Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery

Abstract

BackgroundSpinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected.Case presentationThis case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique.ConclusionsThe real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.

Minimally Invasive Surgery of Spinal Extradural Arachnoid Cyst with High-Resolution Myelography: A Case Report

“…To perform minimally invasive surgery, accurate localization is required. In our case, the most critical diagnostic procedure for accurate localization was myelography with real-time fluoroscopy 12) . There were many factors to consider, including the number of attempts, proper positioning, and intervention room in which a high-resolution imaging study can be performed.…”

“…However, it is clear that side effects will increase with greater surgical extent. It is better to avoid multi-level laminectomy and fusion, as they can cause extensive muscle damage and T-L kyphosis 2, 5,6,12) . Several alternatives to minimally invasive surgical procedures have been reported such as selective laminectomy with fistula closure or imaging-guided aspiration.…”

“…After checking the T12 to L1 levels in a prone position, a one-level laminectomy was performed. After removing the lamina, a large CSF fluid collection and arachnoid cyst wall were seen in the surgical field 4,12) . According to the categories of Nabors et al 9) (Table 1), the cyst was type Ia, without neural tissue.…”

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

“…1,14,15 About the negative findings from this pathology, the most invasive opening in repeated laminectomies is related to complications such as kyphoscoliosis. 2 The patient may also develop syringomyelia and slow progressive myelopathy. 6,8,11…”

“…Spinal arachnoid cysts are uncommon, and intradural cysts are even less common, although the pediatric population is more likely to have an intradural cyst compared with the general population. [1][2][3] The intradural cyst consists of an arachnoid bag filled with cerebrospinal fluid, which consists in a benign lesion that is entirely in the dural space. 4,5 The course of the spinal arachnoid cyst is not fully understood, and many authors create theories to explain the pathophysiology.…”