Lumbar synovial cyst in a adolescence: case report

Background  Spinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s. History  A 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. Magnetic resonance imaging showed a 1.1-cm extradural cystic lesion with a low signal on T1-weighted images and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemilaminectomy and excision of a synovial cyst, and the radicular pain completely regressed. Discussion  We discuss the pathogenesis, radiological techniques and management of synovial cyst in a paediatric patient Conclusion  Intraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis in patients with low back pain and radiculopathy.     

Lumbar synovial cyst in an adolescent: case report

Background  Spinal extradural cysts are a rare cause of spinal cord or nerve root compression which tends to occur in the elderly but rarely reported in the under 20s. History  A 14-year-old girl with a 9-month history of left radicular pain was found to have an intraspinal cystic lesion causing radicular compression. MRI showed a 1.1-cm extradural cystic lesion with a low signal on T1 and high signal on T2-weighted images lying in the spinal canal at the L4 vertebral body level. The patient underwent an L4 hemi-laminectomy and excision of a synovial cyst, and the radicular pain completely regressed. Discussion  We discuss the pathogenesis, radiological techniques, and management of synovial cyst in a pediatric patient. Conclusion  Intraspinal ganglion cysts are extremely rare in children and only two other cases have been reported previously. They are benign lesions, frequently presenting radiculopathy, and should be considered in the differential diagnosis, in patients with low back pain and radiculopathy.     

Bilateral Thoracic Ganglion Cyst : A Rare Case Report

Ganglion cysts usually arise from the tissues around the facet joints. It is usually associated with degenerative cahanges in facet joints. Bilateral thoracic ganglion cysts are very rare and there is no previous case that located in bilateral intervertebral foramen compressing the L1 nerve root associated with severe radiculopathy. We report a 53 years old woman who presented with bilateral groin pain and severe numbness. Magnetic resonance imaging revealed bilateral cystic mass in the intervertebral foramen between 12th thoracal and 1st lumbar vertebrae. The cystic lesions were removed after bilateral exposure of Th12-L1 foramens. The result of hystopathology confirmed the diagnosis as ganglion cyst. The ganglion cyst may compromise lumbar dorsal ganglion when it located in the intervertebral foramen. The surgeon should keep this rare entity in their mind for differential diagnosis.     

An intraneural ganglion cyst causing unilateral hypoglossal nerve palsy

Intracranial ganglion cysts are rare. We report a patient with a rare unilateral hypoglossal nerve palsy caused by an intraneural ganglion cyst. To our knowledge, there are only four reports of ganglion/synovial cysts causing unilateral hypoglossal nerve palsy. Our aim is to present the fifth report, and to compare our findings with the others.     

Acute Myelopathy Caused by a Cervical Synovial Cyst

Synovial cysts of the cervical spine, although they occur infrequently, may cause acute radiculopathy or myelopathy. Here, we report a case of a cervical synovial cyst presenting as acute myelopathy after manual stretching. A 68-year-old man presented with gait disturbance, decreased touch senses, and increased sensitivity to pain below T12 level. These symptoms developed after manual stretching 3 days prior. Computed tomography scanning and magnetic resonance imaging revealed a 1-cm, small multilocular cystic lesion in the spinal canal with cord compression at the C7-T1 level. We performed a left partial laminectomy of C7 and T1 using a posterior approach and completely removed the cystic mass. Histological examination of the resected mass revealed fibrous tissue fragments with amorphous materials and granulation tissue compatible with a synovial cyst. The patient''s symptoms resolved after surgery. We describe a case of acute myelopathy caused by a cervical synovial cyst that was treated by surgical excision. Although cervical synovial cysts are often associated with degenerative facet joints, clinicians should be aware of the possibility that these cysts can cause acute neurologic symptoms.     

Synovial excrescences and cysts of the spine: clinicopathological features and contributions to spinal stenosis

