Magnetic resonance imaging of a spinal extradural arachnoid cyst

Kim, Kwang S.; Weinberg, Peter E.

doi:10.1016/0090-3019(86)90157-6

Cited by 42 publications

(19 citation statements)

References 4 publications

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“…Perineural [3,6,7,23,35,39,43,[45][46][47]53] or lumbosacral extradural [5,12,15,16,25,38,50] arachnoid cysts can take the form of space-occupying cystic dilatations of the lumbosacral nerve roots at or distal to the junction of the posterior root and the dorsal ganglion. Both terms are used for the same entity.…”

Section: Introductionmentioning

confidence: 99%

Lumbosacral extradural arachnoid cysts: diagnostic and indication for surgery

Kunz¹,

Mauer²,

Waldbaur³

1999

European Spine Journal

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] or lumbosacral extradural [5,12,15,16,25,38,50] arachnoid cysts can take the form of space-occupying cystic dilatations of the lumbosacral nerve roots at or distal to the junction of the posterior root and the dorsal ganglion. Both terms are used for the same entity. They are a rare disease. Although this entity has been known since 1937 [16], there are only a few publications describing the clinical course of more than one or two cases [7,24,36,45,47]. In 1959 Nugent reported on seven surgical cases [31]. Recently, Kendall et al. discussed six of their own cases of operated extradural arachnoid cyst, but only two of them were situated in the lumbosacral region [24]. Palmer studied the frequency of spinal arachnoid cysts at the Department of Neurosurgery at the Radcliffe Infirmary in Oxford (UK) in the years 1938-1970, and found only one extradural lumbar arachnoid cyst [32]. The clinical significance remained doubtful [9,34].The availability of MRI has resulted in an increasing number of patients with incidentally diagnosed extradural arachnoid cysts. A total MRI incidence of 4.6% and 1% with symptoms is reported [34]. The higher number of nearly 10%, cited by Xiao in another myelographic study, includes very common small radicular abnormalities [51]. Patients may suffer from different types of low back pain and sciatica. No critical discussion of the indication for surgery has been found in literature so far. Our aim was to compare the results in patients with operative and conservative treatment to define standards for a good surgical result. On account of the low frequency of this entity a prospective study is impossible. Materials and methodsThe clinical records of all patients with a lumbosacral extradural arachnoid cyst attending the neurosurgical department of our hospital in the years 1987-1995 were surveyed. Over these 9 years we operated on 2995 patients with lumbar space-occupying lesions. In Abstract No critical discussion of the indication for the surgical treatment of lumbosacral extradural arachnoid cysts is found in the literature. Therefore, we want to compare the results in patients with operative and conservative treatment to define standards for a good surgical result. Over a period of 9 years, we operated on eight patients with a lumbosacral extradural arachnoid cyst and treated eight others conservatively. Only three of the operated patients experienced a postoperative relief of pain, but none was symptom free. The only one with continuing success had a preoperative history of 1 year only. MRI scans without contrast agent were misinterpreted in one included and one excluded case. The results of conservative treatment were nearly the same as those of operative treatment. MRI is the best diagnostic tool, but a variety of sequences must be used. Patients with a short pain history and a clear neurological deficit profited most from surgery. Patients with slight and not clearly related uncharacteristic symptoms should be excluded from surgery. Key words

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Section: Introductionmentioning

confidence: 99%

Lumbosacral extradural arachnoid cysts: diagnostic and indication for surgery

Kunz¹,

Mauer²,

Waldbaur³

1999

European Spine Journal

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“…The cysts are most commonly located in the thoracic spine, followed by the lumbosacral junction [3, 5, 8, 10, 19, 20, 21]. Thoracic cysts most often occur in the second decade of life because of the small canal at this level, and lumbosacral cysts appear in the 3rd to 5th decades of life because of the larger canal.…”

Section: Discussionmentioning

confidence: 99%

“…Widening of the bony canal represents the slow and progressive enlargement of the cyst. MRI is the diagnostic procedure of choice because of its noninvasiveness and ability to demonstrate the cyst’s nature, exact size, and anatomic relationship with the spinal cord [4, 5, 7, 8, 10, 19, 20, 22, 23]. Although careful physical examination is essential, MRI has improved the ease and accuracy of early diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Compression Caused by Extradural Arachnoid Cysts

Chang¹,

Chou²,

Bell³

et al. 2004

Pediatr Neurosurg

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Most spinal arachnoid cysts are asymptomatic and detected incidentally during magnetic resonance imaging or myelography. The etiology of intraspinal arachnoid cyst is not yet clear. We present two children with three spinal extradural arachnoid cysts and each cyst protruded from a separate dura defect. In both patients, plain radiographs demonstrated widening of the interpedicular distance, which suggested progressive widening of the spinal bony canal. Limited laminectomy was performed to remove the intraspinal cysts. Separate dura defects, the apparent predisposing factors, were also found and repaired. The patients completely recovered neurologically. Radical cyst removal and dura defect closure are the surgical intervention of choice in patients with symptomatic extradural arachnoid cyst.

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“…[2][3][4][5][6][7][8][9] The patients were eight males and two females, aged from 11 to 49 years. Four patients were teenagers and four were in the forties.…”

Section: Discussionmentioning

confidence: 99%