European Spine Journal

, Volume 23, Issue 8, pp 1755–1760 | Cite as

Twist technique for removal of spinal extradural arachnoid cyst: technical note

  • Sang Ho Lee
  • Hyeong Ki Shim
  • Sang Soo Eun
Ideas and Technical Innovations


Study design

We document a spinal extradual arachnoid cyst treated by twist technique. The cyst is tightly adherent to the neural tissue or the dura, and the communication stalk is little or short.


To demonstrate the effectiveness of twist technique of closure of the communication stalk for the removal of spinal extradural arachnoid cyst.

Summary of background data

The standard treatment for a spinal extradural arachnoid cyst is complete excision of the cyst, followed by obliteration of the communication stalk and repair of the dural defect. To our knowledge, twist technique of the communication stalk for removal of spinal extradural arachnoid cyst has not been reported.


A 44-year-old woman presented with a 10-year history of pain and dysesthesia, initially in the posterior neck region and extending gradually to the distal portion of the right upper extremity. Pain and dysesthesia were exaggerated when she was lying down and relieved when standing or walking. She was diagnosed with an extradural arachnid cyst ranging from spinal regions T1 to T3 using MRI. Computerized tomography myelography revealed a mass located posterior to the spinal cord. Pooling of contrast medium was observed in the lesion indicating communication with the subarachnoid space. Laminectomy of the T1–T3 region was performed, preserving the spinous processes and the facet joints. A short communication stalk was found at the proximal root sleeve of right T3. This stalk was closed using twist technique.


The patient experienced marked reduction of pain and dysesthesia after surgery, and the headache and blurred vision completely disappeared. Five days after the operation, she was discharged home in good condition. Postoperative 1 year later, the patient had completely recovered and resumed her normal life.


Twist technique can be seen safe and effective as another surgical option for spinal extradural arachnoid cysts containing a short stalk and dense fibrous adhesion with the dura mater.


Spinal extradual arachnoid cyst Dural defect Communication stalk Twist 



This study was supported by a grant from the Wooridul Spine Hospital. The authors have no personal financial or institutional interest in any of the drugs, materials, or devices in this article.

Conflict of interest



  1. 1.
    Spiegelmann R, Rappaport ZH, Sahar A (1984) Spinal arachnoid cyst with unusual presentation. case report. J Neurosurg 60:613–616. doi: 10.3171/jns.1984.60.3.0613 PubMedCrossRefGoogle Scholar
  2. 2.
    Dickson RA, Arabi K, Goodfellow J (1978) Congenital spinal extradural cyst (lateral meningocele) simulating acute transverse myelitis. report of a case. J Bone Jt Surg 60-B:412–415Google Scholar
  3. 3.
    DiSclafani A 2nd, Canale DJ (1985) Communicating spinal arachnoid cysts: diagnosis by delayed metrizamide computed tomography. Surg Neurol 23:428–430PubMedCrossRefGoogle Scholar
  4. 4.
    Fortuna A, La Torre E, Ciappetta P (1977) Arachnoid diverticula: a unitary approach to spinal cysts communicating with the subarachnoid space. Acta Neurochir (Wien) 39:259–268CrossRefGoogle Scholar
  5. 5.
    McCrum C, Williams B (1982) Spinal extradural arachnoid pouches. report of two cases. J Neurosurg 57:849–852. doi: 10.3171/jns.1982.57.6.0849 PubMedCrossRefGoogle Scholar
  6. 6.
    Di Lorenzo N, Fortuna A, Guidetti B (1982) Craniovertebral junction malformations. clinicoradiological findings, long-term results, and surgical indications in 63 cases. J Neurosurg 57:603–608. doi: 10.3171/jns.1982.57.5.0603 PubMedCrossRefGoogle Scholar
  7. 7.
    Hamamcioglu MK, Kilincer C, Hicdonmez T, Simsek O, Birgili B, Cobanoglu S (2006) Giant cervicothoracic extradural arachnoid cyst: case report. Eur Spine J 15(Suppl 5):595–598. doi: 10.1007/s00586-005-0041-4 PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Cloward RB (1968) Congenital spinal extradural cysts: case report with review of literature. Ann Surg 168:851–864PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Arseni C, Marinescu V, Nicolau S (1968) Extradural spinal arachnoid cysts. (presentations of a case and clinical considerations). Neurologia Psihiatria Neurochirurgia 13:131–139Google Scholar
  10. 10.
    Funao H, Nakamura M, Hosogane N, Watanabe K, Tsuji T, Ishii K, Kamata M, Toyama Y, Chiba K, Matsumoto M (2012) Surgical treatment of spinal extradural arachnoid cysts in the thoracolumbar spine. Neurosurgery 71:278–284. doi: 10.1227/NEU.0b013e318257bf74 PubMedCrossRefGoogle Scholar
  11. 11.
    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 77:369–372. doi: 10.3171/jns.1992.77.3.0369 PubMedCrossRefGoogle Scholar
  12. 12.
    Mao HQ, Yang HL, Geng DC, Bao ZH, Tang TS (2011) Spinal extradural arachnoid cyst following percutaneous vertebroplasty. Eur Spine J 20(Suppl 2):S206–S210. doi: 10.1007/s00586-010-1569-5 PubMedCrossRefGoogle Scholar
  13. 13.
    Endo T, Takahashi T, Jokura H, Tominaga T (2010) Surgical treatment of spinal intradural arachnoid cysts using endoscopy. J Neurosurg Spine 12:641–646PubMedCrossRefGoogle Scholar
  14. 14.
    Gaiser RR, Mauney DL, Imbesi SG (2002) Epidural blood patch in a patient with an arachnoid cyst. J Clin Anesth 14:42–45PubMedCrossRefGoogle Scholar
  15. 15.
    Kikuta K, Hojo M, Gomi M, Hashimoto N, Nozaki K (2006) Expansive duraplasty for the treatment of spinal extradural arachnoid cysts: case report. J Neurosurg Spine 4:251–255. doi: 10.3171/spi.2006.4.3.251 PubMedCrossRefGoogle Scholar
  16. 16.
    Papo I, Longhi G, Caruselli G (1977) Giant spinal extradural cyst. Surg Neurol 8:350–352PubMedGoogle Scholar
  17. 17.
    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 15:293–297 (discussion 298–299)PubMedGoogle Scholar
  18. 18.
    Ersahin Y, Yildizhan A, Seber N (1993) Spinal extradural arachnoid cyst. Childs Nerv Syst 9:250–252PubMedCrossRefGoogle Scholar
  19. 19.
    Cilluffo JM, Gomez MR, Reese DF, Onofrio BM, Miller RH (1981) Idiopathic (“congenital”) spinal arachnoid diverticula. clinical diagnosis and surgical results. Mayo Clinic Proc 56:93–101Google Scholar
  20. 20.
    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:E426–E430PubMedCrossRefGoogle Scholar
  21. 21.
    Prevo RL, Hageman G, Bruyn RP, Broere G, van de Stadt J (1999) Extended extradural spinal arachnoid cyst: an unusual cause of progressive spastic paraparesis. Clin Neurol Neurosurg 101:260–263PubMedCrossRefGoogle Scholar
  22. 22.
    Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, Rizzoli HV (1988) Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 68:366–377. doi: 10.3171/jns.1988.68.3.0366 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of NeurosurgeryWooridul Spine HospitalSeoulKorea
  2. 2.Department of Orthopedic SurgeryWooridul Spine HospitalSeoulKorea

Personalised recommendations