Synovial cysts occur throughout the body and are generally benign lesions with limited clinical consequences. Juxtafacet cysts of the spine, in contrast, often press on a nerve root as it exits in the foramen, causing radiculopathy. Synovial tissue that emanates from the facet joint but extends medially, is an additional important cause of spinal stenosis. Over the past 5 years, neurosurgeons at our institution have operated on a large number of patients with back pain, with removal of abnormal synovial tissues. Histological examination of these tissues distinguishes the different types of pathologic processes responsible for producing symptoms. Juxtafacet cysts may be either mucin-filled ganglion cysts devoid of cyst lining or true synovial cysts with watery content and lined by synovial cells. Ganglion cysts arise in degenerated ligament at the facet joint, and occasionally within synovial stroma. Synovial cysts arise within synovium and, unlike synovial cysts in the extremities, have a thick wall containing granulation tissue, numerous histiocytes and giant cells. This hyperplastic, irritated synovium of the spine, which we term "synovial excrescences", is voluminous and this reactive part overshadows the cystic portion of the lesion in most instances. Iron pigment deposition and inflammation are mild to absent, making synovial excrescences different from pigmented villonodular synovitis. Synovial excrescences of the spine are an important cause of spinal stenosis, predominantly in elderly patients. Surgical removal of excrescences protruding into the spinal canal provides prompt and durable relief of symptoms, usually without the need for extensive bony laminectomy or spinal fusion. Several patients in our study had both spinal ganglion cysts and synovial excrescences, suggesting common risk factors for both lesions.     

Brown-Séquard Syndrome Caused by a Cervical Synovial Cyst

Synovial cysts are recognized as an uncommon cause of radicular and myelopathic symptoms. They are most frequently found in the lumbar region. The cervical spine or cervicothoracic junction is a rare location for a degenerative intraspinal synovial cyst as compared with the lumbar spine. At given cervical spinal levels, synovial cysts probably share clinical features with disc herniation and stenosis. However, the pathogenesis of synovial cysts remains still controversial. Here, we report a rare case of a synovial cyst in the lower cervical spine presented as Brown-Séquard syndrome and include a brief review of the literature. To the best of our knowledge, no previous report has been issued in the English literature on a synovial cyst presenting with Brown-Séquard syndrome. Neurologic function recovered completely after complete removal of the cyst and expansive laminoplasty.     

显微手术治疗骶管Tarlov囊肿

目的探讨骶管Tarlov 囊肿(骶管囊肿)临床特点和手术治疗。方法回顾性分析25例有症状的骶管囊肿临床和影像学特点。结果术后早期25例中21例症状缓解。24例随访3～48个月(平均18月),囊肿未见复发。19例患者症状消失或明显改善,5例仍存在疼痛及麻木不适感,不影响生活及工作。结论对有明确症状的骶管囊肿患者应采取显微手术治疗。手术方式根据骶管囊肿的不同类型,采取囊肿交通孔结扎囊壁切除,或囊肿大部切除神经袖套塑形的方法,并采取带蒂脂肪填塞囊肿切除后遗留的残腔。     

A Ganglion Cyst in the Second Lumbar Intervertebral Foramen

Ganglion cysts usually arise from the tendon sheaths and tissues around the joints. It is usually associated with degenerative arthritic changes in older people. Ganglion cyst in the spine is rare and there is no previous report on case that located in the intervertebral foramen and compressed dorsal root ganglion associated severe radiculopathy. A 29-year-old woman presented with severe left thigh pain and dysesthesia for a month. Magnetic resonance imaging revealed a dumbbell like mass in the intervertebral foramen between second and third lumbar vertebrae on the left side. The lesion was removed after exposure of the L2-L3 intervertebral foramen. The histological examination showed fragmented cystic wall-like structure composed of fibromyxoid tissue but there was no lining epithelium. A ganglion cyst may compromise lumbar dorsal root ganglion when it located in the intervertebral foramen. Although it is very rare location, ganglion cyst should be included in the differential diagnosis for intervertebral foraminal mass lesions.     

Intraspinal synovial cyst at the craniocervical junction

A cystic lesion adjacent to the dens with compression of the lower portion of the medulla oblongata was found on MRI in a 75-year-old male patient with a 2-month history of occipital pain and gait disturbance. Clinically, the patient showed mild tetraparesis, signs of spinal ataxia and symmetrical hyperreflexia. Following subtotal removal of the cyst via left-sided suboccipital craniotomy and left-sided hemilaminectomy of C1 the lesion was classified as synovial cyst on histopathological examination. Postoperatively, the quadriparesis almost completely subsided and the patient is currently doing well, 33 months after surgery. Synovial or ganglion cysts adjacent to the atlantoaxial articulation with ventral compression of the cervicomedullar cord represent rare surgical or radiological entities. Atlantoaxial synovial cysts have no typical radiographic appearance or specific neurological symptoms so that they are frequently misdiagnosed as intraspinal- or skull base tumour, rheumatoid lesion or ectatic vertebral artery. Since no ensuing complications or recurrences have been encountered in cases of incompletely removed cysts the less invasive operative approaches should be used to avoid destabilisation and subsequent additional surgical procedures.     

