Spinal arachnoid web—a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population

Voglis, Stefanos; Romagna, Alexander; Germans, Menno R.; Carreno, I.; Stienen, Martin N.; Henzi, Anna; Frauenknecht, Katrin; Molliqaj, Granit; Tung, Kayee; Tessitore, Enrico; Ginsberg, Howard J.; Bellut, David

doi:10.1016/j.spinee.2021.06.018

Cited by 9 publications

(23 citation statements)

References 36 publications

(55 reference statements)

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“…4 Previous studies describe CT myelography as the preferred imaging modality for diagnosing SAWs, but more recent studies have shown that MRI can better identify and localize these entities via visualization of the web as well as regional CSF flow obstruction. 1,11 Current management of SAWs ranges from conservative therapy to surgical resection. Surgical resection is currently the treatment of choice for symptomatic SAWs since it improves neurological symptoms with minimal risk of complication and offers the potential for cure.…”

Section: Introductionmentioning

confidence: 99%

“…Current management of SAWs ranges from conservative therapy to surgical resection. Surgical resection is currently the treatment of choice for symptomatic SAWs since it improves neurological symptoms with minimal risk of complication and offers the potential for cure 12 . Those treated conservatively either have mild symptoms that do not warrant surgery or comorbidities that render them poor surgical candidates 1,5,13 …”

Section: Introductionmentioning

confidence: 99%

“…Eventually, a prospective trial that compares surgery versus medical/conservative treatment would be best to elucidate the best treatment options for SAWs. Finally, some patients had other more clinically significant medical ailments, such as metastatic cancer or endstage renal disease, which made surgical intervention an unnecessary burden.Studies have shown that surgical resection of arachnoid webs has an excellent prognosis with only a slight chance of recurrence 2,11. In our cohort, surgical resection with thoracic laminectomy and web resection was performed in 26 of 85 patients.…”

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confidence: 97%

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Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Elkadi

Kraus

Krisanda

et al. 2023

Journal of Neuroimaging

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Background and Purpose Spinal arachnoid webs (SAWs) are rare and can present with myelopathic symptoms. This study aims to add 85 more cases of SAWs to the literature so we can continue to analyze clinical and imaging trends of SAWs to better understand this entity and its natural history. Methods An institutional review board‐approved retrospective review of SAW cases between 2016 and 2022 within a metropolitan, multihospital network was performed, searching for MR and CT reports that included “arachnoid web.” Of 108 identified reports, 85 patients had imaging and/or pathologically proven arachnoid webs. Demographic and clinical data were collected. Images were analyzed for SAW level, point of maximum kyphosis, presence of cord expansion, and signal intensity. The electronic medical record (EMR) was reviewed for age, sex, symptom presentation and duration, management, and outcomes. Results Of 85 cases, the most common presenting chief complaint was back pain and weakness. All (100%) SAWs were in the dorsal thoracic subarachnoid space, with 87% (74/85) located from thoracic (T) 2 to T6. Spinal cord expansion and signal abnormality were present in 54.1% and 23.5%, respectively. Twenty‐six underwent surgical resection with 20 showing improvement of at least one symptom. Conclusion We present 85 additional cases of SAWs to the existing literature. Our cases all occurred in the dorsal thoracic subarachnoid space, predominantly from T2 to T6. Patients present with symptoms like other causes of cord compression, and spinal MR studies should be evaluated routinely for the findings of SAWs. Further research could focus on understanding SAW prevalence, risk factors, and pathophysiology.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 97%

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Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Elkadi

Kraus

Krisanda

et al. 2023

Journal of Neuroimaging

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“…In their study, Nisson et al 21 concluded that 95% of SAW cases were located dorsally, with 4% located ventrally and 4% located circumferentially. Voglis et al 31 and Nisson et al 21 reported that 100% of SAWs were in the thoracic spine, with 67% and 72% of the patients, respectively, being male. In contrast, Hamilton et al 11 reported a 2:1 female:male predominance.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, Hamilton et al 11 reported a 2:1 female:male predominance. Aiyer et al 1 noted that patients' ages ranged from the 4th to 7th decade, while Nisson et al 21 reported a mean age of 52 years, and Voglis et al 31 reported a mean age of 54 ± 12.7 years.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of spinal arachnoid web in case of syringomyelia: Strategies and outcomes

Adib

Schittenhelm

Kurucz

et al. 2023

Preprint

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Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and cine), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were TH2/3, TH6, and TH8. Excision of arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary SAW can be safely treated by surgery. Even syringomyelia usually improves inMRI and symptoms also improves, residual symptoms might be observed.

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Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes

et al. 2023

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Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of the spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and CINE), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were T2/3, T6, and T8. Excision of the arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary, SAW can be safely treated by surgery. Even though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).

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Spinal arachnoid web—a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection: analysis of a multicenter patient population

Abstract: Web -a distinct entity of focal arachnopathy with favorable long-term outcome after surgical resection. Analysis of a multicenter patient population.,

Cited by 9 publications

References 36 publications

Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Surgical management of spinal arachnoid web in case of syringomyelia: Strategies and outcomes

Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes

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