Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects

Abstract

Between 1979 and 1991, spinal arachnoid cysts were found in 11 patients aged 19 months to 18 years (mean age 5 1/2 years). Of the 11 patients, six had a myelomeningocele and one diastematomyelia. The presenting symptoms included radicular pain (one patient), progressive weakness (three), increasing scoliosis (one), worsening spasticity (three), and recurrent urinary tract infections and progressive constipation (one). Two patients showed no symptoms from the spinal arachnoid cyst. The distribution of lesions was as follows: cervicomedullary (one patient), cervical (one), cervicothoracic (two), thoracic (four), lumbar (two), and sacral (one). Four of the 11 arachnoid cysts (all intradural) were located anterior to the spinal cord, three of which were in children with a myelomeningocele. Only two of the cysts were extradural; both were found in the lumbosacral region, and one was associated with diastematomyelia. Eight patients were treated with fenestration and/or resection of the cyst wall. Three patients with anterior cysts were treated with shunts, a cyst-to-pleural space shunt in two and a cyst-to-subarachnoid space shunt in one. All of the patients either improved or exhibited an arrest in the progression of their symptoms. Spinal arachnoid cysts are a treatable cause of progressive neurological deficits and, in this series, were frequently found in patients with neural tube defects.

Idiopathic Intradural Extramedullary Arachnoid Cyst and Associated Syringomyelia

“…Several anomalies have reported to be associated to arachnoid cysts, as neural tube defects in children [12] and various vertebral anomalies in adults, as Klippel-Feil anomaly [6] or kyphoscoliosis [1], or rarely spinal cord herniation [13]. In some rare cases [4,14,15] as the one we report, a syryngomielic cavitation can be associated to an idiopathic arachnoid cyst.…”

Spinal extradural meningeal cyst with spinal stenosis

“…6 Congenital lesions have been found in children in association with neural tube defects. 7 Fortuna et al 8 suggested an incarceration of arachnoid granulations growing through cerebrospinal fluid production, which becomes entrapped in the arachnoid diverticula. In the presented case, the origin of the cyst remains unclear.…”

Congenital spinal intradural arachnoid cyst associated with intrathoracic meningocele in a child

“…Partial resection and fenestration of the cyst is the second choice, allowing maximal communication with the subarachnoid space (Alvisi et al, 1987;Osenbach et al, 1992). Shunting of the cyst to the peritoneum, pleural cavity, or subarachnoid space is the third operation type (Rabb et al, 1992;Bassiouni et al, 2004;Wang et al, 2003). Simple aspiration of the cysts will not work, as this maneuver usually results in recurrence.…”

“…The pediatric spinal intradural ACs are, however, even more uncommon (Lee and Cho, 2001), and the exact pathogenesis remains unknown. Spinal ACs have been described in children associated with other neural tube anomalies, including myelomeningocele and diastematomyelia (Rabb et al, 1992) and kyphoscoliosis (Alvisi et al, 1987). But spinal AC associated with intrathoracic meningocele is very rare (Baysefer et al, 2001).…”