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Spinal extradural arachnoid cysts: a rare entity and review of the literature

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Abstract

Objective

Spinal extradural arachnoid cysts (SEDC) are rare primary spinal lesions, accounting for less than 1% of all spinal epidural lesions. The literature contains only case reports of this pathology, and treatment remains controversial due to its rarity. Major reported SEDC cases are caused by leaking out of cerebrospinal fluid through a dural defect in the thecal sac forming an extradural cyst. Other reports describe non-communicating SEDC cases where the dural defect was not identified. We report a literature review on SEDC and the case of a 53 year‑old female who presented with type IA extradural cyst with subarachnoid space communication.

Methods

Literature review, preoperative imaging and surgical technique.

Results

The extradural cyst was excised completely and the dural defect was repaired. After surgical decompression, neurological symptoms gradually recovered.

Conclusions

The extradural arachnoid cyst is an uncommon entity. Preoperative imaging is one of the determining elements in orienting the therapeutic management of the SEDCs. The choice of the surgical technique must be the least invasive in order to avoid postoperative complications. Subtotal or complete excision of the cyst, followed by obliteration of the communication stalk and repair of the dural defect is the gold standard treatment.

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References

  1. Cloward RB (1968) Congenital spinal extradural cysts: case report with review of literature. Ann Surg 168(5):851–864

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Kim IS, Hong JT, Son BC, Lee SW (2010) noncommunicating spinal extradural meningeal cyst in thoracolumbar spine. J Korean Neurosurg Soc 48(6):534–537

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ellika S, Marin H, Pace M, Newman D, Abdulhak M, Kole M (2012) Case Series: Long segment extra-arachnoid fluid collections: role of dynamic CT myelography in diagnosis and treatment planning. Indian J Radiol Imaging 22(2):108–115

    Article  PubMed  PubMed Central  Google Scholar 

  4. McCrum C, Williams B (1982) Spinal extradural arachnoid pouches. Rep two cases J Neurosurg 57(6):849–852

    CAS  Google Scholar 

  5. Woo JB, Son DW, Kang KT et al (2016) Spinal extradural arachnoid cyst. Korean J Neurotrauma 12(2):185–190

    Article  PubMed  PubMed Central  Google Scholar 

  6. Liu JK, Cole CD, Kan P, Schmidt MH (2007) Spinal extradural arachnoid cysts: clinical, radiological, and surgical features. Neurosurg Focus 22(2):1–5

    Article  Google Scholar 

  7. Rohrer DC, Burchiel KJ, Gruber DP (1993) Intraspinal extradural meningeal cyst demonstrating ball-valve mechanism of formation. Case report J Neurosurg 78(1):122–125

    PubMed  CAS  Google Scholar 

  8. Tokmak M, Ozek E, Iplikcioglu AC (2015) Spinal extradural arachnoid cysts: a series of 10 cases. J Neurol Surg A Cent Eur Neurosurg 76(5):348–352

    Article  PubMed  Google Scholar 

  9. Neo M, Koyama T, Sakamoto T, Fujibayashi S, Nakamura T (2004) Detection of a dural defect by cinematic magnetic resonance imaging and its selective closure as a treatment for a spinal extradural arachnoid cyst. Spine 29(19):E426–E430

    Article  PubMed  Google Scholar 

  10. Lombardi G, Morello G (1963) Congenital cysts of the spinal membranes and roots. Br J Radiol 36(423):197–205

    Article  Google Scholar 

  11. Schmutzer M, Tonn JC, Zausinger S (2020) Spinal intradural extramedullary arachnoid cysts in adults-operative therapy and clinical outcome. Acta Neurochir (Wien) 162(3):691–702

    Article  PubMed  Google Scholar 

  12. Funao H, Nakamura M, Hosogane N et al (2012) Surgical treatment of spinal extradural arachnoid cysts in the thoracolumbar spine. Neurosurgery 71(2):278–284

    Article  PubMed  Google Scholar 

  13. Gimeno A (1977) Arachnid, neurenteric, and other cyst. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology: congenital malformations of the spine and spinal. North-Holland Publishing Company, Amsterdam, pp 392–448

