Intrasacral Extradural Arachnoid Cysts -Three Case Reports-

Abstract

Three patients presented with rare intrasacral extradural arachnoid cysts manifesting as sensory deficiencies and pain in the lower extremities. Magnetic resonance imaging with various sequences identified the cysts. Two patients underwent surgery via laminectomy of the sacrum for cyst exploration and disconnection of the cyst with the dural theca. Postoperative outcome was favorable in these two patients. Intrasacral extradural arachnoid cyst should be considered in the differential diagnosis of low back pain.

Spinal Extradural Meningeal Cysts

“…1,20,27 The signal within the cyst may appear hyperintense compared with the CSF in the spinal canal because of the higher protein content of the cyst fluid. These arachnoid diverticula usually present in the third or fourth decade of life; they are mainly sacral in location and cause nonspecific symptoms such as lower back pain that increases with activity or Valsalva's maneuver (in 80% of patients) and perineal paresthesia (in 50% of patients).…”

Role of screening of whole spine with sagittal MRI with MR myelography in early detection and management of occult intrasacral meningocele

“…Patients generally present in middle age with mild or atypical symptoms like back pain, gluteal or perineal pain, radiculopathy, or sphincteric disturbances. [23451213] However, in this study we were able to detect half of the patients in the second decade due to the selected imaging protocol. A subset of the patients with this congenital syndrome may develop progressive symptoms and signs which at times may be related to the cervicodorsal region.…”

“…At times, occult intrasacral meningocele has been used interchangeably in the literature with sacral extradural arachnoid cyst. [12345] Patients with occult intrasacral meningocele may continue to have vague symptoms and these are often missed due to a lack of awareness of this entity and inappropriate imaging protocol. Early detection is critical for timely management of this type of occult spinal dysraphism to prevent further progression of symptoms especially in cases with associated magnetic resonance (MR) findings of a tethered cord.…”

Six cases of occult sacral meningocele

“…One year later, the patient remained asymptomatic, and the radiographic survey documented a now fused/intact sacral roof [Figure 1f]. [1][2][3][4][5]…”

“…Occult sacral meningoceles (OSM) are cerebrospinal fluid (CSF) containing cystic masses that are typically devoid of neural elements. [1,2,[5][6][7][8][9] e radiographic documentation of these lesions is still best-defined utilizing lumbar CT-myelography. [3] Here, we present six patients who presented with symptomatic OSM whose clinical symptoms (i.e., low back pain/radiculopathy) improved with surgery except for bladder dysfunction.…”