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Microsurgical fenestration of idiopathic intramedullary cysts in adult patients

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Abstract

Purpose

The aim of this study is to describe the findings in one of the largest series of microsurgically treated intramedullary cysts investigated by magnetic resonance imaging (MRI), focusing on the peri- and intraoperative setup including detailed neurological and radiological outcome analyses.

Methods

Retrospective analysis of patients with intramedullary cyst who had undergone microsurgical fenestration at our department between 2006 and 2011. Preoperative three-dimensional constructive interference of steady-state MRI was conducted to optimize surgical planning. Intraoperative electrophysiological monitoring included motor-evoked potentials, somatosensory-evoked potentials, and electromyogram. Clinical outcome as well as pre-, postoperative and long-term MRI scans were evaluated.

Results

Eight female patients (median age 58.0 years, range 32–72 years) with a median clinical follow-up of 48.0 months (range 2–69 months) were included. Seven cysts were located in the conus medullaris, one in the cervical spine. Overall, 25.0 % (2/8) showed complete remission of preoperative symptoms, 62.5 % (5/8) improved, and 12.5 % (1/8) asymptomatic patients remained unchanged. Pain syndromes (4/4) as well as motor deficits (2/2) improved in all affected patients and bladder dysfunction (3/4) displayed a high tendency for improvement. Postoperative MRI scans showed permanently decreased cyst volumes by ~80 %.

Conclusion

Microsurgical fenestration of intramedullary cysts using preoperative high-resolution imaging and intraoperative electrophysiological monitoring is a safe and effective treatment option for symptomatic patients.

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Authors and Affiliations

  1. Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany

    Christoph Schwartz, Alexander Romagna, Jörg-Christian Tonn, Stefan Zausinger & Karsten Schöller

  2. Institute of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany

    Jürgen Lutz

  3. Department of Neurosurgery, University of Giessen Medical Center, Klinikstrasse 33, 35392, Giessen, Germany

    Karsten Schöller

Authors
  1. Christoph Schwartz
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  2. Jürgen Lutz
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  3. Alexander Romagna
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  4. Jörg-Christian Tonn
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  5. Stefan Zausinger
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  6. Karsten Schöller
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Corresponding author

Correspondence to Karsten Schöller.

Additional information

C. Schwartz and J. Lutz contributed equally to this study.

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Schwartz, C., Lutz, J., Romagna, A. et al. Microsurgical fenestration of idiopathic intramedullary cysts in adult patients. Eur Spine J 24, 968–974 (2015). https://doi.org/10.1007/s00586-014-3437-1

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  • DOI: https://doi.org/10.1007/s00586-014-3437-1

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