Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The goal of this study was to review all cases of pediatric spinal arachnoid cysts (SACs) surgically treated at the authors' institution between 1992 and 2008 and to compare these cases to the published literature for the general population.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The charts of all pediatric patients with SACs were reviewed for demographics, medical history, presenting symptoms, imaging findings, operative procedure(s), complications, and outcomes. Following a complete literature review, the pediatric data were compared with data from the general population and unique findings associated with pediatric patients were identified.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Thirty-one pediatric patients (median age 6.9 years) underwent operative intervention for SACs between 1992 and 2008 (median duration of follow-up 4.2 years). There were 17 female patients (55%) and 14 male patients (45%). Twenty-one patients (68%) presented with symptoms of radiculopathy or myelopathy. The most common presenting symptoms were pain (42%), lower-extremity weakness (39%), gait instability (32%), spasticity (19%), sensory loss (10%), and bladder dysfunction (7%). In 3 patients (10%) SACs were incidental findings. Intradural SACs were more common (18 patients, 58%) than extradural SACs (11 patients, 36%). One patient (3%) had extradural and intradural components. One patient (3%) had a purely intramedullary cyst, and 1 patient (3%) had both an intradural and intramedullary component. Of the 18 intradural SACs, 9 (50%) were located ventral to the spinal cord and 9 (50%) were dorsally situated. One dorsal intradural SAC had an intramedullary component. All extradural SACs were located dorsal to the spinal cord. Intradural SACs were primarily concentrated in the cervical and thoracic regions (67%), whereas extradural cysts were more evenly distributed between the thoracic, lumbar, and sacral regions. Of the 18 patients with intradural SACs, 13 (72%) had significant previous CNS abnormalities, compared with 3 (27%) of 11 patients with extradural SACs. There were 2 operative complications. One patient had a CSF leak treated with a lumbar drain, and the second patient had a pseudomeningocele. No patients had neurological deterioration as a result of surgical intervention. Twenty-one patients (68%) had complete remission of symptoms, 6 (19%) had improvement, 3 (10%) were stable, and 1 (3%) has worsening of symptoms with recurrence that ultimately required cystoperitoneal shunting, despite multiple failed attempts at fenestration.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Spinal arachnoid cysts are rare lesions in the pediatric population. Affected patients present with back pain, weakness, and/or gait instability. In children, SACs predominantly develop in the thoracic region and are more likely to occur intradurally, compared with SACs in the general population. Overall outcomes following surgical fenestration or excision of SACs are excellent, with complete remission or improvement of symptoms achieved in 87% of cases.</jats:p></jats:sec>

Laminectomy by craniotome for huge spinal extradural arachnoid cyst: a case report

“…The formation of epidural scar, especially the incidence of kyphotic deformity after conventional laminectomy has been reported to be 33-100 % [8,11,12]. Laminoplasty has been recommended to prevent these complications especially for cysts located on thoracic or lumbar spine [6,11,12], and also helps to avoid excessive posterior elements loss.…”

“…Laminoplasty has been recommended to prevent these complications especially for cysts located on thoracic or lumbar spine [6,11,12], and also helps to avoid excessive posterior elements loss. Titanium mini-plates were used for stabilizing laminas into their original positions in laminectomy.…”

Alternative Minimally Invasive Surgical Procedures in Rarely Seen Anterior Cervical Arachnoid Cyst

“…Çağımızda nörogörüntülemenin kolay ulaşılabilir olması nedeniyle insidental olarak da tanı konulsa da ağrı, güç kaybı, ataksi ve/veya üri-ner inkontinans gibi semptomlarla da tanı konulabilmektedir. [1][2][3] Spinal araknoid kistlerin oluşum mekanizması net değildir. Nöral tüp defektleri ve vertebral kolon anomalileri gibi konjenital nedenlerle veya araknoid granülasyonun anormal hipertrofisi ve dilatasyonu, travma, araknoidit, miyelografi esnasında verilen kontrast maddeleler, cerrahi, subaraknoid kanama ve enfeksiyoz gibi akiz nedenler ile oluşan araknoid kistler literatürde bildirilmiştir.…”

Anterior Cervical Arachnoid Cyst in A Child: A Case Report

“…Depending on the location of the cyst and the duration and degree of spinal cord compression, postoperative outcomes vary substantially. Some degree of improvement is reported in 45.0% to 70.0% of cases following surgery, and complete elimination of symptoms is reported in 20.0% to 30.0% of cases 2 . 5 .…”

“…Arachnoid cysts in the spine are rare and are seldom a cause of spinal cord compression. In the spine region they almost always communicate with the intrathecal subarachnoid space through a small defect in the dura 2 . Usually asymptomatic, in some cases can cause local and radicular pain, motor weakness of extremities, sensory disturbances, ataxia, and sphincter disturbances.…”