Clinical Outcomes of Surgical Treatment for Arachnoid Web: A Case Series

Hirai, Takashi; Taniyama, Takashi; Yoshii, Toshitaka; Mizuno, Koichi; Okamoto, Mikio; Inose, Hiroyuki; Yuasa, Masato; Otani, Kazuyuki; Shindo, Shigeo; Nakai, Osamu; Okawa, Atsushi

doi:10.22603/ssrr.2018-0027

Cited by 19 publications

(28 citation statements)

References 13 publications

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“…As for the treatment of AW, all cases reported in the literature were treated surgically. The surgical treatment is removal of the AW after dural incision, with no fixation or decompression [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Nisson et al reported that, after surgery, 91% of patients showed neurological improvement [ 8 ]. On the other hand, Hirai et al showed that the postoperative symptoms tended to improve in 5 cases, but numbness of the lower limbs remained in 3 cases, and bladder disorders did not change after operation in 1 case [ 6 ]. At this time, there are no clear reports on the risks of postoperative residual symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases

Inoue

Miyakoshi

Hongo

et al. 2020

Case Reports in Orthopedics

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Introduction. An arachnoid web (AW) is a relatively rare disease and shows clinical symptoms and radiological findings similar to those of an arachnoid cyst (AC) or spinal cord herniation (SCH). Since the operative procedures for an AW are generally different from those intrathecal disorders, correct preoperative differential diagnosis is important. The purposes of this study were to report the usefulness of magnetic resonance imaging (MRI) and computed tomography (CT) myelography for diagnosing AW and to show the histological findings and clinical results. Case Description. Two patients, a 79-year-old man and a 43-year-old woman, are presented. The primary diagnoses were AC with ossification of the ligamentum flavum and epidural hematoma, respectively, in previous hospitals. They were finally diagnosed by the characteristic MRI and CT myelogram finding called the “scalpel sign.” Histological findings showed epithelial cells and fibrous tissue derived from arachnoid tissues and microcalcifications. After surgery, the scalpel sign has vanished, and aggravation of their symptoms was prevented. Conclusion. An AW is refractory, but early detection by MRI and CT myelography and early treatment improve outcomes after surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases

Inoue

Miyakoshi

Hongo

et al. 2020

Case Reports in Orthopedics

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“…10 also found the scalpel sign in all patients with arachnoid web. 8 , 10 Other advanced MRI techniques have been used in evaluation of arachnoid web. Thin arachnoid bands webs could be identified on high-resolution 3D T2 myelographic sequences.…”

Section: Discussionmentioning

confidence: 99%

“…5–7 It has been hypothesized that arachnoid webs may be idiopathic, remnants of a previous arachnoid cyst that ruptured, or are precursors to arachnoid cysts that have not fully walled off. 3 , 5 , 6 , 8 Arachnoid adhesions could also result secondary to trauma or prior surgery. 9…”

Section: Introductionmentioning

confidence: 99%

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Multi-modality imaging evaluation of the dorsal arachnoid web

et al. 2020

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Purpose Dorsal arachnoid web (DAW) is a rare intradural abnormality which is associated with progressive myelopathy. Our objective was to review multi-modality imaging techniques demonstrating the scalpel sign appearance in evaluation of DAW. Methods We retrospectively reviewed various imaging modalities of patients found to have DAW at our institution during January 2015 to February 2020. Five patients underwent surgical decompression with pathological correlation. The remaining patients were presumptively diagnosed based on the characteristic finding of scalpel sign. Clinical data were evaluated and correlated to imaging findings. All imaging modalities demonstrated the characteristic scalpel sign. Results Sixteen patients (10 females, and six males) with multi-imaging modalities were evaluated. Their mean age was 52 year (range 23–74 years). Fifteen patients underwent conventional spine MRI. Further high-resolution MR imaging techniques, e.g. 3D T2 myelographic sequence, were utilized with two patients. MRI spine CSF flow study was performed to evaluate the flow dynamic across the arachnoid web in one patient. Eight patients were evaluated with CT myelogram. Syrinx formation was discovered in seven (44%) patients; five (71%) of them underwent surgical resection and decompression. Two patients underwent successful catheter-directed fenestration of the web with clinical improvement. We found a statically significant positive correlation between the degree of cord displacement and compression with syrinx formation (r = 0.55 and 0.65 with p-value of 0.03 and 0.009, respectively). Conclusion DAW has characteristic scalpel sign independent of imaging modality. Multi-modality imaging evaluation of DAW is helpful for evaluation and surgical planning.

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