Korean J Neurotrauma.  2016 Oct;12(2):185-190. 10.13004/kjnt.2016.12.2.185.

Spinal Extradural Arachnoid Cyst

• Woo JB
• Son DW
• Kang KT
• Lee JS
• Song GS
• Sung SK
• Lee SW

• KMID: 2356799
• DOI: http://doi.org/10.13004/kjnt.2016.12.2.185

Abstract

A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient's symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.

Keyword

Arachnoid cyst; Fenestration, Labyrinth; Cerebrospinal fluid

MeSH Terms

Adult
Aged
Arachnoid*
Cerebrospinal Fluid
Consensus
Epidural Space
Female
Fenestration, Labyrinth
Follow-Up Studies
Humans
Laminectomy
Magnetic Resonance Imaging
Recurrence
Subarachnoid Space

Figure

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  FIGURE 1 Preoperative images case 1. (A) Multi-level distortion of spinal canal and filling defect from T12 to L5 on myelogram. (B, C) Elongated cystic lesion compressing spinal thecal sac at T12 to L4.

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  FIGURE 2 Intraoperative images of case 1. (A) L1 total laminectomy was performed to exposure dura defect. (B) Repair the defect site with the cyst wall.

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  FIGURE 3 Postoperative images of case 1. (A, B) Magnetic resonance imaging taken 4 months after the surgery showed total removed state of cystic lesion.

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  FIGURE 4 Preoperative images case 2. (A) Computed tomography myelography showed focal enhanced cystic mass that communicated with thecal sac at L1 level. (B, C) Cystic mass compressing dorsal side of thecal sac from T2 to L2 level.

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  FIGURE 5 Intraoperative images of case 2. (A) Total laminectomy T12 and L1 level was performed to exposure the defective site. (B) Using cyst wall fragment, primary repair of defective site was performed.

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  FIGURE 6 Postoperative images of case 2. (A, B) Magnetic resonance imaging taken 2 months after the surgery showed a complete disappearance of the cyst with no evidence of cord compression due to a residual cyst.

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