J Korean Neurosurg Soc.  2021 Mar;64(2):238-246. 10.3340/jkns.2020.0244.

Surgical Treatment of Ten Adults with Spinal Extradural Meningeal Cysts in the Thoracolumbar Spine

• Xu F
• Jian F
• Li L
• Guan J
• Chen Z

• KMID: 2513854
• DOI: http://doi.org/10.3340/jkns.2020.0244

Abstract

Objective
: To retrospectively analyze the clinical characteristics and surgical experience of 10 adults with spinal extradural meningeal cysts (SEMCs) in the thoracolumbar spine which may further provide evidence for surgical decision-making.
Methods
: Ten adults with SEMCs in the thoracolumbar spine were surgically treated and enrolled in this study. Clinical manifestations, imaging data, intraoperative findings and postoperative outcome were recorded.
Results
: Clinical manifestations of SEMCs included motor and sensory dysfunction of the lower limbs and urination and defecation disturbance. The cysts presented as intraspinal occupying lesions dorsal to the spine, ranging from the T8 to L3 level. Defects of eight cases were found on preoperative magnetic resonance imaging (MRI). Selective hemilaminectomy or laminectomy were used to reveal the defect within the cyst, which was further sutured with microscopic technique. The final outcome was excellent or good in seven cases and fair in three cases. No recurrence was observed during follow-up.
Conclusion
: SEMCs are rare intraspinal cystic lesions. Radiography and MRI are clinically practical methods to assess defects within SEMCs. Selective hemilaminectomy or laminectomy may reduce surgical trauma. Detection and microscopic suturing of the defects are the key steps to adequately decompress the nervous tissue and prevent postoperative recurrence.

Keyword

Spinal extradural meningeal cysts; Dural defect; Dural diverticula; Surgery; Thoracolumbar

Figure

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  Fig. 1. Case No. 12. A : Sagittal T2-weighted MR image demonstrates a cyst extending from T11 to L2 with dorsal compression of the spinal cord and cauda equina. B : Axial T2-weighted image reveals cyst extension through the left neural foramina. C : Anteroposterior radiography shows narrowing of bilateral vertebral pedicles from T12 to L1 (nail pointed to spinous process of T12). D : Nerve root fiber moves back and forth via the dural defect.

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  Fig. 2. Case No. 7. A : Sagittal T2-weighted magnetic resonance image demonstrates an irregular cyst extending from T12 to L2 with dorsal compression of the spinal cord. B : Axial T2-weighted image shows a bony erosion in the back of L1 vertebral body (right side) by spinal extradural meningeal cyst and enlargement of bilateral intervertebral foramens.

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  Fig. 3. Case No. 3. A-C : A cyst extended from T10 to L2 with dorsal compression of the spinal cord. All SEMCs shows homogenous low-intensity signals on T1-weighted MRI and high-intensity signals on T2-weighted MRI. No enhancement is demonstrated by contrast agents. A suspected flow void is identified at T12 level. D : Axial T2-weighted image (T12 level) reveals the cyst is larger in the right side. E : Dural defect is identified under T12 nerve root sleeve during surgery, and the nerve root is adherent to the defect. F : Closing of the defect. G : Strengthening with muscle and fibrin sealant at the defect. H : Significant resolution of SEMC and nerve decompression after surgery. SEMC : spinal extradural meningeal cyst, MRI : magnetic resonance imaging.

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  Fig. 4. Case No. 6. A : A cyst extends from T11 to L2 segment. A suspected flow void is identified at T12 level. B : Anteroposterior radiogram demonstrates significant narrowing of left vertebral pedicles of T12 (red arrow). C : However, the cyst presents symmetrically at T12 level on axial T2-weighted image. D : The cyst shranks dramatically and nerve decompression is achieved. E : Postoperative three-dimensional computed tomography reconstruction illustrates the range of hemilaminectomy (from T12 to L2).

Reference

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