Animated respiratory movement of a spinal intradural arachnoid cyst visualized by intraoperative ultrasonography
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This study aims to describe the animated respiratory movement of a spinal intradural arachnoid cyst visualized by intraoperative ultrasonography. A 69-year-old man with a spinal arachnoid cyst of the thoracic spine presented with gait disturbance. Magnetic resonance images showed a mild anterior displacement and flattening of the spinal cord at T4–T5. We performed ultrasonography before incision of the dura during the operation and observed the movement of the cyst consisting of not only pulsation in accordance with the cardiac cycle but also rhythmic expansion and contraction in accordance with the respiratory cycle. In the inspiratory phase, the cyst gradually expanded and pulsated in accordance with the cardiac cycle. In the expiratory phase, the cyst gradually contracted with the same pulsation. After resection of the cyst, the patient’s neurological improvements were excellent. To our knowledge, this is the first report of animated respiratory movement of a spinal arachnoid cyst visualized by intraoperative ultrasonography. Although cine magnetic resonance imaging can detect spinal intradural arachnoid cysts preoperatively, intraoperative ultrasonography is useful for close analysis of their movement and pathology. Considering the dynamic compression mechanism revealed in this study, we think that an early operation should be performed for such cysts.
KeywordsSpinal intradural arachnoid cyst Respiratory movement Pulsation Ultrasonography Thoracic spine
Source of support
No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.
This video demonstrates not only pulsation of the cyst in accordance with the cardiac cycle but also rhythmic expansion and contraction in accordance with the respiratory cycle. (MPG 5535 kb)
This video demonstrates that there was no flattening of the spinal cord and that smooth cerebrospinal fluid flow was reestablished. (MPG 3844 kb)
- 7.Sugiyama S, Hosoe H, Yamamoto T, Miyamoto K, Yoshida M, Shimizu K (2002) Pulsation and cerebrospinal fluid flow in spinal arachnoid cyst; visualization by intraoperative spinal ultrasonography [in Japanese]. Rinsho Seikei Geka 37:217–223Google Scholar