Percutaneous Fenestration of a Spinal Arachnoid Web Using an Intrathecal Catheter: Effect on Cerebrospinal Fluid Flow and Clinical Status

Qureshi, Adnan I; Bains, Navpreet; Balasetti, Vamshi; Salame, Karim; Gomez, Camilo R.; Siddiq, Farhan; Cousins, Joseph P.

doi:10.1016/j.wneu.2020.06.119

Cited by 7 publications

(5 citation statements)

References 41 publications

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“…There was a recent case report published of percutaneous fenestration of a thoracic arachnoid web using a standard lumbar drainage catheter with placement in the lumbar thecal sac and advancement of the catheter to the level of the arachnoid web with resultant clinical improvement. [ 12 ] Outcomes are generally very good with treatment. In a literature review including 19 articles, patients who were followed for an average of 9.2 months had 91% improvement in neurological symptoms with only two patients having worsened symptoms.…”

Section: Discussionmentioning

confidence: 99%

Thoracic dorsal arachnoid web with rapid onset of symptoms: A report of two cases and brief review of the literature

Hines

Wang

Duttlinger

et al. 2021

Surgical Neurology International

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Background: Thoracic arachnoid webs are a rare entity and can be challenging to diagnose with sometimes subtle radiographic findings. Arachnoid webs can cause severe cord compression with associated syrinx and resulting myelopathy, weakness, sensory loss, and bowel/bladder dysfunction. There have been a little over 60 cases total reported in the literature with only one systematic review. The cases presented here have unique features including rapid onset of symptoms, symptomatic syrinx extending into the cervical spine, and intraoperative syrinx drainage, all of which are quite rare in the current published literature for arachnoid webs. Case Description: Here, we present two patients, a 73-year-old man and 58-year-old man presenting with different symptoms and timing of symptom progression but both with “scalpel sign” and associated syrinx present on their MRIs. Each patient underwent a laminectomy with resection of arachnoid web with complete resolution of symptoms in the first case and significant improvement in the second case. Postoperative imaging in both cases showed almost complete resolution of the syrinx. Conclusion: Early clinical evaluation and workup followed by early surgical treatment can lead to dramatic improvement in outcomes after surgery. For patients that are symptomatic from an associated syrinx, a midline myelotomy to facilitate drainage can be considered to be done concomitantly with the arachnoid web resection.

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Section: Discussionmentioning

confidence: 99%

Thoracic dorsal arachnoid web with rapid onset of symptoms: A report of two cases and brief review of the literature

Hines

Wang

Duttlinger

et al. 2021

Surgical Neurology International

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“…A case report by Qureshi et al. 11 further reported that catheter-guided fenestration of SAW produced stable neurological improvement as well. Among patients who had been treated conservatively in our sample (n = 77), there appeared to be lower rates of reporting on follow-up duration and neurological outcome.…”

Section: Discussionmentioning

confidence: 92%

“…Laminectomy with intradural excision was the most common surgical option and was generally associated with symptomatic improvement in the reported cases, 6,10 which aligns with the findings of Nisson et al 6 (Table 1). A case report by Qureshi et al 11 further reported that catheter-guided fenestration of SAW produced stable neurological improvement as well. Among patients who had been treated conservatively in our sample (n 5 77), there appeared to be lower rates of reporting on follow-up duration and neurological outcome.…”

Section: Lessonsmentioning

confidence: 92%

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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“…Vergara et al [ 30 ] presented two cases of minimally invasive resection of SAW. Percutaneous intrathecal catheterization of the arachnoid web was reported in one case [ 23 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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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Percutaneous Fenestration of a Spinal Arachnoid Web Using an Intrathecal Catheter: Effect on Cerebrospinal Fluid Flow and Clinical Status

Cited by 7 publications

References 41 publications

Thoracic dorsal arachnoid web with rapid onset of symptoms: A report of two cases and brief review of the literature

Thoracic dorsal arachnoid web with rapid onset of symptoms: A report of two cases and brief review of the literature

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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