    Google Scholar 

  14. Nabors MW, Pait TG, Byrd EB et al (1988) Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68(3):366–377

    Article  PubMed  CAS  Google Scholar 

  15. Kumar R, Taha J, Greiner AL (1995) Herniation of the spinal cord. Case report J Neurosurg 82(1):131–136

    PubMed  CAS  Google Scholar 

  16. Qi W, Zhao L, Fang J, Chang X, Xu Y (2015) Clinical characteristics and treatment strategies for idiopathic spinal extradural arachnoid cysts: a single-center experience. Acta Neurochir (Wien) 157(3):539–545

    Article  PubMed  Google Scholar 

  17. Cho HY, Lee SH, Kim ES, Eoh W (2015) Symptomatic large spinal extradural arachnoid cyst: a case report. Korean J Spine 12(3):217–220

    Article  PubMed  PubMed Central  Google Scholar 

  18. Garg K, Borkar SA, Kale SS, Sharma BS (2017) Spinal arachnoid cysts - our experience and review of literature. Br J Neurosurg 31(2):172–178

    Article  PubMed  Google Scholar 

  19. Ogura Y, Yabuki S, Iida A et al (2013) FOXC2 mutations in familial and sporadic spinal extradural arachnoid cyst. PLoS ONE 8(11):e80548

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  20. Sangala JR, Uribe JS, Park P, Martinez C, Vale FL (2009) Nerve root prolapse into a spinal arachnoid cyst–an unusual cause of radiculopathy. Clin Neurol Neurosurg 111(5):460–464

    Article  PubMed  Google Scholar 

  21. Choi JY, Kim SH, Lee WS, Sung KH (2006) Spinal extradural arachnoid cyst. Acta Neurochir (Wien) 148(5):579–585

    Article  PubMed  CAS  Google Scholar 

  22. Krings T, Lukas R, Reul J et al (2001) Diagnostic and therapeutic management of spinal arachnoid cysts. Acta Neurochir (Wien) 143(3):227–235

    Article  PubMed  CAS  Google Scholar 

  23. Congia S, Coraddu M, Tronci S, Nurchi G, Fiaschi A (1992) Myelographic and MRI appearances of a thoracic spinal extradural arachnoid cyst of the spine with extra- and intraspinal extension. Neuroradiology 34(5):444–446

    Article  PubMed  CAS  Google Scholar 

  24. Kim KS, Weinberg PE (1986) Magnetic resonance imaging of a spinal extradural arachnoid cyst. Surg Neurol 26(3):249–252

    Article  PubMed  CAS  Google Scholar 

  25. Ball BG, Luetmer PH, Giannini C, Mokri B, Kumar N, Piepgras DG (2012) Ventral “spinal epidural meningeal cysts”–not epidural and not cysts? Case series and review of the literature. Neurosurgery 70(2):320–328

    Article  PubMed  Google Scholar 

  26. Paulsen RD, Call GA, Murtagh FR (1994) Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol 15(2):293–297

    PubMed  PubMed Central  CAS  Google Scholar 

  27. Papo I, Longhi G, Caruselli G (1977) Giant spinal extradural cyst. Surg Neurol 8(5):350–352

    PubMed  CAS  Google Scholar 

  28. Gaiser RR, Mauney DL, Imbesi SG (2002) Epidural blood patch in a patient with an arachnoid cyst. J Clin Anesth 14(1):42–45

    Article  PubMed  Google Scholar 

  29. Endo T, Takahashi T, Jokura H, Tominaga T (2010) Surgical treatment of spinal intradural arachnoid cysts using endoscopy. J Neurosurg Spine 12(6):641–646

    Article  PubMed  Google Scholar 

  30. Spiegelmann R, Rappaport ZH, Sahar A (1984) Spinal arachnoid cyst with unusual presentation. Case report J Neurosurg 60(3):613–616

    PubMed  CAS  Google Scholar 

  31. Rabb CH, McComb JG, Raffel C, Kennedy JG (1992) Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects. J Neurosurg 77(3):369–372

    Article  PubMed  CAS  Google Scholar 

  32. Pyeritz RE, Fishman EK, Bernhardt BA, Siegelman SS (1988) Dural ectasia is a common feature of the Marfan syndrome. Am J Hum Genet 43(5):726–732

    PubMed  PubMed Central  CAS  Google Scholar 

  33. Amhaz HH, Fox BD, Johnson KK et al (2009) Postlaminoplasty kyphotic deformity in the thoracic spine: case report and review of the literature. Pediatr Neurosurg 45(2):151–154

