the subsequent reports as follows: The individual is an adolescent with the history and symptoms of a progressive spastic paraplegia. Pain is

Congenital Spinal Extradural Cyst. Case Report and Review of the Literature

One of the most favorable spinal lesions from the s tandpoin t of both surgical ext irpat ion and recovery of neurological function is the ext radural cyst of nont raumat ic origin. I t is also one of the rarest of intraspinal lesions. To date, including the present case, 34 proved cases have been recorded in the world l i terature to our knowledge. These are listed chronologically in Table 1. The first verified repor t was tha t of Collins and Marks s in 1915, which described a pa t ien t opera ted upon b y Dr. Alfred S. Taylor. The second case, reported b y Mixter 21 in 193~, was somewhat atypical in tha t the cyst was multilocular. The article by Elsberg, D y k e and Brewer 9 in 1934, reporting 4 cases, described the clinical syndrome and suggested the congenital origin of these lesions. These authors were apparen t ly unaware t ha t their Case 4 had been previously repor ted by Collins and Marks 5 (Case ~). In 1937, Cloward and Bucy a recorded a case and carefully reviewed the history, findings and roentgenograms in 9 previously reported cases. In 8 of the 10 cases, the cyst was located in the thoracic region, and each of the pat ients had more or less m a rked radiological s t igmata of kyphosis dorsalis juvenilis (Scheuermann's disease). Cloward and Bucy advanced the hypothesis tha t the extradural cysts, by interfering with the venous drainage of the ver tebra l bodies, caused the kyphosis dorsalis juvenilis. The case reported by Mered i th 2~ is the only one in which the cyst occurred in the cervical region. Some question arises (and was raised by the author) as to whether this cyst was caused by t rauma.* In 1947, Swanson and Fincher 27 repor ted ~ cases of extradural cysts. The lesion in the first pat ient , a ~0-month-old child, was an extensive arachnoidal cyst ; it p ro t ruded through a dural defect extending from the ~nd lumbar to the 1st sacral segment and contained several roots of the cauda equina. I t is probable, as the authors concluded, tha t this lesion was t r aumat i c in origin. In the case of their second pat ient , however, it seems more likely t ha t the lesion was a congenital extradural cyst , the symptoms of which were precipi ta ted b y t r a u m a (sneezing). The la t ter case is included in this review.

Lumbar and sacral cysts of meningeal origin.

An infrequent cause of low back pain, only recently described, is the presence of a meningeal cyst within the lumbar or sacral canal. Although spinal extradural cysts causing cord compression were reported in the literature as far back as 1898 (4), no reference to meningeal cysts in the sacral and lumbar regions appeared prior to 1951. This is due probably to a lack of cognizance of such lesions or to a failure to appreciate the significance of minor myelographic defects which were not compatible with herniated disk or tumor. In 1951, Schreiber and Haddad (5) reported 4 cases of lumbosacral cyst which produced pain. In 2 of these, however, the diagnosis is inacceptable: histologic examination of one specimen revealed it to be a nerve root swollen by hemorrhage, while in the other instance the lesion was described by the surgeon as “a bruised swelling in the nerve.” Thus only 2 of the cases were actually meningeal cysts. Much earlier than this report, another entity was described which, though different, might well be confused with a meningeal cyst. Tarlov, in 1938 (6), described a pathologic entity which he called “perineurial cyst.” Ten years later (7) he reported a case with a typical disk syndrome relieved by excision of a perineurial cyst of the second sacral posterior nerve root and ganglion. We have recently encountered 5 examples of lumbar and sacral meningeal cysts, 4 of which were proved by surgery. The symptoms were vague, and no typical clinical picture could be constructed. Case I: M. O., a 36-year-old Negro male, was admitted to Montefiore Hospital on Oct. 27, 1950. He had been well until January 1948, when he twisted his back while at work. He immediately suffered sharp, severe, low back pain, which persisted. It was relieved by bed rest and aggravated by standing. On occasion, bending over caused pain down the back of both lower extremities. Examination showed forward flexion of the spine to be moderately limited. Straight leg raising was unimpaired but painful on the left side. Percussion over the sacrum produced local pain. No reflex or sensory changes could be demonstrated. Myelography, Oct. 28, 1950, revealed asymmetry of the extreme caudal end of the sac in both anteroposterior and right posterior oblique studies. Compression of the left side of the column was demonstrable in the latter view (Fig. 1). The defects were thought to be due to extrinsic pressure and the presence of a sacral perineurial cyst was considered. On Nov. 1, 1950, a sacral laminectomy was performed. The sacral canal was found to be widened, and a cyst measuring approximately 1.5 cm. in its greatest diameter was uncovered.

Lumbar spinal extradural cyst

A case is reported of an extradural spinal cyst located entirely in the lumbar region and unassociated with kyphosis dorsalis juvenilis.

SPINAL EXTRADURAL CYSTS

1. Two types of spinal extradural cyst are discussed: 1) the type which occurs in adolescents in the dorsal spine with evidence of kyphosis juvenilis; 2) the type which occurs in adults in the dorso-lumbar spine without kyphosis. 2. A fifth case of dorso-lumbar spinal extradural cyst in the adult without deformity is reported. Cysts in this region present common features distinguishing them from the more frequent type which occurs in adolescents. 3. The relationship between spinal extradural cysts, venous drainage of vertebral bodies, and spinal deformity, is discussed.

Spinal Extradural Cysts, Congenital and Acquired

Spinal Extradural Cysts, Congenital and Acquired

Spinal extradural cysts

Spinal extradural cysts