Updated assessment and current classification of spinal meningeal cysts

Nabors, Michael W.; Pait, T. Glenn; Byrd, Edward B.; Karim, Najmaldin O.; Davis, David O.; Kobrine, Arthur I.; Rizzoli, Hugo V.

doi:10.3171/jns.1988.68.3.0366

Cited by 550 publications

(463 citation statements)

References 56 publications

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“…2C), and type III are intradural arachnoid cysts (Fig. 2D) [22]. According to the Nabors et al classification, the lesion described in this patient is a type Ib meningeal cyst.…”

Section: Natarajan Muthukumarmentioning

confidence: 69%

“…This author, therefore, believes that the term "intrasacral meningocele" should not be used to refer to these lesions. Nabors et al [22] classified spinal meningeal cysts into three types. Type I are extradural meningeal cysts without spinal nerve root fibers; these were further subdivided into type Ia, extradural arachnoid cysts ( Fig.…”

Section: Natarajan Muthukumarmentioning

confidence: 99%

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Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain

Muthukumar

2001

Eur Spine J

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IntroductionSacral extradural arachnoid cysts are rare. When present, they produce low back pain and pain in the perineal region, which is aggravated by Valsalva maneuvers and relieved by lying down. A high index of suspicion is required to diagnose this condition. To date, 41 cases have been reported in the English language literature (Table 1). Case reportA 25-year-old man presented with a 2-year history of pain over the low back and perineal region, which had become severe 1 month prior to admission. The pain was aggravated by standing, walking and straining, and was relieved partially by lying down in the prone position. The patient also complained of numbness of both lower limbs on prolonged standing or walking, which was relieved by lying down. There was no other positive history. Examination revealed normal higher functions and cranial nerves. The patient had weakness of the extensor hallucis longus on both sides, left more than right. There was also tenderness over the upper sacral region. Bladder, bowel and sexual functions were normal. There were no other focal neurological deficits. Plain radiographs of the lumbosacral region revealed a suspicious bony erosion in the midsacral region. Magnetic resonance imaging (MRI) revealed a cystic lesion opposite the second and third sacral segments, which was isointense to cerebrospinal fluid (CSF) on T1-and T2-weighted images (Fig. 1). There was evidence of communication of the cyst with the caudal end of the thecal sac. There was no communication with the pelvis. Scalloping of the sacrum was evident. At surgery, laminectomy of S1-S4 was done, and a large, thin-walled bluish cystic mass containing CSF was encountered, which was opened. The cystic mass was found to be communicating with the thecal sac through a defect in the theca. The fistulous communication was obliterated and the defect in the theca was closed with purse-string sutures. Postoperatively, the patient noted marked relief of pain and did not have numbness while standing and walking. Two years following surgery, the patient was neurologically normal without any deficits. DiscussionThe term "occult sacral meningocele" was first introduced by Enderle in 1932 [19]. It has come to mean a sac composed of fibrous tissue resembling dura mater that is usually lined by arachnoid, lies within an enlarged sacral spinal canal, and is attached to the distal termiAbstract Sacral extradural arachnoid cysts are rare. The clinical and radiological features of this condition are characteristic. One such rare case with low back and perineal pain is presented and the literature is reviewed. This patient presented with pain in the low back and perineal region, which was aggravated by standing, walking and straining. The patient also had numbness in both lower limbs, precipitated by standing and walking. Both the symptoms were relieved by lying down. Magnetic resonance imaging (MRI) revealed a sacral extradural arachnoid cyst. Sacral laminectomy with opening of the arachnoid cyst and ligation of the fistulous tract was ...