    Article  PubMed  Google Scholar 

  34. Lee HJ, Cho WH, Han IH, Choi BK (2013) Large thoracolumbar extradural arachnoid cyst excised by minimal skipped hemilaminectomy: a case report. Korean J Spine 10(1):28–31

    Article  PubMed  PubMed Central  Google Scholar 

  35. Novak L, Dobai J, Nemeth T, Fekete M, Prinzinger A, Csecsei GI (2005) Spinal extradural arachnoid cyst causing cord compression in a 15-year-old girl: a case report. Zentralbl Neurochir 66(1):43–46

    Article  PubMed  CAS  Google Scholar 

  36. Cilluffo JM, Gomez MR, Reese DF, Onofrio BM, Miller RH (1981) Idiopathic (“congenital”) spinal arachnoid diverticula. Clinical diagnosis and surgical results. Mayo Clin Proc 56(2):93–101

    PubMed  CAS  Google Scholar 

  37. Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y (2010) Huge thoracolumbar extradural arachnoid cyst excised by recapping T-saw laminoplasty. Spine J 10(11):e14–e18

    Article  PubMed  Google Scholar 

  38. Lee SH, Shim HK, Eun SS (2014) Twist technique for removal of spinal extradural arachnoid cyst: technical note. Eur Spine J 23(8):1755–1760

    Article  PubMed  Google Scholar 

  39. Nakagawa A, Kusaka Y, Jokura H, Shirane R, Tominaga T (2004) Usefulness of constructive interference in steady state (CISS) imaging for the diagnosis and treatment of a large extradural spinal arachnoid cyst. Minim Invasive Neurosurg 47(6):369–372

    Article  PubMed  CAS  Google Scholar 

  40. Epstein NE (2022) Review/perspective on the diagnosis and surgical management of spinal arachnoid cysts. Surg Neurol Int 13:98

    Article  PubMed  PubMed Central  Google Scholar 

  41. Tureyen K, Senol N, Sahin B, Karahan N (2009) Spinal extradural arachnoid cyst. Spine J 9:10–15

    Article  Google Scholar 

  42. Kong WK, Cho KT, Hong SK (2013) Spinal extradural arachnoid cyst: a case report. Korean J Spine 10:32–34

    Article  PubMed  PubMed Central  Google Scholar 

  43. Menezes AH, Hitchon PW, Blouhy BJ (2017) Symptomatic spinal extradural arachnoid cyst with cord compression in a family: case report. J Neurosurg Spine 27:341–345

    Article  PubMed  Google Scholar 

  44. Boody B, Lucasti CJ, Schroeder GD, Heller JE, Vaccaro AR (2019) Extradural arachnoid cyst excision. Clin Spine Surg 32:403–406

    Article  Google Scholar 

  45. Bowman JJ, Edwards CC (2020) Extradural arachnoid cyst with bony erosion: a rare case report. J Spine Surg 6:736–742

    Article  PubMed  PubMed Central  Google Scholar 

  46. Singh S, Bhaisora KS, Sardhara J, Kanti K, Attri G, Mehrotra A et al (2019) Symptomatic extradural spinal arachnoid cyst: more than a simple herniated sac. J Craniovertebr Junction Spine 10:64–71

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France

    Rostom Messerer, Mohammed Aldugman, Alexis Morgado & Cédric Barrey

  2. Department of Neurosurgery, Annecy Genevois Hospital, Epagny Metz-Tessy, France

    Rostom Messerer

Authors
  1. Rostom Messerer
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  2. Mohammed Aldugman
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  3. Alexis Morgado
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  4. Cédric Barrey
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Contributions

Conception and design: RM CB. Acquisition of data: RM, MA. Analysis and interpretation of data: RM, MA, AM, CB, Fung, Peterson. Drafting the article: RM, MA, AM, CB. Critically revising the article: RM, MA, CB. Reviewed submitted version of manuscript: RM, MA AM, CB. Support: Conner, RM CB. Study supervision: RM CB.

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Correspondence to Rostom Messerer.

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Messerer, R., Aldugman, M., Morgado, A. et al. Spinal extradural arachnoid cysts: a rare entity and review of the literature. Eur Spine J 33, 872–880 (2024). https://doi.org/10.1007/s00586-023-08057-w

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  • DOI: https://doi.org/10.1007/s00586-023-08057-w

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