Child's Nervous System

, Volume 29, Issue 4, pp 657–664 | Cite as

Operative management of idiopathic spinal intradural arachnoid cysts in children: a systematic review

  • Petros Evangelou
  • Jürgen Meixensberger
  • Matthias Bernhard
  • Wolfgang Hirsch
  • Wieland Kiess
  • Andreas Merkenschlager
  • Ulf Nestler
  • Matthias Preuss
Original Paper
First Online:
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Accepted:

Abstract

Background

Spinal intradural arachnoid cysts are rare with only a few patients reported so far. Idiopathic, traumatic, posthemorrhagic, and postinflammatory causes have been reported in the literature. Especially, idiopathic lesions, in which other possible etiological factors have been ruled out, seem to be rare.

Patients and Methods

We systematically reviewed the literature in regards to localization within the spinal canal, treatment options, complications, and outcome. Additionally, we present management strategies in two progressively symptomatic children less than 3 years of age with idiopathic intradural arachnoid cysts.

Results

In total, 21 pediatric cases including the presented cases have been analyzed. Anterior idiopathic spinal arachnoid cysts are predominantly located in the cervical spine in 87.5 % of all cases, whereas posterior cysts can be found at thoracic and thoracolumbar segments in 84.6 % of the patients. Most children presented with motor deficits (76.2 %). Twenty-five percent of anterior spinal arachnoid cysts caused back pain as the only presenting symptom. Open fenestration by a dorsal approach has been used in the vast majority of cases. No major surgical complications have been reported. Ninety-four percent of all patients did improve or showed no neurological deficits. Recurrence rate after successful surgical treatment was low (9.5 %).

Conclusion

Idiopathic spinal intradural arachnoid cysts can present with neurological deficits in children. Pathologies are predominantly located in the cervical spine anteriorly and in thoracic and thoracolumbar segments posteriorly to the spinal cord. In symptomatic cases, microsurgical excision and cyst wall fenestration via laminotomy are recommended. Our radiological, intraoperative, and pathological findings support the cerebrospinal fluid obstruction and vent mechanism theory of arachnoid cysts.

Keywords

Idiopathic spinal arachnoid cyst Intradural arachnoid cyst Spinal CSF circulation obstruction 
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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Petros Evangelou
    • 1
  • Jürgen Meixensberger
    • 1
  • Matthias Bernhard
    • 2
  • Wolfgang Hirsch
    • 3
  • Wieland Kiess
    • 4
  • Andreas Merkenschlager
    • 2
  • Ulf Nestler
    • 1
  • Matthias Preuss
    • 1
  1. 1.Department of Neurosurgery, Pediatric NeurosurgeryUniversity Hospital LeipzigLeipzigGermany
  2. 2.Division of NeuropediatricsUniversity Hospital LeipzigLeipzigGermany
  3. 3.Division of Pediatric RadiologyUniversity Hospital LeipzigLeipzigGermany
  4. 4.Department of Children’s and Adolescence HealthUniversity Hospital LeipzigLeipzigGermany

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