Foramen Magnum Arachnoid Cyst Induces Compression of the Spinal Cord and Syringomyelia: Case Report and Literature Review

Abstract

It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.

Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia

“…More recently, Huang et al report on the case of syringomyelia in the context of a localized foramen magnum arachnoid cyst with minimal extension into the posterior fossa [14]. They reported good clinical and radiological resolution of the syrinx following excision of the cyst wall and posterior fossa decompression.…”

Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

“…Various treatment options have been suggested in the management of PFAC. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 ] Recent advances in neurosurgical techniques and neuroendoscopy, continue to favor endoscopic fenestration over shunt insertion as the method of choice for initial cyst decompression. [ 9 11 14 18 19 ] Holst et al ., in their recent article has stated that the best surgical treatment of cerebral arachnoid cysts is still controversial.…”

“…The optimal surgical management of PFAC still remains controversial. [ 3 4 5 6 7 8 9 10 11 12 13 14 15 16 ] Reviewing the literature and taking into consideration the advancements made in the field of radiology like computed tomography (CT) and MRI scan, surgical techniques like endoscopy and results of long-term follow-up of our cases, we propose a surgical strategy for management of these PFAC. This would aid the surgeon in decision making regarding the best type of surgical approach to the PFAC, which is suited to include the surgeon's expertise, the availability of the neurosurgical armamentarium and would also give excellent long-term results.…”

Syringomyelia Associated with a Huge Retrocerebellar Arachnoid Cyst: A Case Report

“…Removal of the underlying pathology and stablishing the normal CSF flow at the foramen magnum is the main stay of treatment for syringomyelia 9) . For cases of foramen magnum arachnoid cyst with direct compression of the spinal cord and syringomyelia, excision should be performed as much as possible with complete decompression of the posterior fossa, which should result in a satisfying outcome even if the arachnoid cyst is unable to be completely excised 7) .…”