Systematic Review of Surgical Management of Spinal Intradural Arachnoid Cysts

Mirza, Asfand Baig; Bartram, James; Vastani, Amisha; Gebreyohanes, Axumawi; Banna, Qusai Al; Lavrador, José Pedro; Vasan, Ahilan Kailaya; Grahovac, Gordan

doi:10.1016/j.wneu.2021.10.173

Cited by 8 publications

(3 citation statements)

References 36 publications

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“…[23][24][25] Primary arachnoid cysts typically respond well to fenestration or marsupialization while secondary arachnoid cysts are challenging and have high rates of recurrence. 26,27 Cyst shunting may be considered for recurrent or surgically inaccessible cysts.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic spinal arachnoid cyst with spastic diplegia secondary to cerebral palsy: illustrative case

Guillotte,

Alkiswani,

Keeler

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Selective dorsal rhizotomy (SDR) can improve the spastic gait of carefully selected patients with cerebral palsy. Spinal arachnoid cysts are a rare pathology that can also cause spastic gait secondary to spinal cord compression. OBSERVATIONS The authors present an interesting case of a child with cerebral palsy and spastic diplegia. He was evaluated by a multidisciplinary team and determined to be a good candidate for SDR. Preoperative evaluation included magnetic resonance imaging (MRI) of the spine, which identified an arachnoid cyst causing spinal cord compression. The cyst was surgically fenestrated, which provided some gait improvement. After recovering from cyst fenestration surgery, the patient underwent SDR providing further gait improvement. LESSONS SDR can be beneficial for some patients with spastic diplegia. Most guidelines do not include spinal MRI in the preoperative evaluation for SDR. However, spinal MRI can be beneficial for surgical planning by localizing the level of the conus. It may also identify additional spinal pathology that is contributing to the patient’s spasticity. In rare cases, such as this one, patients may benefit from staged surgery to address structural causes of spastic gait prior to proceeding with SDR.

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Section: Discussionmentioning

confidence: 99%

Symptomatic spinal arachnoid cyst with spastic diplegia secondary to cerebral palsy: illustrative case

Guillotte,

Alkiswani,

Keeler

et al. 2023

Journal of Neurosurgery: Case Lessons

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“…While spinal extradural arachnoid cysts (extradural SACs) are more common than spinal intradural arachnoid cysts (intradural SACs), both lesions are typically single, sporadic, and recur infrequently after treatment [ 8 ]. The recurrence rates after surgical excision of intradural SACs in the adult and pediatric populations have been estimated at 13% [ 1 ] and 9.5% [ 4 ], respectively. While a 2009 report identified about 20 cases of multiple extradural ones [ 2 ], the prevalence of multiple intradural SACs within the literature has yet to be covered.…”

Section: Introductionmentioning

confidence: 99%

An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature

et al. 2023

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Spinal arachnoid cysts (SACs) arise either intra- or extradurally and are usually solitary, while cases of multiple SACs have been scarcely reported in the literature. Herein, we report on a rare case of multiple and recurring intradural spinal arachnoid cysts (SACs) causing severe spinal cord compression and neuropathic radicular pain, in a 35-year-old female with a 10-year follow-up. Two separate attempts at surgery were performed but only provided temporary relief since the cysts recurred and new ones formed along the entirety of the spinal cord. Finally, a conservative approach with physiotherapy and a combination of analgesic medications was pursued.

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“…The current dogma for management of SAC is to treat symptomatic patients with surgery and to use observational management for asymptomatic patients or those with minimal symptoms [ 1 , 2 , 4 , 5 ]. Surgical management includes exploration and decompression through cyst excision, marsupialization, fenestration, shunting or a combination of these techniques [ 2 , 4 , 14 ]. Whether an observational method of treatment is the optimal therapy or potentially harmful for minimally symptomatic cases remains unknown as the natural progression of this rare pathology is understudied.…”

Section: Introductionmentioning

confidence: 99%

Impact of Surgical Timing on Neurological Outcomes for Spinal Arachnoid Cyst: A Single Institution Series

Chatain

Shrestha²,

Kortz³

et al. 2022

Neurospine

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Objective: Spinal arachnoid cysts (SACs) are rare lesions that often present with back pain and myelopathy. There is a paucity of literature evaluating the impact of surgical timing on neurological outcomes for primary SAC management. To compare long-term neurological outcomes in patients who were managed differently and to understand natural progression of SAC.Methods: We conducted a retrospective analysis of adult patients treated for SAC at our institution from 2010 to 2021, stratified into 3 groups (conservative management only, surgical management, or conservative followed by surgical management). Study outcome measures were neurological outcomes as measured by modified McCormick Neurologic Scale (MNS), postoperative complications, and cyst recurrence. Nonparametric analysis was performed to evaluate differences between groups for selected endpoints.Results: Thirty-six patients with SAC were identified. Eighteen patients were managed surgically. The remaining 18 patients were managed conservatively with outpatient serial imaging, 7 of whom (38.9%) ultimately underwent surgical treatment due to neurological decline. Most common presenting symptoms included back pain (50.0%), extremity weakness (36.1%), and numbness/paresthesia (36.1%). Initial/preoperative (p = 0.017) and 1-year postoperative (p = 0.006) MNS were significantly different between the 3 groups, but not at 6 weeks or 6 months postoperatively (p > 0.05). Additionally, at 1 year, there was no difference in MNS between patients managed surgically and those managed conservatively but ultimately underwent surgery (p > 0.99).Conclusion: Delayed surgical intervention in minimally symptomatic patients does not seem to result in worse long-term neurofunctional outcomes. At 1 year, postoperative MNS were significantly higher in both surgical groups, when compared to the conservative group highlighting worsening clinical picture regardless of preoperative observational status.

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Systematic Review of Surgical Management of Spinal Intradural Arachnoid Cysts

Cited by 8 publications

References 36 publications

Symptomatic spinal arachnoid cyst with spastic diplegia secondary to cerebral palsy: illustrative case

Symptomatic spinal arachnoid cyst with spastic diplegia secondary to cerebral palsy: illustrative case

An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature

Impact of Surgical Timing on Neurological Outcomes for Spinal Arachnoid Cyst: A Single Institution Series

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