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Neonatal anterior cervical arachnoid cyst: case report and review of the literature

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Abstract

Objective

Anterior cervical arachnoid cysts are rare in the pediatric population, with only 16 cases reported. We present the first case of an anterior cervical arachnoid cyst in a neonate and review the literature on pediatric cervical arachnoid cysts.

Clinical presentation

A 16-day-old baby girl with a history of myelomeningocele repair progressively developed symptoms of upper extremity weakness over the course of 2 weeks. Magnetic resonance imaging (MRI) demonstrated a compressive arachnoid cyst extending from C2 to C7.

Intervention

The child was taken for posterior cervical laminoplasty and cyst fenestration. Intraoperatively, diffuse cervical arachnoiditis was noted. Rapid improvement in upper extremity paresis was noted within 24 h of surgery, and MRI confirmed decompression of the cyst. However, flaccid upper extremity paresis recurred within 2 weeks. MRI confirmed recurrence of the anterior cervical arachnoid cyst. The child was taken for a secondary fenestration and stenting of the cyst. Only partial improvement in arm function was noted by 1 month following reoperation.

Conclusion

Arachnoid cysts can be effectively treated with surgical fenestration, shunting, and complete or partial excision. Rapid identification and treatment results in improvement in myelopathic symptoms; however, the most efficacious treatment modality remains unknown. Of the 17 cases of anterior cervical arachnoid cysts reported in the literature, 11 (65%) have had either prior myelomeningocele repair or a history of spinal trauma. Anterior cervical arachnoid cysts should be considered in the differential diagnosis of acute onset myelopathy in the pediatric population especially in cases with a history of spinal trauma or myelomeningocele repair.

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Acknowledgments

We thank Dr. J. Gordon McComb for helpful communications regarding this manuscript. No specific grant funding was utilized to support this work.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Meyer 8–161, 21287, Baltimore, MD, USA

    Kaisorn L. Chaichana, Matthew J. McGirt & George I. Jallo

  2. Harvard Medical School, MIT Division of Health, Science and Technology, Harvard University, Cambridge, MA, USA

    Felipe Jain

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  1. Felipe Jain
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  2. Kaisorn L. Chaichana
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  3. Matthew J. McGirt
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  4. George I. Jallo
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Correspondence to Matthew J. McGirt.

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Jain, F., Chaichana, K.L., McGirt, M.J. et al. Neonatal anterior cervical arachnoid cyst: case report and review of the literature. Childs Nerv Syst 24, 965–970 (2008). https://doi.org/10.1007/s00381-008-0612-x

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  • DOI: https://doi.org/10.1007/s00381-008-0612-x

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