Spinal Intradural Juxtamedullary Cysts in the Adult: Surgical Management and Outcome

Abstract

Intradural cysts should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts with large craniocaudal extensions effectively ameliorated patients' symptomatology. A description of the first documented case of a surgically treated intradural cervical nerve root cyst is provided.

Severe focal myelopathy secondary to chronic compression by an arachnoid pseudocyst in a Rottweiler

“…However, both in humans and dogs, a complete block of contrast medium flow at the lesion site similar to what was seen in the present case has also been described, thus suggesting the presence of a SAP totally isolated from the subarachnoid space and mimicking an intradural lesion (Bassiouni et al 2004, Jurina andGrevel 2004). This may cause minimal compliance of the fluid-filled cystic structure and persistent spinal cord compression that might explain the dilatation and severity of the lesions (Gnirs et al 2003, Wang et al 2003, Bassiouni et al 2004). …”

“…It is speculated that this type of oligodendrocyte loss contributes to long-tract degeneration observed in chronic compressive myelopathies (Yamaura et al 2002). In humans with longstanding myelopathies secondary to SAP, these changes may ultimately lead to fibrosis, atrophy and permanent neurological defi cits, although a positive correlation between duration of preoperative disease and outcome is not always possible (Yamaura et al 2002, Bassiouni et al 2004). …”

Idiopathic Intradural Extramedullary Arachnoid Cyst and Associated Syringomyelia

“…Craniocaudal extension of these cysts may involve up to 17 vertebral levels [1]. Most are dorsal to the spinal cord, and a minor percentage, as in our case, is ventrally located [1][2][3][4]. Intradural extramedullary arachnoid cysts are less common than extradural ones [2,4] and are twice as frequent in males as in females [5].…”

“…As for their location, the majority of intradural spinal arachnoid cysts occur in the thoracic region (80%); 15% of cases are described in the cervical region and 5% in the lumbar region. Craniocaudal extension of these cysts may involve up to 17 vertebral levels [1]. Most are dorsal to the spinal cord, and a minor percentage, as in our case, is ventrally located [1][2][3][4].…”

“…Spinal arachnoid cysts can be congenital in origin or secondary to trauma, infection, subarachnoid haemorrhage, meningeal infection, and other insults that cause inflammation and subarachnoid adhesions [1].…”