A Rare Cause of Thoracic Spinal Cord Compression by Multiple Large Tarlov Cysts / 대한신경손상학회지

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.

Digital Subtraction Cystography for Detection of Communicating Holes of Spinal Extradural Arachnoid Cysts

OBJECTIVE: The purpose of this study was to demonstrate the usefulness of digital subtraction cystography to identify communicating holes between a spinal extradural arachnoid cyst (SEAC) and the subarachnoid space prior to cyst removal and hole closure. MATERIALS AND METHODS: Six patients with SEAC were enrolled in this retrospective study. Digital subtraction cystography and subsequent CT myelography were performed for every patient. The presence and location of the communicating holes on cystography were documented. We evaluated the MRI characteristics of the cysts, including location, size, and associated spinal cord compression; furthermore, we reviewed cystographic images, CT myelograms, procedural reports, and medical records for analysis. If surgery was performed after cystography, intraoperative findings were compared with preoperative cystography. RESULTS: The location of the communicating hole between the arachnoid cyst and the subarachnoid space was identified by digital subtraction cystography in all cases (n = 6). Surgical resection of SEAC was performed in 4 patients, and intraoperative location of the communicating hole exactly corresponded to the preoperative identification. CONCLUSION: Fluoroscopic-guided cystography for SEAC accurately demonstrates the presence and location of dural defects. Preoperative digital subtraction cystography is useful for detection of a communicating hole between a cyst and the subarachnoid space.

Surgical Treatment of Spinal Extradural Arachnoid Cyst: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a case of spinal extradural arachnoid cyst. SUMMARY OF LITERATURE REVIEW: Extradural arachonid cysts of the spine are a rare cause of spinal cord and nerve root compression. There are few reports about it, and the etiology remains unclear. MATERIALS AND METHODS: The authors performed a clinical and radiographic case review. RESULTS: A 56-year-old male patient presented with both lower extremity radiating pain and tingling sensation in both feet for four years. His MRI revealed a large, well-demarcated extradural lesion, isointense to cerebrospinal fluid from L1 to L3. We performed dural repair and laminectomy for partial resection of the cyst. The outcome was good in the immediate postoperative period, and the patient made a full recovery without complications. CONCLUSIONS: Surgical treatment should be considered for large spinal extradural arachnoid cysts with neurologic symptoms when conservative treatment does not work.

Spinal Extradural Arachnoid Cyst: A Case Report

Spinal arachnoid cyst is a rare cause of myelopathy secondary to spinal cord compression. We report a case presenting extradural arachnoid cyst of probable traumatic origin leading to irreversible neurological deficits including paraparesis and neurogenic bladder. The patient presented progressive paraparesis and voiding difficulty. Magnetic resonance imaging (MRI) of the spine revealed long segmental cystic lesion of cerebrospinal fluid (CSF) signal intensity at dorsal extramedullary space of T11 to L3 level suggesting arachnoid cyst with diffuse cord compression. On the operation, an ovoid shaped dural defect was identified at right sided dorsolateral aspect of the dura mater between nerve root sleeves at T11 and T12 level. The patient was treated by microsurgical repair of the dural defect and intraoperative findings revealed no further leakage of CSF. The neurological status of the patient was stationary on follow-up examination postoperatively. We postulate that delayed-onset post-traumatic extradural arachnoid cyst should be taken into consideration on the differential diagnosis of intrapinal cysts.

Retroperitoneal Spinal Extradural Arachnoid Cyst Combined with Congenital Hemivertebrae

Spinal extradural arachnoid cysts usually cause symptoms related to spinal cord or nerve root compression. Here, we report an atypical presentation of a spinal extradural arachnoid cyst combined with congenital hemivertebra which was presented as a retroperitoneal mass that exerted mass effects to the abdominal organs. On image studies, the communication between the cystic pedicle and the spinal arachnoid space was indistinct. Based on our experience and the literature of the pathogenesis, we planned anterior approach for removal of the arachnoid cyst in order to focus on mass removal rather than ligation of the fistulous channel. In our estimation this was feasible considering radiologic findings and also essential for the symptom relief. The cyst was totally removed with the clogged 'thecal sac-side' end of the cystic pedicle. The patient was free of abdominal discomfort by one month after the surgery.

Septated Extradural Arachnoid Cyst in Thoracolumbar Spine Causing Myelopathy

Spinal extradural arachnoid cyst is uncommon and rarely cause neural compression. We report a rare case of severe cord compression due to septated spinal extradural arachnoid cyst. A 35-year-old woman has developed back pain 3 months prior to her visit, but recently motor weakness and urinary incontinence occurred. Magnetic resonance images showed an extradural cyst posterior to the cord, which was flattened and displaced from T12 to L2. Urgent decompressive laminectomy and cyst removal was performed. Histopathological examination confirmed that cyst wall was formed by nonspecific fibrous connective tissue without a single-cell layer of inner arachnoid lining. Motor weakness and voiding difficulty were recovered completely after operation.

Retroperitoneal Hematoma after Excision of Lumbar Extradural Arachnoid Cyst: Case Report

Many cases of retroperitoneal hematoma related to spine surgery have been reported, however, most of them were caused by major vessel injury related to intradiscal or retroperitoneal procedures. We report an unusual case of a retroperitoneal hematoma followed by surgical excision of the lumbar extradural arachnoid cyst without intradiscal procedure. To our best knowledge, this complication without intradiscal procedure has not been described previoulsly. The pathogenetic mechanism of retroperitoneal hematoma in this report is unclear. We discuss the plausible pathophysiological mechanisms of retroperitoneal hematoma which developed after excision of arachnoid cyst.