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

Abstract

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.

Iatrogenic intradural spinal arachnoid cyst as a complication of lumbar spine surgery

“…Iatrogenic spinal arachnoid cysts are rare and of the few reported cases in the literature, none were associated with lumbar surgery. 2,3,5,8 Valls et al 10 did report on a case in which a thoracic arachnoid cyst became symptomatic after a lumbar laminectomy. However, in this case the cyst was not iatrogenic at the site of surgery as there was no dural violation during the lumbar laminectomy and the thoracic arachnoid cyst was believed to be preexisting.…”

“…1,4,6,9 Iatrogenic causes of acquired spinal arachnoid cysts are rare, but have been reported following spinal injections, lumbar puncture, and even skull base surgery. 2,3,5,8 We report 2 cases of iatrogenic spinal arachnoid cyst formation that occurred after incidental durotomy during lumbar spine surgery.…”

A review of spinal arachnoid cysts

“…3,8 A patient can have more than one spinal arachnoid cyst, or both a spinal arachnoid cyst and a concurrent intracranial arachnoid cyst or a tumor. 9…”