Spinal Arachnoid Cyst in Children

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Wihasto Suryaningtyas
Keyword(s):  
Arachnoid Cyst ◽  
Nerve Root ◽  
Financial Burden ◽  
Trauma Surgery ◽  
Arachnoid Cysts ◽  
History Of ◽  
Spinal Arachnoid Cyst ◽  
Intradural Arachnoid Cysts ◽  
Nerve Root Involvement

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.

Spinal Arachnoid Cyst in Children

2018 ◽  
Vol 1 (2) ◽  
pp. 25
Author(s):  
Wihasto Suryaningtyas
Keyword(s):  
Arachnoid Cyst ◽  
Nerve Root ◽  
Financial Burden ◽  
Trauma Surgery ◽  
Arachnoid Cysts ◽  
History Of ◽  
Spinal Arachnoid Cyst ◽  
Intradural Arachnoid Cysts ◽  
Nerve Root Involvement

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel. 

Syringomyelia associated with intradural arachnoid cysts

2006 ◽  
Vol 5 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Strategies ◽  
Tethered Cord ◽  
Arachnoid Cysts ◽  
Cavity Size ◽  
Neurological Improvement ◽  
Arm Pain ◽  
History Of ◽  
Intradural Arachnoid Cysts

Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.

scholarly journals Syringomyelia associated with intradural arachnoid cysts

2007 ◽  
Vol 22 (2) ◽  
pp. 111-116
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Strategies ◽  
Tethered Cord ◽  
Arachnoid Cysts ◽  
Cavity Size ◽  
Neurological Improvement ◽  
Arm Pain ◽  
History Of ◽  
Intradural Arachnoid Cysts

Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.

Management of complex giant spinal arachnoid cysts presenting with myelopathy

2011 ◽  
Vol 15 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Sunil V. Furtado ◽  
Sumit Thakar ◽  
Ganesh K. Murthy ◽  
Ravi Dadlani ◽  
Alangar S. Hegde
Keyword(s):  
Surgical Management ◽  
Arachnoid Cyst ◽  
Spastic Paraparesis ◽  
Arachnoid Cysts ◽  
Complex Nature ◽  
Radical Excision ◽  
Dural Defect ◽  
Spinal Arachnoid Cyst ◽  
Postoperative Instability

A giant spinal arachnoid cyst is an unusual cause of progressive epidural compressive syndrome. The authors describe 4 cases of a “complex” subtype of this lesion and discuss aspects of surgical management. The patients presented with progressive spastic paraparesis and were found to harbor extensive spinal extradural arachnoid cysts with multiple septations and significant paraspinal extensions. Extensive laminotomy and excision of the cyst along with its extensions were performed in all cases. Compared with previously indexed cases of surgically managed extensive spinal extradural arachnoid cysts, the cases reported here are unique because of their complex nature. Curative treatment consists of radical excision inclusive of the paraspinal extensions as well as closure of a dural defect, if found. A laminotomy or laminoplasty should be performed to avoid postoperative instability related to the extensive exposure. Extended follow-up and instrumentation may be required in select cases.

A sacral arachnoid cyst causing holocord syringomyelia

2011 ◽  
Vol 8 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Sumit Thakar ◽  
Narayanam Anantha Sai Kiran ◽  
Alangar S. Hegde
Keyword(s):  
Mr Imaging ◽  
Arachnoid Cyst ◽  
Complete Resolution ◽  
Spastic Paraparesis ◽  
Arachnoid Cysts ◽  
Sensory Loss ◽  
Low Back ◽  
Filum Terminale ◽  
Sensory Deficits

Spinal extradural arachnoid cysts (ACs) have an infrequent predilection for the sacrum. As with their counterparts in other regions of the spine, cysts in this location are mostly asymptomatic. Common presentations in symptomatic cases include pain in the low back or perineum, radiculopathy, and sphincteric dysfunction. The authors report a hitherto undescribed presentation in which the predominant symptoms are those related to an associated holocord syrinx. This 15-year-old boy presented with fluctuating, spastic paraparesis and a dissociated sensory loss in the trunk. Admission MR imaging of the spine showed an extradural AC from S-2 to S-4 and a holocord, nonenhancing syrinx. The patient underwent S-2 laminectomy, fenestration of the cyst, and partial excision of its wall. Intradural exploration revealed a normal-looking filum terminale and the absence of any dural communication with the cyst. At a follow-up visit 6 months after surgery, his motor and sensory deficits had resolved. Follow-up MR imaging showed complete resolution of the syrinx in the absence of the sacral AC. This is the first report of a sacral extradural AC causing holocord syringomyelia. Because conventional theories of syrinx formation were not helpful in elucidating this case, a hypothesis is postulated to explain the clinicoradiological oddity.

