A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias

Klekamp, Jörg

doi:10.1093/neuros/nyx049

Cited by 24 publications

(33 citation statements)

References 92 publications

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“…Based on our experience and previous literature, a defect of thoracolumbar SEMC is commonly found at the T12 to L1 segments, in close proximity to the branching point of the nerve root sleeve 1,3,11,12) . In our series, all 10 defects were located in this region.…”

Section: Location Of Defects and Intraoperative Findingsmentioning

confidence: 84%

“…The cyst gradually expands with tension as CSF gathers within it and finally compresses the nervous tissues 1,14,24) . Postoperative histopathology of the resected cyst wall revealed arachnoid epithelial and compact fibrous connective tissue, which suggested dural components are contained in the outer wall of the cyst 1,2,11,26) .…”

Section: Etiologymentioning

confidence: 99%

“…Pathologies of the spinal dura were classified into three categories : dural diverticula (type I), dissections (type II), and ectasias (type III), and SEMCs were categorized as dural diverticula. SEMCs presented as extradural cystic occupying lesions filled by CSF 11) . The mainstream hypothesis is that SEMC is caused by herniation of arachnoid tissue via a dural defect which connecting the cyst and the subarachnoid space.…”

Section: Etiologymentioning

confidence: 99%

“…Spinal extradural meningeal cysts (SEMCs) are rare pathological entities caused by intraspinal cystic compression to the spinal cord and/or nerve roots which may lead to a series of neurological disorders, accounting for only 1-3% of intraspinal lesions 1,11,24) . As the pathogenesis is not clear, many nomenclatures were used in the previous reports to describe these entities, such as extradural meningeal/arachnoid cysts, arach-noid diverticula, pouches, meningoceles 1,19,20,22,27) .…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Jian

et al. 2021

J Korean Neurosurg Soc

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Objective : To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making. Methods : Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded. Results : Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up. Conclusion : SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.

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Section: Location Of Defects and Intraoperative Findingsmentioning

confidence: 84%

Section: Etiologymentioning

confidence: 99%

Section: Etiologymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Jian

et al. 2021

J Korean Neurosurg Soc

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“…The present course suggests that the increasing dural defect was related to degenerative changes. These include small bony spurs or calcified osteochondroses that may cause dural tears leading to larger defects and cord herniation [ 10 ]. This view is supported by the fact that the defects tend to be at the level of intervertebral spaces and that large calcified thoracic disc herniations tend to perforate the dura [ 11 – 13 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: case report illustrating diagnostic and therapeutic implications

et al. 2020

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Background: Anterior spinal cord herniation (aSCH) is a rare cause of myelopathy which may present as pure motor syndrome and mimic other degenerative diseases of the spinal cord. In slowly progressive cases, diagnosis may be impeded by equivocal imaging results and mistaken for evolving upper motor neuron disease. As early imaging studies are lacking, we aimed to provide a detailed description of imaging and neurophysiology findings in a patient with aSCH, focusing on the early symptomatic stages. Case presentation: We here present the case of a 51-year old male patient with an episode of pain in the right trunk and a normal spinal MRI. After a symptom-free interval of 8 years, spasticity and paresis evolved in the right leg. There was subtle ventral displacement and posterior indentation of the thoracic spinal cord on MRI which, in retrospect, was missed as an early sign of aSCH. After another 3 years, symptoms spread to the left leg and a sensory deficit of the trunk became evident. Follow-up MRI now clearly showed an aSCH. Neurosurgical intervention consisted of remobilization of the herniated spinal cord and patch closure of the dura defect. Over the following years, motor and sensory symptoms partially improved. Conclusions: The history of this patient with aSCH illustrates the importance of careful longitudinal clinical follow-up with repeated imaging studies in progressive upper motor neuron syndromes. Specific attention should be paid to a history of truncal pain and to MRI findings of a ventrally displaced spinal cord. Neurosurgical intervention may halt the progression of herniation.

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Pathologies of Spinal Meninges

Klekamp

2022

Color Atlas of Spinal Cord Surgery

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A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias

Cited by 24 publications

References 92 publications

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: case report illustrating diagnostic and therapeutic implications

Pathologies of Spinal Meninges

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