Symptomatic Anterior Spinal Arachnoid Diverticulum

Chan, Richard C.; Thompson, Gordon; Bratty, Paul J. A.

doi:10.1227/00006123-198505000-00014

Cited by 40 publications

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“…The majority of intradural spinal arachnoid cysts occur in the thoracic region (80%), with only 15% in the cervical region and 5% in the lumbar region. Most are dorsal to the neural elements (80%) in the canal and only 20% are ventrally located [9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. In our literature research of the Medline database, comprising reports published between 1966 and April 2001, we retrieved only 11 cases in which the intradural arachnoid cyst was located anterior to the cervical spinal cord [4, 9, 11, 18, 20, 21, 22], of which 8 were in the pediatric age group, like our case 2 (table 1) [4, 18, 21, 22, 23, 24].…”

Section: Discussionmentioning

confidence: 99%

“…Intradural arachnoid cysts are difficult to diagnose and are often an incidental finding [9, 11]. Plain radiography is usually not very helpful for diagnosis, and enlargement of the spinal canal, posterior vertebral body scalloping, pedicle erosion, widening of the interpedicular distance and thinning of the laminae were only found occasionally.…”

Section: Discussionmentioning

confidence: 99%

“…Myelography, postcontrast CT myelography and MRI have been used in diagnosis. Chan et al [11]postulated that the most important preoperative diagnostic procedure is myelography performed with the patient in both supine and prone positions with delayed (2–4 h) CT imaging to maximize the chance of filling the diverticulum with contrast. Because multiple symptomatic cysts can occur, a myelogram of the entire spine is recommended by Kriss and Kriss [7]to rule out a second cyst.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature

Lee

Cho²

2001

Pediatr Neurosurg

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Spinal arachnoid cysts are a relatively uncommon lesion that may be either intra- or extradural, and intradural spinal arachnoid cysts are even less common. These cysts are usually asymptomatic but may produce symptoms by compressing the spinal cord or nerve roots suddenly or progressively. We present three cases in the pediatric age group with spinal intradural arachnoid cysts without a preceding history of trauma. Three patients with symptomatic intradural arachnoid cysts were investigated with conventional T1- and T2-weighted magnetic resonance imaging (MRI). The MRI scans demonstrated the intradural arachnoid cysts with slightly lower CSF signal intensity on the gradient echo images and slightly higher signal intensity on T1-weighted images. The first cyst was located at the level T12–L1 and compressed the conus medullaris, with neurogenic bladder and cauda equina syndrome for 2 months. The second was located at the level C5–T1 ventrally, with spastic gait and neurogenic bladder for 4 years. The other was located at T2–3 ventrally, with sudden onset of quadriplegia after jumping rope. The combined treatment of total resection and wide fenestration in our three patients produced an excellent return of neurologic function in each one, except for residual urinary disturbance in case 2. Intradural spinal arachnoid cysts appear to result from an alteration of the arachnoid trabeculae; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and congenital. The majority of intradural spinal arachnoid cysts occur in the thoracic region and most are dorsal to the neural elements. Only 10 cases have been reported in which the intradural arachnoid cysts were located anterior to the cervical spinal cord, of which 8 were in the pediatric age group, like our case 2. Myelography, postcontrast CT myelography and MRI have been demonstrated as useful for the diagnosis of intradural arachnoid cysts. MRI is the imaging modality of choice, and the extent, size and nature of the lesion in our cases were well demonstrated by MRI. Surgical treatment is necessary if progressive neurological dysfunction appears in the course of spinal cord compression. Complete surgical excision of the cysts is the best choice of treatment, and wide fenestration and shunting of the cyst to the peritoneum, pleural cavity or right atrium were the modalities of choice. MRI offers a noninvasive and effective means to make the diagnosis of arachnoid cysts easier. Intradural arachnoid cysts may cause progressive myelopathy; however, the postoperative prognosis is good if the operation is performed prior to neurologic deficits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature

Lee

Cho²

2001

Pediatr Neurosurg

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“…8) The pathogenesis of intradural arachnoid cysts remains obscure, although a congenital origin has been postulated. Widening of the congenital septum posticum 1,11) or a diverticulum caused by abnormal distribution of Thoracic Arachnoid Cyst and Epidural Hematoma arachnoid trabeculae 8,10,15) may be the cause of congenital arachnoid cysts. Other etiologies including trauma or inflammation have been also reported.…”

Section: Discussionmentioning

confidence: 99%

“…2,4) The pathogenesis of this entity is not clear, however congenital, traumatic, or inflammatory etiologies have been reported. 1,3,8,10,11,14,15) Spinal intradural arachnoid cyst and spinal epidural hematoma are well-known entities, but no association has been reported. Here we describe a case of intradural arachnoid cyst of the thoracic spine which developed at the same location after surgery in the dorsal subarachnoid space for ventral epidural hematoma.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Intradural Arachnoid Cyst Associated With Surgical Removal of Epidural Hematoma-Case Report-

Endo

Takahashi

Shimizu

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 54-year-old woman presented with a very rare association of spinal intradural arachnoid cyst and spinal epidural hematoma manifesting as paraparesis subsequent to severe back pain. Magnetic resonance (MR) imaging disclosed a ventral epidural hematoma extending from the T-4 to T-6 levels and compressing the spinal cord ventrally. Emergent surgical evacuation of the epidural hematoma was carried out 22 hours after the onset. MR imaging obtained 2 days after surgery showed enlargement of the dorsal subarachnoid space at the T-3 to T-8 levels. The patient could walk independently within 6 months after discharge, but paraparesis recurred 3 years after surgery. MR imaging showed formation of an intradural arachnoid cyst, which compressed the spinal cord dorsally. She underwent arachnoid cystectomy, and recovered ambulation postoperatively. This case of intradural arachnoid cyst of the thoracic spine which appeared after surgical removal of an epidural hematoma at the same spinal level indicates some association between the epidural hematoma and the arachnoid cyst.

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Spinal meningeal malformations in children (without meningoceles or meningomyeloceles)

Richaud

1988

Child's Nerv Syst

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Symptomatic Anterior Spinal Arachnoid Diverticulum

Cited by 40 publications

References 0 publications

Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature

Symptomatic Spinal Intradural Arachnoid Cysts in the Pediatric Age Group: Description of Three New Cases and Review of the Literature

Thoracic Intradural Arachnoid Cyst Associated With Surgical Removal of Epidural Hematoma-Case Report-

Spinal meningeal malformations in children (without meningoceles or meningomyeloceles)

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