Spinal Intradural Juxtamedullary Cysts in the Adult: Surgical Management and Outcome

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1352-1360 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Uwe Hübschen ◽  
Hermann-Josef König ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Management ◽  
Nerve Root ◽  
Pain Syndrome ◽  
Radicular Pain ◽  
Arachnoid Cysts ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Neuroepithelial Cysts

Abstract OBJECTIVE: Intradural nonneoplastic cysts compressing the spinal cord are rare lesions. We retrospectively analyzed a series of patients harboring this entity with regard to clinical and radiological features, surgical management, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, radiological investigations, and follow-up data of 11 women and 10 men (mean age, 43.6 yr) with intradural juxtamedullary spinal cysts, which were consecutively treated microsurgically at our institutions between January 1995 and January 2003. All lesions were approached via a laminectomy, hemilaminectomy, or laminoplasty at the corresponding vertebral levels and histopathologically verified. The patients were routinely scheduled for clinical follow-up 2 and 6 months after surgery. Baseline postoperative magnetic resonance imaging (MRI) was ordered 6 months after surgery. Thereafter, follow-up was performed at 1-year intervals, with neurological examination and MRI. RESULTS: According to presenting symptomatology, two main patient groups could be differentiated: one group with a myelopathic syndrome (10 patients) and another group with a predominant radicular pain syndrome (8 patients). Histopathological examination revealed 16 arachnoid cysts, 4 neuroepithelial cysts, and 1 cervical nerve root cyst. Most arachnoid cysts (12 cases) were located on the dorsal aspect of the thoracic spinal cord. The mean craniocaudal extension of these cysts was 3.7 vertebral levels, and complete resection was performed. In four patients, the arachnoid cyst was situated ventral to the spinal cord and involved up to 17 vertebral levels. These patients had a history of major spinal trauma, and the cyst was generously fenestrated at its greatest circumference as depicted on preoperative MRI scans. The four neuroepithelial cysts and the cervical nerve root cyst were located on the ventral or ventrolateral aspect of the spinal cord, and their maximum sagittal extension was two spinal vertebral levels. Symptoms in all but two patients demonstrated major improvement; in particular, radiating pain disappeared immediately after surgery. There was no cyst recurrence on MRI after a mean follow-up period of 3.2 years. CONCLUSION: Intradural cysts should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts with large craniocaudal extensions effectively ameliorated patients' symptomatology. A description of the first documented case of a surgically treated intradural cervical nerve root cyst is provided.

Surgical treatment of laterally ruptured cervical disc

1973 ◽  
Vol 38 (6) ◽  
pp. 679-683 ◽  
Author(s):  
Francis Murphey ◽  
James C. H. Simmons ◽  
Bruce Brunson
Keyword(s):  
Nerve Root ◽  
Cervical Disc ◽  
Root Pressure ◽  
Content Type ◽  
Arm Pain ◽  
Follow Up Study ◽  
History Of ◽  
Neurosurgical Operation ◽  
Better Than

✓ From the analysis of 648 patients operated on for ruptured cervical discs between 1939 and March of 1972 and a follow-up study of 380 of these patients, the following conclusions seem justified. Osteophytes or hypertrophic spurs rarely produced the classical clinical picture or deficits. Ninety per cent of the patients awakened in the morning with pain in the neck and rhomboid region. Ten per cent had a history of injury, but there was no characteristic pattern as in lumbar discs. Only one patient had a typical hyperextension injury. Anterior chest pain occurred in one-fifth of the cases. Pain in the neck, rhomboid region, and anterior chest was referred from the discs, while the arm pain was usually the result of nerve root compression; however, in a few cases the degenerating disc caused referred pain to the arm without any nerve root pressure. Since accurate diagnosis can be made on clinical grounds, myelography is not necessary in most cases. In our experience conservative treatment was usually unsuccessful while the surgical results were better than in almost any other neurosurgical operation. The nerve root syndromes associated with extruded lateral cervical discs are outlined and the indications and contraindications for myelography discussed.

Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts

2011 ◽  
Vol 7 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Todd D. Vogel ◽  
Abdul A. Baker ◽  
Neal B. Patel ◽  
Laurie L. Ackerman ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Morbidity Rate ◽  
Initial Symptom ◽  
Salvage Procedure ◽  
The Third ◽  
First Line Therapy ◽  
Posterior Fossa Cyst

Object The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods The authors performed a retrospective review of 79 consecutive patients (1993–2010) with surgically treated intracranial arachnoid cysts. Results The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions Posterior fossa cyst–ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.

scholarly journals Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 256-259 ◽  
Author(s):  
Saleh Baeesa ◽  
Abdalrahman Aljameely
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Benign Lesions ◽  
Clinical And Radiological Results

AbstractIntramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up.Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

Microsurgical Keyhole Approach for Middle Fossa Arachnoid Cyst Fenestration

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1138-1145 ◽  
Author(s):  
Michael L. Levy ◽  
Michael Wang ◽  
Henry E. Aryan ◽  
Kevin Yoo ◽  
Hal Meltzer
Keyword(s):  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Treatment Modalities ◽  
Middle Fossa ◽  
Imaging Studies ◽  
Cyst Size ◽  
Serial Imaging ◽  
Keyhole Approach ◽  
Cyst Fenestration

Abstract OBJECTIVE The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to provide a baseline for comparisons of the efficacies of other treatment modalities. METHODS A retrospective review of data for 50 children who underwent keyhole craniotomy for fenestration of temporal arachnoid cysts between 1994 and 2001 was performed after institutional review board approval. During that period, the first-line treatment for all symptomatic middle fossa arachnoid cysts was microcraniotomy for fenestration. Microsurgical dissection to create communications between the cyst cavity and basal cisterns was the goal. All patient records were reviewed and numerous variables related to presentation, cyst size and classification, treatment, cyst resolution, symptom resolution, follow-up periods, and cyst outcomes were recorded. RESULTS Fifty temporal arachnoid cysts in 50 treated patients were identified. The average age at the time of surgery was 68 ± 57.2 months. The follow-up periods averaged 36 months. There were 34 male and 16 female patients in the series. Twenty-six cysts were on the left side. Indications for surgery included intractable headaches (45%), increasing cyst size (21%), seizures (25%), and hemiparesis (8%). The symptoms most likely to improve were hemiparesis (100%) and abducens nerve palsies. Headaches (67%) and seizure disorders (50%) were less likely to improve. Nine patients exhibited progressive increases in cyst size in serial imaging studies. Those patients were monitored for a mean of 40 ± 23 months before intervention. In the entire series, 82% of patients demonstrated decreases in cyst size in serial imaging studies. Of those patients, 18% demonstrated complete cyst effacement. Overall, 83% of patients with Grade II cysts and 75% of patients with Grade III cysts exhibited evidence of decreases in cyst size in long-term monitoring. Two patients required shunting after craniotomy (4%). Hospital stays averaged 3.4 days. Total surgical times averaged 115 minutes. No significant blood loss occurred (5–50 ml). Complications included spontaneously resolving pseudomeningocele (10%), transient Cranial Nerve III palsy (6%), cerebrospinal fluid leak (6%), subdural hematoma (4%), and wound infection (2%). CONCLUSION A microsurgical keyhole approach to arachnoid cyst fenestration is a safe effective method for treating middle fossa cysts. This procedure can be performed with minimal morbidity via a minicraniotomy. Compared with an endoscopic approach, better control of hemostasis can be obtained, because of the ability to use bipolar forceps and other standard instruments. The operative time and length of hospital stay were not excessively increased.

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