Spinal Extradural Arachnoid Cyst

Spinal extradural arachnoid cyst (SEAC) is a rare disease and uncommon cause of compressive myelopathy. The etiology remains still unclear. We experienced 2 cases of SEACs and reviewed the cases and previous literatures. A 59-year-old man complained of both leg radiating pain and paresthesia for 4 years. His MRI showed an extradural cyst from T12 to L3 and we performed cyst fenestration and repaired the dural defect with tailored laminectomy. Another 51-year-old female patient visited our clinical with left buttock pain and paresthesia for 3 years. A large extradural cyst was found at T1-L2 level on MRI and a communication between the cyst and subarachnoid space was illustrated by CT-myelography. We performed cyst fenestration with primary repair of dural defect. Both patients'' symptoms gradually subsided and follow up images taken 1-2 months postoperatively showed nearly disappeared cysts. There has been no documented recurrence in these two cases so far. Tailored laminotomy with cyst fenestration can be a safe and effective alternative choice in treating SEACs compared to traditional complete resection of cyst wall with multi-level laminectomy.     

Extradural arachnoid cysts in children

Background Extradural arachnoid cysts in the spine are uncommon causes of spinal cord compression in the pediatric population that are thought to arise from congenital defects in the dura mater. Most reports describe such cysts as communicating with the intrathecal subarachnoid space through a small defect in the dura. Excision of the cyst with obliteration of the communicating dural defect is the mainstay of treatment in symptomatic patients. Solitary extradural arachnoid cysts have been reported in several studies, but multiple extradural arachnoid cysts are very rarely reported in children. Materials and methods The authors report a case of multiple extradural spinal arachnoid cysts in a 14-year-old boy who presented progressive lower extremity weakness, myelopathy, and severe gait ataxia. Magnetic resonance (MR) of the spine demonstrated four extradural arachnoid cysts extending from T-1 to T-9. The patient underwent a thoracic laminoplasty for en bloc resection of the spinal extradural arachnoid cysts. Postoperatively, the patient’s motor strength and ambulation improved immediately. Conclusions Multiple spinal extradural arachnoid cysts are rarely reported in the literature. Excision of the cysts at the spinal cord level leads to a favorable outcome.     

Syringomyelia Associated with a Spinal Arachnoid Cyst

While syringomyelia is not a rare spinal disorder, syringomyelia associated with a spinal arachnoid cyst is very unusual. Here, we report a 62-year-old man who suffered from gait disturbance and numbness of bilateral lower extremities. Spinal magnetic resonance imaging (MRI) showed the presence of a spinal arachnoid cyst between the 7th cervical and 3rd thoracic vertebral segment and syringomyelia extending between the 6th cervical and 1st thoracic vertebral segment. The cyst had compressed the spinal cord anteriorly. Syringomyelia usually results from lesions that partially obstruct cerebrospinal fluid flow. Therefore, we concluded that the spinal arachnoid cyst was causing the syringomyelia. After simple excision of the arachnoid cyst, the symptoms were relieved. A follow-up MRI demonstrated that the syringomyelia had significantly decreased in size after removal of the arachnoid cyst. This report presents an unusual case of gait disturbance caused by syringomyelia associated with a spinal arachnoid cyst.     

脑电监测颅内蛛网膜囊肿继发癫(癎)的显微外科治疗

目的:探讨颅内蛛网膜囊肿(IAC)与癫癎的关系以及显微外科治疗方法。方法:应用脑电监测对颅内IAC伴癫癎的26例患者进行显微手术治疗。均行颅内IAC切除,致灶局限于脑非功能区者行致灶切除;致灶局限于脑功能区行灶区皮质热灼术。结果:26例患者中完全不发作者11例,显著改善者10例,无变化者5例。结论:颅内IAC可引起癫癎,显微手术切除IAC的同时,应用脑电监测行致灶切除和(或)皮质热灼术,对IAC伴癫癎患者的治疗较为理想。     

