Dorsal Arachnoid Web: A Rare Cause of Myelopathy

Buttiens, Arvy; Feyen, Bart; Dekeyzer, Sven

doi:10.5334/jbsr.2592

Cited by 4 publications

(8 citation statements)

References 1 publication

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“…1,29 In T2-weighted constructive interference in steady state sequences or true FISP, it might be possible to visualize the web. 4,5,23 In our series, it was possible to visualize the SAW in T2 true FISP MRI. Chang et al 6 concluded that localizing the location of CSF blockage precisely limits the extent of resection.…”

Section: Radiological Diagnosis and Radiological Fumentioning

confidence: 71%

“…Hamilton et al 11 and Buttiens et al 5 concluded that is the gold standard for diagnosing SAW with the pathognomonic so-called "scalpel sign" (or scalpel blade sign) 21 because of the resemblance of the silhouette of a surgical scalpel blade. 11 However, it might be di cult for MRI to visualize focal arachnoid lesions.…”

Section: Radiological Diagnosis and Radiological Fumentioning

confidence: 99%

“…21 On the day of surgery, half of the patients had symptoms for 1 year or longer. 21 Other authors reported additional symptoms such as progressive myelopathy, 5,23 back pain, 11,23 clonus, 3,11 hyperre exia, and the Schiff-Sherrington phenomenon. 11…”

Section: Pathophysiology Of Syringomyelia In Sawmentioning

confidence: 99%

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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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Section: Radiological Diagnosis and Radiological Fumentioning

confidence: 71%

Section: Radiological Diagnosis and Radiological Fumentioning

confidence: 99%

See 1 more Smart Citation

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

Adib

Schittenhelm

Kurucz

et al. 2023

Preprint

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“…Despite increasing research in recent years, the etiology of SAW is still unclear. Some researchers posit that webs form from disrupted arachnoid cyst formation, from the rupture of an arachnoid cyst, 13 , 14 or as a sequela of spinal trauma or surgery. Similar to Nisson et al., 6 we found a low prevalence of previous spinal surgery or trauma among our sample, indicating that additional research into the causes of SAW is warranted.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Multiple studies have further suggested that SAW is underdiagnosed and underreported, perhaps due to slow symptom progression as described in our sample (mean symptom duration >3 years) or to the potential for asymptomatic presentation. 13 The heterogeneity of symptoms experienced by patients with SAW may also complicate diagnosis. Patients in our sample presented with various combinations of symptoms ranging from pain to incontinence and gait disturbance.…”

Section: Discussionmentioning

confidence: 99%

Resection of an incidentally discovered spinal arachnoid web: illustrative case

Vattipally,

Ahmadi,

Weber-Levine

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Spinal arachnoid webs (SAWs) are rare pathologies of the spinal meninges often associated with syringomyelia and the radiographic “scalpel sign.” Patients can experience pain, numbness, gait disturbances, or no symptoms at all. They are typically diagnosed via magnetic resonance imaging and treated with laminectomy and excision. OBSERVATIONS A 61-year-old male presented after a mechanical fall and had an incidentally discovered SAW on imaging. He was initially asymptomatic and was therefore conservatively managed. Several years later, however, the patient experienced new-onset back pain, paresthesia, and balance problems, with interval imaging demonstrating worsening of the edema surrounding his SAW. The patient subsequently underwent resection of the SAW, which led to significant resolution of his symptoms. LESSONS An SAW can be asymptomatic or can manifest with a wide variety of symptoms. When this condition is incidentally discovered in asymptomatic patients, neurosurgeons should guide these patients to follow-up urgently if they develop any neurological symptoms. At that time, further imaging can be performed to determine if surgical treatment is indicated. Although SAW is rare, clinicians should be aware of the signs and symptoms, because prompt surgical intervention can significantly improve neurological symptoms.

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Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes

et al. 2023

View full text Add to dashboard Cite

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 the 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 T2/3, T6, and T8. Excision of the 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 though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).

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Dorsal Arachnoid Web: A Rare Cause of Myelopathy

Abstract: Teaching point: The scalpel sign is pathognomonic for a dorsal arachnoid web, a rare clinical-radiologic entity that can cause myelopathy.

Cited by 4 publications

References 1 publication

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

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

Resection of an incidentally discovered spinal arachnoid web: illustrative case

Surgical management of syringomyelia associated with spinal arachnoid web: strategies and outcomes

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