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“…2C), and type III are intradural arachnoid cysts (Fig. 2D) [22]. According to the Nabors et al classification, the lesion described in this patient is a type Ib meningeal cyst.…”

Section: Natarajan Muthukumarmentioning

confidence: 69%

Section: Natarajan Muthukumarmentioning

confidence: 99%

Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain

Muthukumar

2001

Eur Spine J

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“…In the Rottweiler of the present study the pseudo cyst was completely isolated from the subarachnoid space, hence corresponding to category III of human SAP (Nabors et al 1988). A functional one-way valve might have developed, allowing the inflow of cerebro spinal fluid, but blocking its outflow from the cavity and leading to progressive expansion and spinal cord compression (Summers et al 1995, Jurina andGrevel 2004).…”

Section: Discussionmentioning

confidence: 59%

Severe focal myelopathy secondary to chronic compression by an arachnoid pseudocyst in a Rottweiler

Polizopoulou

Souftas

Brellou

et al. 2017

J Hellenic Vet Med Soc

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A four-year old Rottweiler was presented with tetraplegia, established progressively over a 4-month period. Initiallythe dog developed paresis of the posterior limbs that subsequently evolved to tetraparesis and finally tetraplegia. Upon neurological examination the dog exhibited spastic tetraplegia with exaggerated spinal reflexes in all four limbs. The neuroanatomical lesion localization indicated a focal or diffuse cervical spinal cord disease. Cisternal myelography revealed obstruction of the contrast medium flow at the level of C5 vertebral body. Magnetic resonance imaging disclosed intradural-extramedullary compression of the spinal cord at the level of C5-C6 intervertebral disc by a spinal arachnoid pseudocyst, syrinx formation and myelopathy expressed as abnormally higher signal on T2-weighted images at the C5 segment level. Severe demyelination, involving exclusively the white matter of the grossly affected segments and extending rostrally into the brainstem and caudally into the thoracic spinal cord segments, was noticed on histopathology. The unusually severe secondary degenerative change in the cervical spinal cord white matter, inflicted by focal SAP compression, was the most interesting finding.

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“…4 Type I lesions are extradural meningeal cysts without spinal nerve root fibres, which can be subdivided into Type IA extradural meningeal cysts and Type IB sacral meningocele. Type II meningeal cysts are extradural and contain nerve root fibres ('Tarlov's perineural cyst').…”

Section: Discussionmentioning

confidence: 99%

“…Spinal abnormalities are associated with a higher incidence of spinal meningeal cysts. 4 The clinical findings should lead to diagnostic imaging. Plain X-rays can reveal hereditary bone defects.…”

Section: Discussionmentioning

confidence: 99%

Spinal extradural meningeal cyst with spinal stenosis

et al. 2005

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Study design: Case report.Objective: To present a rare pathology causing a common disease. Setting: Spine unit of the orthopaedic surgery department of a university hospital in Berlin/ Germany. Case report: A 39-year-old female with an intraspinal extradural arachnoid cyst of the lumbar spine presented with intermittent radiating lumbar pain. The magnetic resonance imaging (MRI) showed a dorsal spinal extradural arachnoid cyst at L3/4. After wide laminotomy L3, operative cyst resection and stabilisation at L3/4 by posterior lumbar interbody fusion (PLIF), major symptom relief occurred. Conclusion: Spinal extradural arachnoid cysts are a rare entity causing low back pain and intermittent radicular syndromes. They can be caused by arachnoid herniation through dural weak spots which are hereditary or occur after trauma. A ball-valve mechanism promotes growth. The main diagnostic tool for spinal extradural cysts is the MRI scan. Additionally, myelography is helpful to demonstrate fluid communication. Complete surgical removal of the cyst should be attempted to reduce risk of recurrence. If extensive decompression is needed for the surgical approach causing segmental instability, interbody fusion is recommended. The outcome depends on age, duration and degree of neurological damage.

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Updated assessment and current classification of spinal meningeal cysts

Cited by 550 publications

References 56 publications

Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain

Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain

Severe focal myelopathy secondary to chronic compression by an arachnoid pseudocyst in a Rottweiler

Spinal extradural meningeal cyst with spinal stenosis

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