Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases

Inoue, Junya; Miyakoshi, Naohisa; Hongo, Michio; Kobayashi, Takashi; Abe, Tomoki; Kikuchi, Kazuma; Abe, Eiji; Kasukawa, Yuji; Ishikawa, Yoshinori; Kudo, Daisuke; Kinoshita, Hayato; Kimura, Ryota; Shimada, Yasuhiro

doi:10.1155/2020/8816598

Cited by 9 publications

(17 citation statements)

References 11 publications

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“…While there is no pathological definition of the arachnoid web, the arachnoid membrane-like epithelial tissue observed in our specimen was consistent with that previously described. 11) In the arachnoid web diagnosis, the important finding of "scalpel sign" was found on the MR images, which indicated the dorsal indentation of the spinal cord. Thus, our case corresponded to the entity of the arachnoid web.…”

Section: Discussionmentioning

confidence: 99%

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Case of Syringomyelia Associated with Ossified Yellow Ligament and Arachnoid Web

BAMBA¹,

FUKUNAGA²,

Umegaki

et al. 2022

NMC Case Report Journal

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Syringomyelia is often associated with Chiari malformation, trauma, infection, and spinal cord tumor. Although they are relatively rare diseases, arachnoid cysts and its related pathology, "arachnoid web" can sometimes lead to syrinx formation at the thoracic vertebral level. However, syrinx formation caused by degenerative spinal disorders, particularly at the thoracic vertebral levels, has rarely been reported. Herein, we present a case of syringomyelia with thoracic ossified yellow ligament (OYL) in a 79-year-old man, who underwent initial posterior decompression followed by arachnoid web removal. Posterior decompression via laminectomy of thoracic vertebra 2 and removal of the OYL improved the syrinx partially, but dorsal indentation of the spinal cord and a remnant syrinx were observed in postoperative magnetic resonance images, subsequent to the second surgery's successful removal of the arachnoid web, which had dorsally compressed the spinal cord. After the second operation, the syrinx shrunk further, and the patient could walk independently at 5 months after the operations. In our case, both the OYL and arachnoid web were responsible for syrinx formation. Therefore, the coincidence of degenerative vertebral diseases with a syrinx might indicate the coexistence of an underlying lesion. Furthermore, the arachnoid web in this case might have formed due to the denaturation of the arachnoid cyst triggered by the OYL.

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Section: Discussionmentioning

confidence: 99%

“…While there is no pathological definition of the arachnoid web, the arachnoid membrane-like epithelial tissue observed in our specimen was consistent with that previously described. 11 )…”

Section: Discussionmentioning

confidence: 99%

Case of Syringomyelia Associated with Ossified Yellow Ligament and Arachnoid Web

BAMBA¹,

FUKUNAGA²,

Umegaki

et al. 2022

NMC Case Report Journal

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“…Arachnoid web should be differentiated from ventral cord herniation and arachnoid cyst [5] and can be diagnosed radiologically by the characteristic feature scalpel sign [6]. It usually manifests as symptoms of progressive myelopathy and can be treated successfully with surgical removal [3,7].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, this intermedullary CSF pressure gradient can result in syringomyelia. The typical location of syringomyelia is either rostral or caudal to the arachnid web because the specific structure of arachnoid web can promote one-way flow of CSF and unidirectional syringomyelia [7].…”

Section: B Amentioning

confidence: 99%

Diagnosis and surgical treatment of arachnoid web

Park

Kim

Jang

et al. 2021

J Korean Soc Geriatr Neurosurg

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The term "arachnoid web" was first mentioned by Mallucci et al.[1] in 1997 as one of the possible causes of idiopathic syringomyelia. They reported that arachnoid webs or pouches create syringomyelia by partially blocking the flow of cerebrospinal fluid (CSF) and can originate from the septum posticum. Then, the disease entity of arachnoid web was verified by Paramore [2] in 2000. He reported two cases of arachnoid web characterized by focal indentation of the dorsal thoracic cord that was not true arachnoid cyst but blocking CSF flow in magnetic resonance imaging (MRI) and computed tomography (CT) myelogram. Both patients presented with weakness of lower extremities and were treated with surgical resection, which produced improvement clinically and radiologically. Since then, a few case reports and studies have been pub-Arachnoid web is a rare disease entity that can cause progressive myelopathy and most often develops at the upper thoracic level. Its pathophysiology is unclear, but may be associated with degeneration of the septum posticum in the dorsal subarachnoid space, which alters the flow of cerebrospinal fluid (CSF) and subsequently leads to cord compression and syringomyelia. It often presents with pain, paresthesia, and extremity weakness. Arachnoid web is diagnosed by a typical pattern of displacement of the spinal cord, known as the scalpel sign, with intact ventral dura mater and disturbed but conserved CSF flow. Arachnoid web should be differentiated from other disease entities sharing the feature of ventral displacement of the dorsal spinal cord, such as arachnoid cyst or spinal cord herniation. The treatment for arachnoid web is surgical resection. We report a 66-year-old female who was diagnosed with arachnoid web in the dorsum of the spinal cord at the T3 level. She had suffered from weakness of both legs for 3 months. She underwent laminectomy of T3 and T4 and the dura was opened. The web was resected and the displacement of the spinal cord then improved.

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“…Innou et al 14 and Ben Ali et al 3 concluded that a change of arachnoid after infection or trauma might lead to SAW. In a histopathological analysis of SAW connective tissue, Chang et al 6 found small numbers of CD3 + T cells.…”

Section: Pathophysiologymentioning

confidence: 99%

Surgical management of spinal arachnoid web in case of syringomyelia: Strategies and outcomes

Adib

Schittenhelm

Kurucz

et al. 2023

Preprint

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Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and cine), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were TH2/3, TH6, and TH8. Excision of arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary SAW can be safely treated by surgery. Even syringomyelia usually improves inMRI and symptoms also improves, residual symptoms might be observed.

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Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases

Cited by 9 publications

References 11 publications

Case of Syringomyelia Associated with Ossified Yellow Ligament and Arachnoid Web

Case of Syringomyelia Associated with Ossified Yellow Ligament and Arachnoid Web

Diagnosis and surgical treatment of arachnoid web

Surgical management of spinal arachnoid web in case of syringomyelia: Strategies and outcomes

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