Recurrent Spinal Intramedullary Arachnoid Cyst: Case Report and Literature Review

Ichinose, Toshiya; Miyashita, Katsuyoshi; Tanaka, Shingo; Oikawa, Nozomu; Oishi, Masahiro; Nambu, Iku; Kinoshita, Masashi; Nakada, Mitsutoshi

doi:10.1016/j.wneu.2020.02.106

Cited by 16 publications

(9 citation statements)

References 17 publications

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“…However, in this case, the cyst in the RMC was an IMAC. Although the pathoembryogenesis of IMAC itself is also unknown [21, 22], in this case, there was a notch on the wall of the cyst, suggesting that an extramedullary arachnoid cyst or subarachnoid space had entered the RMC.…”

Section: Discussionmentioning

confidence: 98%

Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst

et al. 2022

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Introduction The retained medullary cord (RMC) is a newly defined entity of closed spinal dysraphism that is thought to originate from regression failure of the medullary cord during the last phase of secondary neurulation. The terminal myelocystocele (TMC) is an unusual type of closed spinal dysraphism, characterized by localized cystic dilatation of the terminal part of the central canal that then herniates through a posterior spinal bifida. The co-occurrence of RMC and TMC is extremely rare. Case Presentation We treated a baby girl with a huge sacrococcygeal meningocele-like sac with two components. Untethering surgery and repair surgery for the sac revealed that RMC, associated with intramedullary arachnoid cyst (IMAC), was terminated at the bottom of the rostral cyst, forming the septum of the two cystic components, and the caudal cyst was TMC derived from the central canal-like ependymal lining lumen (CC-LELL) of the RMC at the septum. IMAC within the RMC, communicated with TMC, and both contained xanthochromic fluid with the same properties. Conclusion We speculated that the mass effect of the coexistent IMAC impeded the flow of cerebrospinal fluid in the CC-LELL within the RMC and eventually formed a huge TMC. In the surgical strategies for these complex pathologies, we stressed the importance to identify the electophysiological border between the functional cord and nonfunctional RMC and severe RMC at this border to untether the cord, as with a typical or simple RMC.

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Section: Discussionmentioning

confidence: 98%

Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst

et al. 2022

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“…The reasons speculated for recurrence were incomplete excision of the cyst, an unnoticed ventral subarachnoid channel, postoperative adhesion, and fibrosis. [ 13 , 19 ] Zekaj et al . reported a case of development of an IMAC on follow-up after near-total removal of an intradural extramedullary cyst, with a small part of cyst wall left behind.…”

Section: Discussionmentioning

confidence: 99%

Conus medullaris intramedullary arachnoid cyst- case report and review of the literature

Thakur¹,

Rangnekar

Aroor

et al. 2021

Surgical Neurology International

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Background: Spinal intramedullary cysts present a radiological dilemma. We present a rare case of a conus intramedullary arachnoid cyst and report on its differentiating features and management. Case Description: We report a case of a 30-month-old child who presented with decreased gluteal sensation and urinary dribbling for 6 months. Apart from some slowness in walking, the power was normal in all four limbs. Imaging showed a non-enhancing, T2-weighted hyperintense 12 × 8 mm conus intramedullary cyst without any edema. A T12-L1 laminotomy followed by marsupialization of the cyst was done. Histopathology was suggestive of an arachnoid cyst. The postoperative course was uneventful with improvement in muscle strength and achievement of regular milestones. We also present the pertinent review of the literature to date. Conclusion: Intramedullary arachnoid cysts are a rare entity and should form the differential diagnosis for cysts presenting in the conus medullaris. Simple decompressive options may suffice for symptomatic cases and radical excision may be avoided. A high index of suspicion is essential considering the subtle nature of presenting symptoms.

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“…SAC give rise to compression of the spinal cord secondary to the complex CSF flow within the spinal canal ( 2 , 7 ). Cystic enlargement, secondary to fluctuations in CSF pressure (Valsalva manoeuvre) has been explained by a 1-way ball-valve effect at the cyst neck ( 2 , 8 ).…”

Section: Reflectionmentioning

confidence: 99%

“…Surgery is the gold standard of treatment ( 6 , 9 , 10 ). Surgery should be considered in patients with progressive worsening of symptoms or recurrence ( 8 ). Surgical marsupialization with or without laminectomy is the most commonly used technique ( 2 ).…”

Section: Reflectionmentioning

confidence: 99%

Correlation of spinal cord injury with development of spinal arachnoid cysts: Two case reports

Raes

Oostra

2021

JRM-CC

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Background Spinal arachnoid cysts are rare entities, which are composed of a duplication in the arachnoid membrane and resultant cerebrospinal fluid collection, which may present with a progressive myelopathy. The most common symptoms caused by spinal cord compression are paraesthesia, neuropathic pain, paresis and gait ataxia. Clinical cases We report here 2 cases from different perspectives of a spinal arachnoid cysts in spinal cord injury. The first case was the occurrence of a spinal cord injury due to compression of a spinal arachnoid cysts causing myelopathy. The second case is a patient who had a traumatic paraplegia for which stabilizing surgery was required and who subsequently developed a spinal arachnoid cysts with neuropathic pain. Both cases required surgery with immediate improvement. However, after a few months both patients needed a revision due to recurrence. Conclusion Spinal arachnoid cysts may present with a heterogeneous clinical picture. If cysts are not clinically apparent, a conservative treatment with careful observation can be a justifiable option. In patients with progressive symptoms, surgery is the gold standard of care. However, the literature describes the need for revision surgery in only 12.5% of cases. Regular follow-up is necessary because both of the patients reported here needed revision surgery. LAY ABSTRACT Spinal cysts are cerebrospinal fluid pockets that may compress the spinal cord. They may present with different symptoms; for example, sensory disorders, pain, loss of strength and difficulty walking. We report here 2 patients with a spinal cord injury with spinal arachnoid cysts. In the case of patients with worsening symptoms, surgery is the gold standard of care. Regular follow-up is necessary; and both patients reported here needed revision surgery.

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Recurrent Spinal Intramedullary Arachnoid Cyst: Case Report and Literature Review

Cited by 16 publications

References 17 publications

Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst

Retained Medullary Cord Associated with Terminal Myelocystocele and Intramedullary Arachnoid Cyst

Conus medullaris intramedullary arachnoid cyst- case report and review of the literature

Correlation of spinal cord injury with development of spinal arachnoid cysts: Two case reports

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