J Korean Neurosurg Soc.  2013 May;53(5):309-311. 10.3340/jkns.2013.53.5.309.

Bilateral Thoracic Ganglion Cyst : A Rare Case Report

• Kazanci B
• Tehli O
• Turkoglu E
• Guclu B

• KMID: 1426202
• DOI: http://doi.org/10.3340/jkns.2013.53.5.309

Abstract

Ganglion cysts usually arise from the tissues around the facet joints. It is usually associated with degenerative cahanges in facet joints. Bilateral thoracic ganglion cysts are very rare and there is no previous case that located in bilateral intervertebral foramen compressing the L1 nerve root associated with severe radiculopathy. We report a 53 years old woman who presented with bilateral groin pain and severe numbness. Magnetic resonance imaging revealed bilateral cystic mass in the intervertebral foramen between 12th thoracal and 1st lumbar vertebrae. The cystic lesions were removed after bilateral exposure of Th12-L1 foramens. The result of hystopathology confirmed the diagnosis as ganglion cyst. The ganglion cyst may compromise lumbar dorsal ganglion when it located in the intervertebral foramen. The surgeon should keep this rare entity in their mind for differential diagnosis.

Keyword

Ganglion cyst; Radiculopathy; Synovial cyst; Thoracic spine

MeSH Terms

Diagnosis, Differential
Female
Ganglion Cysts
Groin
Humans
Hypesthesia
Lumbar Vertebrae
Magnetic Resonance Imaging
Radiculopathy
Synovial Cyst
Zygapophyseal Joint

Figure

• 

  Fig. 1 Axial T2-weighted thoracolomber MRI shows cystic mass in the bilateral intervertebral foramen between 12th thoracal and 1st lumbar vertebrae.

• 

  Fig. 2 Preoperative right sided (A) and left sided (B) sagittal T2 images shows cystic mass associated with the synovial joints bilaterally as well as bilateral nerve roots compression.

• 

  Fig. 3 Photomicrographs shows the wall of the cyst is lined by nonsynovial flattened cells and is surrounded by a dense inflammatory cell.

Reference

1. Boviatsis EJ, Stavrinou LC, Kouyialis AT, Gavra MM, Stavrinou PC, Themistokleous M, et al. Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. Eur Spine J. 2008; 17:831–837. PMID: 18389295.

2. Cheng YY, Chen CC, Yang MS, Hung HC, Lee SK. Intraspinal extradural ganglion cyst of the cervical spine. J Formos Med Assoc. 2004; 103:230–233. PMID: 15124052.

3. Cho SM, Rhee WT, Lee SY, Lee SB. Ganglion cyst of the posterior longitudinal ligament causing lumbar radiculopathy. J Korean Neurosurg Soc. 2010; 47:298–301. PMID: 20461173.

4. Cohen-Gadol AA, White JB, Lynch JJ, Miller GM, Krauss WE. Synovial cysts of the thoracic spine. J Neurosurg Spine. 2004; 1:52–57. PMID: 15291021.

5. Hemminghytt S, Daniels DL, Williams AL, Haughton VM. Intraspinal synovial cysts : natural history and diagnosis by CT. Radiology. 1982; 145:375–376. PMID: 7134440.

6. Holtzman RN, Dubin R, Yang WC, Rorat E, Liu HM, Leeds NE. Bilateral symptomatic intraspinal T12-L1 synovial cysts. Surg Neurol. 1987; 28:225–230. PMID: 3629450.

7. Kao CC, Uihlein A, Bickel WH, Soule EH. Lumbar intraspinal extradural ganglion cyst. J Neurosurg. 1968; 29:168–172. PMID: 5673315.

8. Kim SW, Choi JH, Kim MS, Chang CH. A ganglion cyst in the second lumbar intervertebral foramen. J Korean Neurosurg Soc. 2011; 49:237–240. PMID: 21607185.

9. Liu SS, Williams KD, Drayer BP, Spetzler RF, Sonntag VK. Synovial cysts of the lumbosacral spine: diagnosis by MR imaging. AJNR Am J Neuroradiol. 1989; 10:1239–1242. PMID: 2512789.

10. Lopes NM, Aesse FF, Lopes DK. Compression of thoracic nerve root by a facet joint synovial cyst: case report. Surg Neurol. 1992; 38:338–340. PMID: 1485209.

11. Martin D, Awwad E, Sundaram M. Radiologic case study. Lumbar ganglion cyst causing radiculopathy. Orthopedics. 1990; 13:11771182–1883. PMID: 2147482.

12. Oertel MF, Ryang Y, Ince A, Gilsbach JM, Rohde V. Microsurgical therapy of symptomatic lumbar juxta facet cysts. Minim Invasive Neurosurg. 2003; 46:349–353. PMID: 14968402.

13. Pendleton B, Carl B, Pollay M. Spinal extradural benign synovial or ganglion cyst : case report and review of the literature. Neurosurgery. 1983; 13:322–326. PMID: 6621847.

14. Radatz M, Jakubowski J, Cooper J, Powell T. Synovial cysts of the lumbar spine: a review. Br J Neurosurg. 1997; 11:520–524. PMID: 11013623.

15. Shah RV, Lutz GE. Lumbar intraspinal synovial cysts: conservative management and review of the world's literature. Spine J. 2003; 3:479–488. PMID: 14609693.

16. Weyns F, Van Calenbergh F, Goffin J, Plets C. Intraspinal juxta-facet cysts: a case of bilateral ganglion cysts. Clin Neurol Neurosurg. 1992; 94:55–59. PMID: 1321700.

17. Wilby MJ, Fraser RD, Vernon-Roberts B, Moore RJ. The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine (Phila Pa 1976). 2009; 34:2518–2524. PMID: 19927101.

18. Yamamoto A, Nishiura I, Handa H, Kondo A. Ganglion cyst in the ligamentum flavum of the cervical spine causing myelopathy: report of two cases. Surg Neurol. 2001; 56:390–395. PMID: 11755976.