[Spinal cysts : Diagnostic workup and therapy]

Spinal Cord Müllerian-Like Cyst at the T12 Vertebral Level: A Case Report and Literature Review

Müllerian cysts are rare developmental anomalies, typically found in the pelvis, with extrapelvic occurrences reported but spinal cord involvement being exceedingly rare. We present the first reported case of a Müllerian-like cyst located on the surface of the spinal cord at the T12 vertebral level. A 49-year-old woman presented with low back and right leg pain, including electric shock-like sensations during sneezing. Physical examination revealed sensory deficits in the right L5 dermatome, and MRI demonstrated an intradural extramedullary cystic lesion at T12, appearing isointense to cerebrospinal fluid on all sequences, with a subtle surface irregularity. A T12 recapping T-saw laminoplasty was performed for surgical excision, and a subtle surface defect on the spinal cord was identified intraoperatively. Pathological examination confirmed the diagnosis of a Müllerian-like cyst. This case highlights the importance of considering Müllerian-like cysts in the differential diagnosis of intradural spinal cysts, even at unusual locations, and demonstrates that careful review of imaging findings, including subtle surface irregularities, can aid in accurate diagnosis and surgical planning. Complete surgical resection is the treatment of choice, and the prognosis is generally excellent.

Neglected Tarlov cysts: a case of a Tarlov cyst with spermatorrhea

Background

Tarlov cysts are a commonly misdiagnosed condition, which can present with many rare symptoms. We report a case of a Tarlov cyst with spermatorrhea and review the pertinent literature.

Case presentation

A 42-year-old male patient had a history of spermatorrhea for > 10 years, but was incorrectly diagnosed as the patient and the doctors consistently mistook the symptoms for a genitourinary disease. Magnetic resonance imaging showed that two cysts in the sacral canal. The diagnosis was Tarlov cyst. We performed surgery to remove the cyst and the symptoms of spermatorrhea disappeared after the operation.

Conclusions

This case demonstrates that orthopedics and urologists should improve their understanding of Tarlov cysts to avoid misdiagnosis and mistreatment.

Multiple extradural spinal arachnoid cysts: A case report

Background:

Extradural spinal arachnoid cysts (SACs) rarely cause neural compression and disability.

Case Description:

A 38-year-old female presented with a history of two episodes of falling due to transient weakness in the lower limbs. The neurological examination showed normal motor and sensory function, but hyperreflexia. The thoracic magnetic resonance imaging revealed multiple extradural SACs between the T3-L1 levels. Following complete surgical resection of the most symptomatic cyst, she did well. The histopathological examination confirmed a Type I extradural SAC.

Conclusion:

Here, we discussed one case and reviewed the literature on the diagnosis and treatment of multiple extradural SACs.

[Nonneoplastic lesions of the spinal canal]

Numerous vascular, inflammatory, degenerative and tumorous lesions of the spinal canal can cause paraplegic symptoms. In addition to the neurological examination and the leading symptoms, the first topographical classification of the (suspected) disease is essential for further diagnostics. Hence, high-resolution magnet resonance imaging (MRI) is the gold standard for the majority of questions. To avoid diagnostic and therapeutic mistakes, differentiation of intraspinal tumors from tumor-like (nonneoplastic) lesions is indispensable, which is often only possible after follow-up imaging or surgical exploration.