Synovial cysts of the lumbar spine

Background and purposeSynovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal.Material and methodsThe retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis.ResultsSynovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients.ConclusionsSurgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.     

Ganglion cyst of the cervical spine presenting with Brown-Sequard syndrome

Ganglion cysts of the spine are uncommon. They occur mostly in the dorsolateral trunk and arise with the greatest frequency in the lumbar spine. However, they are rarely symptomatic. We report a rare case of a patient with a ganglion cyst of the lower cervical spine presenting with acute Brown-Sequard syndrome. The patient had no history of trauma. Magnetic resonance imaging of the cervical spine showed a cystic lesion connecting to the synovial joint C6-7 and compressing the posterior aspect of the spinal cord. The patient underwent emergent C6-7 laminectomy with total removal of the cyst. Neurological function recovered completely 4 months after operation. Ganglion cysts should be considered in the differential diagnosis of an extradural mass of the cervical spine. Magnetic resonance imaging provides a rapid and correct diagnosis, and laminectomy with removal of the cyst results in good neurological recovery.     

Symptomatic sacral Tarlov cyst: Case report and review of literature

Tarlov cysts are a common finding in MRI. Most of them are asymptomatic but in some cases can cause pain in urogenital region. Diagnosis and treatment are controversial and most of the symptomatic cases are not well diagnosed and treated because of unawareness of neurosurgeons about them. Treatment of symptomatic TC is effective and good results have been published with percutaneous and surgical techniques. A case of a young woman with a symptomatic sacral cyst treated surgically successfully is presented and literature about it is reviewed.     

Foraminal Synovial Cyst Associated with Ankylosing Spondylitis

Ankylosing spondylitis (AS) is frequently associated with inflammatory lesions of the spine and continuous fatigue stress fractures; however, an association with an intraspinal synovial cyst has not been previously reported. A 55-year-old man with a five year history of AS who presented with back pain and a right radiculopathy was admitted to the hospital. Five years previously, he underwent a percutaneous vertebroplasty for an osteoporotic L1 compression fracture, and was diagnosed with AS at that time. Plain radiographs showed aggravated kyphosis and a stress fracture through the ossified posterior element, below the prior vertebroplasty. Magnetic resonance images revealed a right foraminal cystic lesion at the L2-L3 level with effacement of the nerve root. A 1.6 cm cystic lesion that appeared to arise from the L2-L3 facet joint without direct communication was excised from the L2-L3 foramen. Pathological examination confirmed synovial cyst. The patient''s symptoms resolved immediately after surgery except for a mild dysesthesia of the right leg. We report herein a rare case of foraminal synovial cyst associated with AS accompanying posterior element fracture with a review of literature.     

Resolution of a synovial cyst of the lumbar spine without surgical therapy -- a case report

Synovial cysts originating from the facet joint of the lumbar spine are a rare cause of radiculopathy. Surgical resection is considered to be the treatment of choice, although very little is known about the natural history of spinal synovial cysts. Only six cases have been published up to now concerning the spontaneous regression of a cyst without invasive therapy. We present the history of a patient suffering from sciatic pain caused by a synovial cyst at the level of L4/5, and we describe the spontaneous remission of the cyst, discussing the radiological and clinical findings and comparing our findings with respect to the current literature. CLINICAL PRESENTATION: The patient suffered from sciatic pain for 5 months without neurological deficits. Magnetic resonance tomography revealed a cystic structure adjacent to the facet joint L4/5. Presuming a synovial cyst, we scheduled surgery and at the same time started conservative treatment, including physical therapy and analgesic medication. The patient's condition improved significantly during conservative treatment, so that surgery was cancelled. A second magnetic resonance tomography showed that the cyst had dramatically shrunken, without any narrowing of the spinal canal. CONCLUSIONS: Up to now, synovial cysts of the lumbar spine have usually been treated operatively, but we and others have shown that spontaneous resolution of the cyst seems possible, so that extensive conservative treatment should always be considered as the first therapeutic option, provided that there are no severe neurological deficits.     

Paraparesis caused by a bilateral cervical synovial cyst

We describe a 64-year-old man who suffered from rapidly progressive paraparesis. At operation the cervical cord of the patient was found to be displaced anteriorly due to compression caused by an epidural synovial cyst. The cyst was located bilaterally on the dorsolateral aspect of both CVII facet joints. The rapid development of paraparesis in this patient can, thus, be explained by the enlargement of the cyst on both sides of the spinal cord. After microsurgical removal of the cystic tumor, the recovery of the patient was good. Cervical epidural cysts are extremely rare, and only anecdotal cases have been reported in the literature. Among all previously described patients the present case is unique due to the bilateral location of the cyst.     