Spinal Extradural Meningeal Cyst in Klippel-Trenaunay Syndrome

A case of a symptomatic spinal extradural meningeal cyst (SEMC) in Klippel-Trenaunay syndrome (KTS) is introduced. A 38-year-old woman presented with right L2 radiculopathy. She underwent operations for varicose veins in both her lower extremities. She had port-wine nevi on her trunk and extremities. The edematous change in both legs had waxed and waned. Magnetic resonance imaging showed an 11.8×13 mm extradural meningeal cyst growing through the intervertebral foramen in L2-3. Multiple meningeal cysts were located in the dorsal aspect of the spinal cord from T3 to T10. A 5.8×6.2 mm cyst was also found in left pleural cavity. The extradural meningeal cyst was completely excised and the preoperative symptom was improved. KTS is a congenital disorder due to a mesodermal abnormality, which may predispose the dura to weakness. The SEMC may occur through the dural defect or weakened point.     

Technical Considerations to Prevent Postoperative Endocrine Dysfunction after the Fenestration of Suprasellar Arachnoid Cyst

Objective

The endocrine dysfunction after the operation for suprasellar arachnoid cysts is not rare. The careful operation to prevent structures can prevent this complication, but it is not enough and effective to prevent it. Authors present technical surgical considerations to prevent this complication with a review of our suprasellar arachnoid cyst patients who had postoperative endocrine dysfunction.

Methods

From January 2002 to December 2009, eight patients who had suprasellar arachnoid cysts with visual impairment underwent surgery. The mean age was 57.1 years (range, 33-77). Preoperatively, their endocrine function was clinically normal, and laboratory hormonal levels were within normal ranges. Cyst fenestration was performed by craniotomy (n=6) or by a neuro-endoscopic procedure (n=2), and, simultaneously, along with a cyst wall biopsy.

Results

The surgery was uneventful in all eight patients, and there were no neurological morbidities. However, in four patients, endocrine dysfunction occurred postoperatively. We compared these four patients (group A) to the other 4 patients without endocrine dysfunction (group B) with intraoperative findings and with the histopathological findings of the cyst wall biopsy. The group A patients had more abundant vasculature on the cystic wall than the group B patients according to both the intraoperative findings and the histopathological findings.

Conclusion

When performing a surgical cyst wall fenestration, surgeons should try to minimize the destruction of the cystic wall vasculature and not to make the fenestration at a site that contains many vascular striae.     

Cognitive Function and Language of a Child with an Arachnoid Cyst in the Left Frontai Fossa

Summary: The authors inspected the cognitive function of a boy with a congenital arachnoid cyst in the left frontal fossa. Neuropsychological tests described his cognition, including language, memory, and frontal functions, as mildly retarded overall. The boy's verbal ability was delayed, but his frontal function was intact. We supposed that the cyst would not affect his cognitive function. SPECT images showed low perfusion in the left temporal lobe. Dysfunction of the left temporal lobe should cause delayed language leading to learning difficulty. Neuropsychological evaluation of cognitive function concurrent with rCBF imaging was necessary not only for describing the influence of the cyst but also in discriminating its psychological aspects     

Air Embolus to Arachnoid Cyst as a Rare Delayed Complication of Intrathecal Medication Delivery

Introduction: Intrathecal (IT) medication delivery is a commonly used technique for the treatment of chronic intractable pain. Cerebrospinal fluid (CSF) loculation at the catheter tip has been described as a cause of progressive loss of drug effect that can often be difficult to diagnose. Methods: The clinical course of a 56‐year‐old woman was reviewed, including past imaging studies. Results: The patient presented with acute lower extremity paresis secondary to air trapped within an arachnoid cyst thought to be due to long‐term use of IT morphine and an undiagnosed CSF loculation. She rapidly recovered after surgical decompression. Discussion: Symptomatic pneumorachis is rare. In this case, because of radiographically impressive compression and severe deficit, we felt that the trapped air was equivalent to a mass lesion and treated it aggressively. The arachnoid cyst was near the level of the catheter tip prior to revision, and we have retrospectively inferred a causal relationship.