Spinal Extradural Arachnoid Cyst. Case Report.

Hatashita, Shizuo; Kondo, Akihide; Shimizu, Takashi; Kurosu, Akihiro; Ueno, Hideo

doi:10.2176/nmc.41.318

Cited by 57 publications

(34 citation statements)

References 7 publications

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“…SEAC is more commonly found among male patients and during the second decade of their life. SEACs can be found in any location, although mostly reported to be located at mid thoracic to the thoraco-lumbar junction, commonly in a posterior position 1,3,4,6,10,12) . SEAC is an outpouching herniation of arachnoid membrane through a dural defect that may communicate to intradural subarachnoid space 5) .…”

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Spinal extradural arachnoid cyst

Choi¹,

Kim

Lee³

et al. 2006

Acta Neurochir (Wien)

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A 59-year-old man presented with both leg radiating pain and paresthesia for 4 years. Other physical findings were not remarkable. MRI showed a large, elongated posterior extradural cyst from T12 to L3 with surrounding bony erosion (Fig. 1A, B).Thinned overlying laminas were found on operative field and the cyst was ruptured during laminectomy. There was a hole-like dural defect near to right L1 root sleeve and we performed primary closure of the defect. Some part of cyst wall was also removed.The patient's symptoms were gradually subsided and follow up image taken 1 month after the operation showed complete disappearance of the cyst (Fig. 1C). Case 2A 51-year-old female patient visited our clinic with left buttock pain and paresthesia for 3 years. Her pain was aggravated on coughing and she also complained of gait disturbance with both sole numbness on walking.MRI showed a large extradural cyst located posterior to the INTRODUCTIONSpinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. SEAC is more commonly found among male patients and during the second decade of their life. SEACs can be found in any location, although mostly reported to be located at mid thoracic to the thoraco-lumbar junction, commonly in a posterior position 1,3,4,6,10,12) . SEAC is an outpouching herniation of arachnoid membrane through a dural defect that may communicate to intradural subarachnoid space 5) . The etiology of this herniation is still unclear and can be either congenital or acquired 6) . These cysts can result in fluctuating symptoms associated with cord or root compression. It is assumed that they can be enlarged by subsequent pressure change in the cerebrospinal fluid (CSF) during exercise and Valsalva maneuvers as there is micro-communication between the cysts and subarachnoid space 2,6) . Despite the rarity of SEACs, they are important in neurosurgical view because they are surgically curable disease. Diverse surgical techniques have been introduced and many reports reviewed favorable outcome of SEACs with surgical treatment. We experienced 2 cases of SEACs and performed cyst fenestration and primary repair of dural defects for all of them. The aim of this article Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, KoreaSpinal 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 cys...

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Spinal extradural arachnoid cyst

Choi¹,

Kim

Lee³

et al. 2006

Acta Neurochir (Wien)

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“…The site of the communication with the subarachnoid space varies from the dorsal midline to the root sleeve. 1,8) Communication with the subarachnoid space is reported in about half of the cases based on operative findings or preoperative myelography, 3,8) but we should try to identify the fistula during the operation by forced inflation of the patient's lung by the anesthetist using the Valsalva maneuver. We believe that the best surgical treatment to eradicate the valve-like mechanism is complete resection of the cyst and tight closure of the dural defect.…”

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confidence: 99%

Thoracolumbar Extradural Arachnoid Cyst

Tomii

Mizuno

Takeda

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Three cases of symptomatic extradural arachnoid cyst were treated by surgery. Total excision of the cyst followed by tight closure of the fistula by suture was achieved in all 3 cases. Surgery improved the neurological deficits but urinary incontinence persisted in all three patients. Obliteration of the fistula is considered to be important at surgery from the etiological perspective of the cyst. There are many surgical options, but surgical removal of the cyst and obliteration of the communication usually leads to prompt improvement in neurological deficits. Instability, malalignment, and worsening scoliosis are well-recognized postoperative complications of excessive laminotomy, but the exposure should be wide enough to cover the cyst completely at the operation. Wide exposure of the entire cyst is preferable to avoid missing the fistula and to identify any adhesions or fistula between the cyst and the dura. Identification of the fistula location based on preoperative imaging studies is also important.

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“…Excision of plaques and diffuse arachnoid plaques failed to demonstrate long-term improvement in reports by Sakai et al [5] and Papavlosopoulos et al [6]. Additional reports of cyst excision without arachnoid ossification have had favorable results [20][21][22]. Unfortunately, there is a paucity of reports of arachnoid ossification with diffuse arachnoid cysts to demonstrate consist surgical outcomes.…”

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confidence: 99%

Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy

Abrams

Mindea

et al. 2011

Eur Spine J

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Objective To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Summary of background data Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae. Methods An 81-year-old female clinically presents with rapidly progressive myelopathy. Pre-operative magnetic resonance imaging identified multiple compressive thoracic intrathecal cysts. Surgical exploration and decompression of these cysts identified calcified plaques within the arachnoid. Histopathologic examination revealed fibrocalcific tissue undergoing ossification with bone marrow elements. Results Due to progressive myelopathy, the thoracic cysts were decompressed and calcified plaques were excised, once identified intra-operatively. Conclusions On last examination, the patient's neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.

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Spinal Extradural Arachnoid Cyst. Case Report.

Cited by 57 publications

References 7 publications

Spinal extradural arachnoid cyst

Spinal extradural arachnoid cyst

Thoracolumbar Extradural Arachnoid Cyst

Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy

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