Diagnosis and surgical management of intraspinal synovial cysts: report of 19 cases

OBJECTIVE: Synovial cysts of the vertebral facet joints are a source of nerve root compression. Different surgical procedures are in use, but no consensus has been formed so far as to which method should be used in synovial cysts. To clarify the role of surgical management, the efficacy of operative procedures and factors influencing the outcome in our own series of 19 patients treated between 1994 and 1998 were analysed. METHODS: Nineteen patients with a mean age of 65 years underwent surgery for medically intractable radicular pain or neurological deficits caused by synovial cysts. The patients' records were retrospectively analysed for neurological deficits, cysts diameter, operative approach, segmental hypermobility, and clinical outcome; CT and MRI were analysed for additional degenerative changes. RESULTS: In 17 patients an excellent result and in two patients a good postoperative result was achieved. Twelve patients were found to have hypermobility of the facet joints and six had spondylolisthesis. There was no correlation between cyst diameter, operative approach, and outcome. No intraoperative or postoperative complications occurred. CONCLUSIONS: Age and hypermobility may play a part in the aetiology of facet joint synovial cysts. As all operative strategies showed equally good clinical outcome, total excision via a small flavectomy as the least invasive approach should be considered therapy of choice in patients with cysts causing neurological deficits.     

Multiple pineal cysts associated with an ependymal cyst presenting with infantile spasm

We present a unique case of infantile spasm in a patient with multiple pineal cysts associated with an ependymal cyst. Such a morphological etiology, to our knowledge, has not been described for patients with infantile spasm. Although postoperative neuroradiological studies demonstrated satisfactory surgical results, the patient continued to have seizures.     

Nerve root prolapse into a spinal arachnoid cyst—An unusual cause of radiculopathy

Arachnoid cysts are rare lesions of the spine and can present with myelopathy, radiculopathy, local pain or a combination of these symptoms. Nerve root prolapse into an arachnoid cyst causing radiculopathy has not been reported before. We report a nerve root prolapse into a spinal arachnoid cyst presenting clinically as radiculopathy. An 18-year-old female patient presented with mid-back pain, right anterior thigh pain and hip flexor weakness. Magnetic resonance imaging (MRI) and computerized tomography (CT) myelography revealed an arachnoid cyst at T12-L1 level on the right side. At surgery, a nerve root was seen prolapsing into an extradural arachnoid cyst. The nerve root was replaced back into dural sac and the dural defect closed. At 20 months of follow-up, the patient continues to be asymptomatic with no evidence of recurrence on imaging. Replacing the prolapsed nerve root into the dural sac with meticulous closure of the dural defect could lead to good clinical outcome. We propose a modification to the popular classification of these lesions to better rationalize their surgical management. Classification of extradural arachnoid spinal cysts (Nabors's type 1) should be based on the presence or absence of dural communication. Sacral meningoceles (Nabors’ type 1B) should be excluded from the classification as they have free communication with the thecal sac and are not true spinal cysts.     

Colloid cysts in children, a clinical and radiological study

Introduction Colloid cysts are uncommon in children. They occur more frequently in young adults.Methodology This is a retrospective study on all pediatric patients (≤18 years) with colloid cysts treated surgically in our institute between 1977 and 2005.Results A total of 43 patients with colloid cyst were treated surgically. Seven pediatric patients (16% of the total number of patients) were identified. Patients’ ages ranged from 6 to 18 years (mean of 14.1±4.67). They all presented clinically with symptoms and signs of increased intracranial pressure. Radiologically, the cyst size ranged from 10 to 25 mm (mean of 16.1±5.2). All patients had either diagnostic computed tomography (CT) or magnetic resonance imaging (MRI), or both. The colloid cysts appeared hyperdense on CT in five patients (83%) and isodense in one (six available studies). On MRI, all (five available studies) lesions were hyperintense on T2-weighted images. All seven patients had complete cyst resection. Either transcortical (five patients) or transcallosal approaches (two patients) was used in the surgical resection. There was no mortality. One patient developed a delayed cerebrospinal fluid leak related to hydrocephalus, and another patient developed a delayed postoperative seizure. The radiological findings supported the aggressive clinical scenario of these lesions in the pediatric group of patients.Conclusion In conclusion, colloid cysts can occur in children. They are associated with more aggressive clinical and radiological patterns. Early surgical intervention is highly recommended.