Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery

Shibata, Toshihiko; Nakamura, Hiroaki; Yamano, Yoshiki

doi:10.1038/sj.sc.3101217

Cited by 20 publications

(15 citation statements)

References 16 publications

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“…2 Tethering of the spinal cord and arachnoid cyst formation have been associated with previous trauma. 1,16,18,34,37 Arachnoiditis has been found to occur as a result of infection (for example, tuberculosis and malarial infections of the meninges), 9,10,20,24,27 and after cranial aneurysmal subarachnoid hemorrhage, with blood settling in the spinal subarachnoid space and causing delayed arachnoiditis. 3,13,23,39 Ionic intrathecal contrast administration is another known cause of thoracic and lumbar arachnoiditis.…”

Section: Discussionmentioning

confidence: 99%

“…contrast 4,15 and epidural anesthesia, 40 traumatic arachnoiditis, 17,22,25,38 arachnoiditis from subarachnoid hemorrhage, 3,23,39 congenital arachnoid malformations, 6,19,28,32,35 and traumatic 17,37,41 and idiopathic arachnoid cysts. 1,7,13,14,16,21,26,30,34,36,42 Treatment, including nonsurgical and surgical management strategies, has provided mixed results, and follow-up offered in the medical literature has been poor.…”

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confidence: 99%

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Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Griessenauer¹,

Bauer²,

Moore

et al. 2014

SPI

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Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Griessenauer¹,

Bauer²,

Moore

et al. 2014

SPI

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“…5,14) Ventriculoperitoneal shunting may be effective in some cases. 1,9) The surgical outcome is unpredictable.…”

Section: Discussionmentioning

confidence: 99%

“…Acquired spinal arachnoid cyst, also called subarachnoid cyst, 16) is a sequela of chronic inflammation in the subarachnoid space. The initiating cause may be trauma, 5,7,14) myelography dye, 10) subarachnoid hemorrhage, 9,17) or infection. 1,12) Acquired spinal arachnoid cyst often occurs at the thoracic level and can arise ventral, lateral, or dorsal to the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Spinal Arachnoid Cyst Causing Paraplegia Following Skull Base Surgery-Case Report-

Kurokawa

Kawase

2006

Neurol. Med. Chir.(Tokyo)

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A 40-year-old woman presented with a right petroclival meningioma compressing the brainstem and manifesting as a 6-month history of headache and gait difficulty. The patient underwent subtotal removal of the tumor via an anterior transpetrosal approach. The postoperative course was complicated by cerebrospinal fluid rhinorrhea, bacterial meningitis, and acute hemorrhagic rectal ulcer. The patient was discharged home in good condition after prolonged medical treatment. Four months after the surgery, the patient noted recurrence of gait difficulty. Magnetic resonance (MR) imaging of the brain showed enlargement of the ventricles and no residual brainstem compression. A ventriculoperitoneal shunt was placed, but the symptoms were unchanged. The shunt was removed 2 months later because of infection. The patient's gait gradually deteriorated, although repeat brain MR imaging showed no significant increase in ventricular size. Ten months after the initial surgery she became paraplegic. MR imaging of the thoracic spine revealed a large arachnoid cyst extending from C-6 to T-6. The patient underwent T2-4 laminectomy, partial removal of the cyst wall, and duraplasty, but no clinical improvement was observed. Preexisting long-tract signs and coincidental hydrocephalus confused the neurological findings and delayed detection of the spinal lesion in this case. Neurosurgeons should be alert to the possibilities of insidious spinal lesion if the patient has progressive neurological disorder which does not match the known cranial lesion.

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“…Endo et al reported an arachnoid cyst after the operation of an epidural spinal haematoma, whereas Bassiouni et al after a major spinal trauma. Other causes of arachnoid spinal intradural cysts included also traumatic causes such as vertebral fracture [25] or traumatic syringomyelia [2,16].…”

Section: Discussionmentioning

confidence: 99%

Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case

et al. 2009

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Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. The diagnosis is clinical and radiological with the use of MRI, CT myelography or a combination of both. The best treatment option is complete removal of the cyst. However, even when paresis is regressing there is no good recovery from neuropathic pain. Laminectomy approach can cause postoperative complications especially when the cyst(s) expand(s) in more than one level. Alternatively, a cyst fenestration can be performed, including the levels of the maximal spinal cord compression. The clinical outcome is as good as after the cyst resection enabling the patient to walk again. The neuropathic pain may persist and require medication. A clinical case is presented, and the literature is reviewed. In the present case we report a patient with intradural arachnoid cysts extending from T6 to L2 and causing severe gait ataxia as well as neuropathic pain and hypaesthesia. The spinal-cord was compressed at T8 and T12. Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.

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Intradural arachnoid cyst associated with thoracic spinal compression fracture: 7-year follow up after surgery

Cited by 20 publications

References 16 publications

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Spinal Arachnoid Cyst Causing Paraplegia Following Skull Base Surgery-Case Report-

Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case

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