Neuroimaging findings and pathophysiology of dorsal spinal arachnoid webs: illustrative case

Pham, Nancy; Ebinu, Julius O.; Karnati, Tejas; Hacein‐Bey, Lotfi

doi:10.3171/case2142

Cited by 6 publications

(5 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The pia mater of the spinal cord is fixed to the dura mater on both sides by the dentate ligaments [ 23 ] and at the dorsal side by the septum posticum (or posterior septum) [ 21 , 23 , 25 ]. An intermediate leptomeningeal layer is closely attached to the inner aspect of the arachnoid [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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).

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The pia mater of the spinal cord is xed to the dura mater on both sides by the dentate ligaments 23 and at the dorsal side by the septum posticum (or posterior septum). 21,23,25 An intermediate leptomeningeal layer is closely attached to the inner aspect of the arachnoid. 20 The septum posticum is important to stabilize the dorsal spinal cord against the ventral displacement at the thoracic spine level of the normal thoracic kyphosis, 7,23 which could explain the predilection of an arachnoid web at the upper thoracic levels.…”

Section: Pathophysiologymentioning

confidence: 99%

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

Adib

Schittenhelm

Kurucz

et al. 2023

Preprint

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 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.

show abstract

“…They found both patients had improved symptoms over time, and they recommended guided treatment based on presentation. 15 Pham et al described one case of SAW where the patient had a complete resolution of symptoms following surgery. 16 This retrospective case series was intended to identify patients with SAWs to illustrate better the clinical and imaging features and prognosis of SAWs and continue to add more cases to the literature.…”

Section: Introductionmentioning

confidence: 99%

Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Elkadi

Kraus

Krisanda

et al. 2023

Journal of Neuroimaging

View full text Add to dashboard Cite

Background and Purpose Spinal arachnoid webs (SAWs) are rare and can present with myelopathic symptoms. This study aims to add 85 more cases of SAWs to the literature so we can continue to analyze clinical and imaging trends of SAWs to better understand this entity and its natural history. Methods An institutional review board‐approved retrospective review of SAW cases between 2016 and 2022 within a metropolitan, multihospital network was performed, searching for MR and CT reports that included “arachnoid web.” Of 108 identified reports, 85 patients had imaging and/or pathologically proven arachnoid webs. Demographic and clinical data were collected. Images were analyzed for SAW level, point of maximum kyphosis, presence of cord expansion, and signal intensity. The electronic medical record (EMR) was reviewed for age, sex, symptom presentation and duration, management, and outcomes. Results Of 85 cases, the most common presenting chief complaint was back pain and weakness. All (100%) SAWs were in the dorsal thoracic subarachnoid space, with 87% (74/85) located from thoracic (T) 2 to T6. Spinal cord expansion and signal abnormality were present in 54.1% and 23.5%, respectively. Twenty‐six underwent surgical resection with 20 showing improvement of at least one symptom. Conclusion We present 85 additional cases of SAWs to the existing literature. Our cases all occurred in the dorsal thoracic subarachnoid space, predominantly from T2 to T6. Patients present with symptoms like other causes of cord compression, and spinal MR studies should be evaluated routinely for the findings of SAWs. Further research could focus on understanding SAW prevalence, risk factors, and pathophysiology.

show abstract

Neuroimaging findings and pathophysiology of dorsal spinal arachnoid webs: illustrative case

Cited by 6 publications

References 42 publications

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

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

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

Spinal arachnoid webs in adults: Clinical and imaging features in a multicenter study

Contact Info

Product

Resources

About