Abstract
Background
To investigate characteristic clinical and radiological features of extradural arachnoid cysts (EDACs) in the thoracolumbar region, a retrospective review of medical records and imaging studies was performed. EDACs are well known but relatively rare lesions in the thoracolumbar spinal canal. The most common site is the lower thoracic spine, and it may cause neurological symptoms by compressing the spinal cord or nerve root. In this study, the pathogenesis, symptomatology, diagnostic approach, and surgical management of EDACs will be discussed.
Methods
We studied 14 consecutive patients who were surgically treated for EDACs in the thoracolumbar region at our institute between March 2000 and January 2011. The history, clinical presentations, image findings, operative findings, and surgical outcomes of these patients were retrospectively analyzed. The mean follow-up period was 28 months (range: 6–72 months).
Results
Progressive motor weakness was the predominant symptom in all patients. Nine patients had radicular leg pain and back pain in the thoracolumbar area. On MRI, the cyst compressed the dural sac and spinal cord posteriorly typically with bilateral foraminal extensions. On radiological study, a communication point with the subarachnoid was hardly observed. The surgical treatment of EDACs included complete resection of the walls and closing the communicating point with the subarachnoid space. All patients showed excellent outcomes according to Odom’s criteria without recurrence. One CSF leakage and one postoperative hematoma were noted.
Conclusions
Thoracolumbar EDAC patients presented paraparesis and leg pain. Complete excision and closing the communicating point with the subarachnoid space were the choices of treatment, and the outcomes were favorable.
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References
Agnoli AL, Schonmayr R, Laun A (1982) Intraspinal arachnoid cysts. Acta Neurochir (Wien) 61:291–302
Choi JY, Kim SH, Lee WS, Sung KH (2006) Spinal extradural arachnoid cyst. Acta Neurochir (Wien) 148:579–585, discussion 585
Cloward RB (1968) Congenital spinal extradural cysts: case report with review of literature. Ann Surg 168:851–864
Congia S, Coraddu M, Tronci S, Nurchi G, Fiaschi A (1992) Myelographic and MRI appearances of a thoracic spinal extradural arachnoid cyst of the spine with extra- and intraspinal extension. Neuroradiology 34:444–446
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 (Phila Pa 1976) 28:E229–E233
Fortuna A, La Torre E, Ciappetta P (1977) Arachnoid diverticula: a unitary approach to spinal cysts communicating with the subarachnoid space. Acta Neurochir (Wien) 39:259–268
Gray L, Djang WT, Friedman AH (1988) MR imaging of thoracic extradural arachnoid cysts. J Comput Assist Tomogr 12:646–648
Kazan S, Ozdemir O, Akyuz M, Tuncer R (1999) Spinal intradural arachnoid cysts located anterior to the cervical spinal cord. Report of two cases and review of the literature. J Neurosurg 91:211–215
Kendall BE, Valentine AR, Keis B (1982) Spinal arachnoid cysts: clinical and radiological correlation with prognosis. Neuroradiology 22:225–234
Kim KS, Weinberg PE (1986) Magnetic resonance imaging of a spinal extradural arachnoid cyst. Surg Neurol 26:249–252
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) 143:227–234, discussion 234–225
Kulkarni AG, Goel A, Thiruppathy SP, Desai K (2004) Extradural arachnoid cysts: a study of seven cases. Br J Neurosurg 18:484–488
Kumar K, Malik S, Schulte PA (2003) Symptomatic spinal arachnoid cysts: report of two cases with review of the literature. Spine (Phila Pa 1976) 28:E25–E29
Kunz U, Mauer UM, Waldbaur H (1999) Lumbosacral extradural arachnoid cysts: diagnostic and indication for surgery. Eur Spine J 8:218–222
Lesoin F, Leys D, Rousseaux M, Cama A, Jomin M, Petit H (1985) Spinal intradural arachnoid cysts. Acta Neurochir (Wien) 76:125–128
Liu H, Ishihara H, Kawaguchi Y, Abe Y, Otaya A, Sakurai S, Seki S, Kimura T (2004) Large thoracolumbar extradural arachnoid cyst. Orthopedics 27:225–226
McCrum C, Williams B (1982) Spinal extradural arachnoid pouches. Report of two cases. J Neurosurg 57:849–852
Muthukumar N (2002) Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain. Eur Spine J 11:162–166
Osenbach RK, Godersky JC, Traynelis VC, Schelper RD (1992) Intradural extramedullary cysts of the spinal canal: clinical presentation, radiographic diagnosis, and surgical management. Neurosurgery 30:35–42
Palmer JJ (1974) Spinal arachnoid cysts. Report of six cases. J Neurosurg 41:728–735
Payer M, Bruhlhart K (2011) Spinal extradural arachnoid cyst: review of surgical techniques. J Clin Neurosci 18:559–560
Perret G, Green D, Keller J (1962) Diagnosis and treatment of intradural arachnoid cysts of the thoracic spine. Radiology 79:425–429
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 101:260–263
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
Rohrer DC, Burchiel KJ, Gruber DP (1993) Intraspinal extradural meningeal cyst demonstrating ball-valve mechanism of formation. Case report. J Neurosurg 78:122–125
Stern WE (1988) Dural ectasia and the Marfan syndrome. J Neurosurg 69:221–227
Teng P, Papatheodorou C (1966) Spinal arachnoid diverticula. Br J Radiol 39:249–254
Conflicts of interest
This study was supported by a grant from the National Research Foundation in Korea funded by the Ministry of Education, Science and Technology (2010K001350)
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Comment
The authors present a nice case series of patients with extradural arachnoid cysts. The patients were well treated and overall did well. The images are high quality and illustrate the pathology well.
Daniel Resnick
Wisconsin, USA
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Oh, J.K., Lee, D.Y., Kim, T.Y. et al. Thoracolumbar extradural arachnoid cysts: a study of 14 consecutive cases. Acta Neurochir 154, 341–348 (2012). https://doi.org/10.1007/s00701-011-1110-6
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DOI: https://doi.org/10.1007/s00701-011-1110-6