Acta Neurochirurgica

, Volume 152, Issue 7, pp 1245–1249 | Cite as

Pulsatile wall movement of spinal arachnoid cyst deteriorates spinal cord symptoms: report of three cases

  • Takeo BabaEmail author
  • Izumi Koyanagi
  • Kazuhisa Yoshifuji
  • Tomohiro Murakami
  • Kiyohiro Houkin
Case Report



Symptomatic spinal arachnoid cyst is a rare disease and the pathophysiology causing spinal cord symptoms has not been well clarified.

Patients and methods

The authors report three symptomatic cases of spinal arachnoid cyst at the thoracic level. These patients, aged from 70 to 73 years, showed progressive gait disturbance for a few months before admission. Phase-contrast cine magnetic resonance imaging demonstrated significant compression at the rostral side of the cyst during the diastolic phase of the cardiac cycle. Intraoperative ultrasonography demonstrated that the maximum expansion of the cyst and compression of the dorsal spinal cord occurred when the cerebrospinal fluid moved rostrally during diastole. All patients showed good improvement of their symptoms after surgical removal of the arachnoid cyst.


This report proposes the pathophysiology that the pulsatile enlargement of the arachnoid cyst during diastolic cardiac phase can be an important factor for deterioration of spinal cord symptoms.


Cardiac cycle Cerebrospinal fluid Cine magnetic resonance imaging Spinal arachnoid cyst Ultrasonography 

Supplementary material

Movie 1

(MPG 3034 kb)

Movie 2

(MPG 2419 kb)


  1. 1.
    Abou-Fakhr FS, Kanaan SV, Youness FM, Hourani MH, Haddad MC (2002) Thoracic spinal intradural arachnoid cyst: report of two cases and review of the literature. Eur Radiol 12:877–882CrossRefPubMedGoogle Scholar
  2. 2.
    Agnoli AL, Schonmayr R, Laun A (1982) Intraspinal arachnoid cysts. Acta Neurochir (Wien) 61:291–302CrossRefGoogle Scholar
  3. 3.
    Brodbelt AR, Stoodley MA (2003) Syringomyelia and the arachnoid web. Acta Neurochir 145:707–711CrossRefGoogle Scholar
  4. 4.
    Dietemann JL, Filippi de la Palavesa MM, Kastler B, Warter JM, Buchheit F (1991) Thoracic intradural arachnoid cyst: possible pitfalls with myelo-CT and MR. Neuroradiology 33:90–91CrossRefPubMedGoogle Scholar
  5. 5.
    Doita M, Nishida K, Miura J, Takada T, Kurosaka M, Fujii M (2003) Kinematic magnetic resonance imaging of a thoracic spinal extradural arachnoid cyst: an alternative suggestion for exacerbation of symptoms during straining. Spine 28:E229–E233CrossRefPubMedGoogle Scholar
  6. 6.
    Fortuna A, Mercuri S (1983) Intradural spinal cysts. Acta Neurochir (Wien) 68:289–314CrossRefGoogle Scholar
  7. 7.
    Fujimura M, Tominaga T, Koshu K, Shimizu H, Yoshimoto T (1996) Cine-mode magnetic resonance imaging of a thoracic intradural arachnoid cyst: case report. Surg Neurol 45:533–536CrossRefPubMedGoogle Scholar
  8. 8.
    Holly LT, Batzdorf U (2006) Syringomyelia associated with intradural arachnoid cysts. J Neurosurg Spine 5:111–116CrossRefPubMedGoogle Scholar
  9. 9.
    Krings T, Lukas R, Reul J, Spetzger U, Reinges MH, Gilsbach JM, Thron A (2001) Diagnostic and therapeutic management of spinal arachnoid cysts. Acta Neurochir (Wien) 143:227–235CrossRefGoogle Scholar
  10. 10.
    Kumar K, Malik S, Schulte PA (2003) Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine 28:E25–E29CrossRefPubMedGoogle Scholar
  11. 11.
    Lee TT, Alameda GJ, Camilo E, Green BA (2001) Surgical treatment of post-traumatic myelopathy associated with syringomyelia. Spine 26:S119–S127CrossRefPubMedGoogle Scholar
  12. 12.
    Lesoin F, Rousseau M, Thomas CE 3rd, Jomin M (1984) Post traumatic spinal arachnoid cysts. Acta Neurochir (Wien) 70:227–234CrossRefGoogle Scholar
  13. 13.
    Nauta HJ, Dolan E, Yasargil MG (1983) Microsurgical anatomy of spinal subarachnoid space. Surg Neurol 19:431–437CrossRefPubMedGoogle Scholar
  14. 14.
    Palmer JJ (1974) Spinal arachnoid cysts. Report of six cases. J Neurosurg 41:728–735CrossRefPubMedGoogle Scholar
  15. 15.
    Perret G, Green D, Keller J (1962) Diagnosis and treatment of intradural arachnoid cysts of the thoracic spine. Radiology 79:425–429PubMedGoogle Scholar
  16. 16.
    Shimizu H, Tominaga T, Takahashi A, Yoshimoto T (1997) Cine magnetic resonance imaging of spinal intradural arachnoid cysts. Neurosurgery 41:95–100CrossRefPubMedGoogle Scholar
  17. 17.
    Sklar E, Quencer RM, Green BA, Montalvo BM, Post MJ (1989) Acquired spinal subarachnoid cysts: evaluation with MR, CT myelography, and intraoperative sonography. Am J Roentgenol 153:1057–1064Google Scholar
  18. 18.
    Tumialán LM, Cawley CM, Barrow DL (2005) Arachnoid cyst with associated arachnoiditis developing after subarachnoid hemorrhage. Case report. J Neurosurg 103:1088–1091CrossRefPubMedGoogle Scholar
  19. 19.
    Valls PL, Naul LG, Kanter SL (1990) Paraplegia after a routine lumbar laminectomy: report of a rare complication and successful management. Neurosurgery 27:638–640CrossRefPubMedGoogle Scholar
  20. 20.
    Wang MY, Levi AD, Green BA (2003) Intradural spinal arachnoid cysts in adults. Surg Neurol 60:49–55CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Takeo Baba
    • 1
    Email author
  • Izumi Koyanagi
    • 2
  • Kazuhisa Yoshifuji
    • 3
  • Tomohiro Murakami
    • 2
  • Kiyohiro Houkin
    • 2
  1. 1.Department of NeurosurgeryShinsapporo Neurosurgical HospitalSapporoJapan
  2. 2.Department of NeurosurgerySapporo Medical University, School of MedicineSapporoJapan
  3. 3.Department of NeurosurgeryHokkaido Medical Center for Child Health and RehabilitationSapporoJapan

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