Intradural spinal arachnoid cyst resection: implications of duraplasty in a large case series

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Optimal diagnosis and management strategies for intradural spinal arachnoid cysts (SACs) are still unresolved given the rare nature of this entity, with few large case series and virtually no statistical analyses of patient characteristics in the literature. Here, the authors studied a large patient cohort with these lesions to determine whether pre- or postoperative attributes could be used to aid in either diagnosis or prognosis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A chart review was completed at a single institution for the period from 2002 to 2016 to determine the preoperative characteristics and postoperative outcomes of 21 patients with exclusively intradural SACs. Patients were assessed for symptoms such as weakness, pain, sensory changes, bowel and/or bladder dysfunction, and gait changes. Postoperatively, patients were analyzed for symptom improvement, complication occurrence, and duration of follow-up.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Approximately two-thirds of the patients in this series had developed SACs idiopathically, and the mean duration of symptoms prior to diagnosis was 15 months among all patients. A slight majority (57%) underwent CT myelography in the course of diagnosis, and a quarter of the patients had a syrinx. There was a statistically significant association between location of the SAC and number of presenting signs and symptoms; that is, patients with cysts in the lumbosacral region had more symptoms than those with cysts at the cervical or thoracic levels (p = 0.031). Overall, outcomes were largely positive, with approximately 60%–70% of patients experiencing postoperative improvement in symptoms, with motor weakness showing the highest response rate (71%) and pain symptoms the least likely to subside (50%). In the cohort with preoperative pain, those who had undergone expansile duraplasty were significantly more likely to experience relief of their pain symptoms (p = 0.028), which may have been a result of the superior restoration of cerebrospinal fluid pathways allowing for more adequate reduction in compression.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In this large case series on intradural SACs, new light has been shed on aspects of both pre- and postoperative care for patients with these rare lesions. Specifically, the authors revealed that lumbosacral intradural SACs may be associated with a higher disease burden and that patients who undergo expansile duraplasty may have an increased likelihood of experiencing postoperative pain relief.</jats:p></jats:sec>

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

“…Therefore, the cyst is completely dried out and the communication with the arachnoid space is closed, repairing the dural failure. [11][12][13] If left untreated, spinal cysts would cause permanent severe neurological damage. In the case of asymptomatic individuals, is indicated the constant monitoring of the cyst.…”

A 16-year old man with an intradural extramedullary arachnoid cyst in the spine: a rare case

“…Intradural extramedullary cyst in the spine is an extremely uncommon case and rarely causes spinal cord compression [1,2]. This cyst is suspected result from a congenital disorder of the dura mater and is almost always related to the intrathecal subarachnoid space via small defects in the dura mater.…”

“…arachnoid cyst, ependymal cyst, heterogeneous or neurenteric cyst, teratogenic cyst, and epithelial cyst [3]. These cysts have the same origin, except on small cases of arachnoid cysts appearing after trauma or arachnoiditis [2]. The following is a spinal cyst classification according to Nabor (table 1).…”

“…The most common ones are slowly progressive myelopathy or myeloradiculopathy [2]. An intradural extramedullary arachnoid cyst is exceptionally rare to cause myelopathy or spinal cord compression, only 1 -3% of the cases lead to spinal cord compression [3,5,7].…”

“…The symptoms can occur intermittently and can be worsened by gravitational position. Symptom remissions and fluctuations have been reported on approximately 30% of the cases [1,2].…”