Spinal arachnoid cyst developing after surgical treatment of a ruptured vertebral artery aneurysm: a possible complication of topical use of fibrin glue

Abstract

A case is reported of a 59-year-old man with a spinal arachnoid cyst accompanied by spinal arachnoiditis. The patient developed symptoms after treatment for a ruptured vertebral artery aneurysm, in which fibrin glue was used for reconstruction of the suboccipital bone defect. It is believed that the fibrin glue may have played a role in forming the arachnoid cyst. The authors urge the readers to keep in mind the possibility of subclinical spinal arachnoiditis in the patients with aneurysmal subarachnoid hemorrhage and suggest that care should be taken to avoid any possible adverse effect of fibrin glue.

Spinal extradural arachnoid cyst following percutaneous vertebroplasty

“…Most of the spinal extradural arachnoid cysts are often attributed to congenital defects [7]. Another possibility is that they develop secondary to inflammation, trauma or iatrogenic causes such as lumbar puncture, anesthetic procedures or intradural surgery [16,28,29,31]. In the current case, we did not find cysts in the spinal canal prevertebroplasty, so congenital cause can be ruled out.…”

Syringomyelia and Arachnoid Cysts Associated With Spinal Arachnoiditis Following Subarachnoid Hemorrhage

“…8,12) In addition, according to previous studies, protracted bed rest and fibrin glue usage also cause spinal arachnoiditis. 13) Furthermore, repeated SAH, as well as occult meningitis caused by lumbar drainage, may have contributed to the manifestation of adhesive arachnoiditis in this case. Thus, collapse of the subarachnoid space due to the lumbar drainage might enhance adhesion of the arachnoid membrane.…”

“…1,5,13) Our patient presented with paraparesis, paresthesia, and urinary incontinence. Multiple arachnoid cysts which compress the spinal cord from the ventral side might contribute to paraparesis as a pyramidal sign.…”

“…According to previous studies, ruptured aneurysm located in the posterior circulation may pose a higher risk for adhesive arachnoiditis compared with aneurysm in the anterior circulation. 1,5,9,10,13,14) We speculate that the hematoma volume in the spinal subarachnoid space is related with the occurrence of spinal arachnoiditis. Adhesive arachnoiditis occurred in cases treated with both clipping and coiling, so the chronic inflammatory response of the pia-arachnoid mater persisting due to SAH is thought to be a cause of spinal arachnoiditis.…”

“…Patients with arachnoid cysts, which tend to occur on the ventral side, demonstrated paraparesis 5,7,13,15) and patients with syringomyelia demonstrated sensory disturbance. 1,5,13) Our patient presented with paraparesis, paresthesia, and urinary incontinence.…”