Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

Chellathurai, Amarnath; Balasubramaniam, Suhasini; Gnanasihamani, Sathyan; Ramasamy, Sukumar; Durairajan, Jayamani

doi:10.4184/asj.2018.12.2.224

Cited by 10 publications

(25 citation statements)

References 16 publications

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“…[5] For VSCH, the preoperative MRI alone usually proved diagnostic in 30% of patients, while SAC, MRI, and CT myelography combined may be diagnostic in 68% of cases. [1][2][3][4][5][6][7] Here, although the MRI showed a positive "scalpel sign" consistent with a DAW, the CT myelogram was interpreted as showing a VSCH. Notably, this "misdiagnosis" could have significantly impacted surgery, as DAWs are usually approached posteriorly, while VSCH is more frequently approached anteriorly.…”

Section: Combined Mr and Myelo-ct In The Diagnosis Of Daw Sac And Vschmentioning

confidence: 99%

“…Also, a dorsal indentation of cord (e.g., the "scalpel sign") and/ or an abnormal lesion on T-2 axial images in the dorsal subarachnoid space. [1][2][3]6] Further supporting, the diagnosis of DAW is CSF flow quantitative study using a cardiacgated phase-contrast cine-mode that can show a marked reduction in rostral CSF flow in the dorsal subarachnoid space. [1] Alternatively, the diagnosis of VSCH would be better confirmed by an MR or myelo-CT documenting a segment of cord parenchyma extending outside the dura mater, while for SAC, there would be no such pathognomonic MR signs.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…For DAW, there are no pathognomonic signs on CT myelogram. [1][2][3][4][5][6][7] Alternatively, with VSCH, the CT myelogram shows herniation of the cord through a dural defect with no contrast seen anterior to the cord itself while for SAC; the flow of contrast on a myelo-CT study is interrupted by a space-occupying lesion in the dorsal subarachnoid space. [1,7]…”

Section: Computed Tomography Myelogrammentioning

confidence: 99%

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Rare dorsal thoracic arachnoid web mimics spinal cord herniation on imaging

Aljuboori¹,

Boakye²

2020

Surgical Neurology International

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Background: Dorsal arachnoid webs (DAWs) are rare clinical entities that can mimic other conditions on magnetic resonance imaging (MRI). Here, we present a case of DAW that was misdiagnosed on MR as a ventral cord herniation. Case Description: A 35-year-old female presented with a 1-year history of lower extremity weakness and numbness. The MRI of the thoracic spine showed ventral cord displacement with syringomyelia. The computed tomography myelogram demonstrated ventral cord herniation. Intraoperatively, the patient had a dorsal thoracic web in the absence of cord herniation. Within 8 postoperative weeks, the patient had improved, and the follow-up MI showed a significant reduction in the syrinx size. Conclusion: On MR scans, DAWs may look like ventral cord herniation. However, the positive “scalpel sign” and syrinx, the absence of an arachnoid cyst on myelography, and the findings on cine MR help differentiate DAWs from ventral cord herniation.

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Section: Combined Mr and Myelo-ct In The Diagnosis Of Daw Sac And Vschmentioning

confidence: 99%

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Section: Computed Tomography Myelogrammentioning

confidence: 99%

See 1 more Smart Citation

Rare dorsal thoracic arachnoid web mimics spinal cord herniation on imaging

Aljuboori¹,

Boakye²

2020

Surgical Neurology International

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“…Imaging findings are important in diagnosing AW. Several characteristic imaging findings such as the scalpel sign, syringomyelia, and dorsal indentation (ventral deviation of the spinal cord) have been reported on MRI and CT myelography [ 3 – 10 ]. The scalpel sign is also called the “scalpel blade” sign, because the shape of the spinal cord in the sagittal section of MRI resembles a scalpel blade [ 3 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The findings of syringomyelia are also characteristic imaging findings of AW [ 3 – 10 ]. Spinal cavities may be found at the upper and lower levels of an AW, and the mechanism has been reported to be due to CSF pressure differences.…”

Section: Discussionmentioning

confidence: 99%

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

Inoue

Miyakoshi

Hongo

et al. 2020

Case Reports in Orthopedics

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Introduction. An arachnoid web (AW) is a relatively rare disease and shows clinical symptoms and radiological findings similar to those of an arachnoid cyst (AC) or spinal cord herniation (SCH). Since the operative procedures for an AW are generally different from those intrathecal disorders, correct preoperative differential diagnosis is important. The purposes of this study were to report the usefulness of magnetic resonance imaging (MRI) and computed tomography (CT) myelography for diagnosing AW and to show the histological findings and clinical results. Case Description. Two patients, a 79-year-old man and a 43-year-old woman, are presented. The primary diagnoses were AC with ossification of the ligamentum flavum and epidural hematoma, respectively, in previous hospitals. They were finally diagnosed by the characteristic MRI and CT myelogram finding called the “scalpel sign.” Histological findings showed epithelial cells and fibrous tissue derived from arachnoid tissues and microcalcifications. After surgery, the scalpel sign has vanished, and aggravation of their symptoms was prevented. Conclusion. An AW is refractory, but early detection by MRI and CT myelography and early treatment improve outcomes after surgery.

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

et al. 2023

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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 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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Pathophysiology and Grading of the Ventral Displacement of Dorsal Spinal Cord Spectrum

Cited by 10 publications

References 16 publications

Rare dorsal thoracic arachnoid web mimics spinal cord herniation on imaging

Rare dorsal thoracic arachnoid web mimics spinal cord herniation on imaging

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

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

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