Spinal Extradural Arachnoid Cyst

Abstract

Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy.

Extensive spinal intradural arachnoid cyst exhibiting a “double cord sign” on magnetic resonance imaging

“…10,16,[20][21][22] If the cyst adheres to the spinal canal, marsupialization is recommended to relieve symptoms successfully. 23 The best reliable treatment is complete surgical excision of the cystic structure in order to recover the neurologic symptoms. In our case, because the lesions were long extending arachnoid cysts, it is difficult to determine how many levels should be performed during the operation.…”

Spinal extradural arachnoid cysts

“…4,9,14 In adults pre-diagnosis period is usually longer and even the patient might complain of pain about a decade or two before the establishment of correct diagnosis. 3,17,18,41 The most common presenting symptom is axial or radicular pain. The spectrum of radicular pain varies from intercostal and abdominal pain to upper or lower limb radiculopathy.…”

“…(Figure 3E) Extradural spinal arachnoid cysts are rare expanding lesions mostly located in the posterolateral aspect of the thoracic or thoracolumbar region displacing the spinal cord or cauda equina anteriorly. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]24,[29][30][31] Although, spinal extradural arachnoid cysts might rarely develop after blunt or penetrating traumas, but non-traumatic cysts are generally believed to be congenital. 9,12 Presence of extradural arachnoid cysts in two and three siblings in a few separate reports…”

“…[2][3][4][6][7][8]12,13,[17][18][19]24 Duration of the symptoms might vary from one month to a quarter of century. 3,9,13,14,17,18,41 In children, the period prior the correct diagnosis and from diagnosis to surgery is short and is mostly from six to twelve months. 4,9,14 In adults pre-diagnosis period is usually longer and even the patient might complain of pain about a decade or two before the establishment of correct diagnosis.…”

Laminectomy by craniotome for huge spinal extradural arachnoid cyst: a case report

“…Spinal extradural arachnoid cyst (SEAC) is a rare cause of compressive myelopathy [1][2][3]. This lesion is reported to develop in any location, however most commonly occurs in posterior or posterolateral thoracic spine to the thoracolumbar area [4,5].…”