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

Endo, Hidenori; Takahashi, Toshiyuki; Shimizu, Hiroaki; Tominaga, Teiji

doi:10.2176/nmc.44.607

Cited by 14 publications

(14 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rare and exceptional causes of SEH described in the literature include the ingestion of large amounts of garlic, 24 trumpet playing, 17 chiropractic spinal manipulation therapy, 21 acupuncture, 22 cocaine abuse, 33 lupus erythematosus, 28 ankylosing spondylitis, 4 immobilization of a "hangman's fracture," 12 rupture of a synovial cyst 49 or arachnoid cyst, 23 and pseudogout. 18 These can all be associated with one of the etiological types that we considered: coagulopathy, trauma, spinal puncture, and metabolic disease.…”

Section: Rare Cases Of Sehmentioning

confidence: 99%

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Domenicucci¹,

Mancarella²,

Santoro³

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEThe goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes.METHODSThe authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results. Statistical analysis was also performed in 720 (71.3%) cases to study the incidence of etiological factors that favor SEH formation: coagulopathy, trauma, spinal puncture, pregnancy, and multifactorial disorders. The clinical status at admission and long-term outcome were studied for each group. Clinical status was assessed using the Neuro-Grade (NG) scale.RESULTSThe mean patient age was 47.97 years (range 0–91 years), and a significant proportion of patients were male (60%, p < 0.001). A bimodal distribution has been reported for age at onset with peaks in the 2nd and 6th decades of life. The cause of the SEH was not reported in 42% of cases. The etiology concerned mainly iatrogenic factors (18%), such as coagulopathy or spinal puncture, rather than noniatrogenic factors (29%), such as genetic or metabolic coagulopathy, trauma, and pregnancy. The etiology was multifactorial in 11.1% of cases. The most common sites for SEH were C-6 (n = 293, 31%) and T-12 (n = 208, 22%), with maximum extension of 6 vertebral bodies in 720 cases (75%). At admission, 806 (84%) cases had moderate neurological impairment (NG 2 or 3), and only lumbar hematoma was associated with a good initial clinical neurological status (NG 0 or 1). Surgery was performed in 767 (80%) cases. Mortality was greater in patients older than 40 years of age (9%; p < 0.01). Sex did not influence any of these data (p > 0.05).CONCLUSIONSFactors that contribute to the formation of acute SEH are iatrogenic, not iatrogenic, or multifactorial. The treatment of choice is surgery, and the results of treatment are influenced by the patient’s clinical and neurological status at admission, age, and the craniocaudal site.

show abstract

Section: Rare Cases Of Sehmentioning

confidence: 99%

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Domenicucci¹,

Mancarella²,

Santoro³

et al. 2017

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

show abstract

“…1,16,18,34,37 Arachnoiditis has been found to occur as a result of infection (for example, tuberculosis and malarial infections of the meninges), 9,10,20,24,27 and after cranial aneurysmal subarachnoid hemorrhage, with blood settling in the spinal subarachnoid space and causing delayed arachnoiditis. 3,13,23,39 Ionic intrathecal contrast administration is another known cause of thoracic and lumbar arachnoiditis. 15 Idiopathic causes of arachnoid adhesions, tethering, and scarring are rare but have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…1,7,13,14,16,21,26,30,34,36,42 Treatment, including nonsurgical and surgical management strategies, has provided mixed results, and follow-up offered in the medical literature has been poor. 22,23,25,33 This report describes our experience with thoracic arachnoid pathology, including our series of patients with thoracic spinal cord herniation that has been previously described.…”

mentioning

confidence: 99%

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Griessenauer¹,

Bauer²,

Moore

et al. 2014

SPI

View full text Add to dashboard Cite

Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

show abstract

“…The first search for arachnoid spinal cysts revealed 105 results (out of 500), including multiple extradural arachnoidal cysts and arachnoiditis, as a complication of infection [20], or formation of cysts as a complication of haematomas or surgery [9]. In our search we excluded children with other neural tube deformities.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Intradural spinal arachnoid cysts appear to result from an alteration of the arachnoid trabeculae; some of them are ascribed anecdotally to previous trauma or arachnoiditis [18], whereas the majority are idiopathic [11]. Other causes are considered to be postoperative complications, including lumbar myelography [13], meningitis with adhesions in the subarachnoidal space, epidural haematoma after surgical removal [3,9,13].…”

Section: Introductionmentioning

confidence: 99%

Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case

et al. 2009

View full text Add to dashboard Cite

Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. The diagnosis is clinical and radiological with the use of MRI, CT myelography or a combination of both. The best treatment option is complete removal of the cyst. However, even when paresis is regressing there is no good recovery from neuropathic pain. Laminectomy approach can cause postoperative complications especially when the cyst(s) expand(s) in more than one level. Alternatively, a cyst fenestration can be performed, including the levels of the maximal spinal cord compression. The clinical outcome is as good as after the cyst resection enabling the patient to walk again. The neuropathic pain may persist and require medication. A clinical case is presented, and the literature is reviewed. In the present case we report a patient with intradural arachnoid cysts extending from T6 to L2 and causing severe gait ataxia as well as neuropathic pain and hypaesthesia. The spinal-cord was compressed at T8 and T12. Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.

show abstract

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

Cited by 14 publications

References 15 publications

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Spinal epidural hematomas: personal experience and literature review of more than 1000 cases

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case

Contact Info

Product

Resources

About