1
|
Wang YB, Wang DH, Deng SL. Symptomatic secondary spinal arachnoid cysts: a systematic review. Spine J 2023:S1529-9430(23)00105-5. [PMID: 36924909 DOI: 10.1016/j.spinee.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long rostral-caudal extensions and many are related to arachnoiditis, leading to difficult-to-treat disorders. Thus far, due to the scarcity of reports, the features of the disease and the optimal therapeutic strategies remain unclear. PURPOSE To investigate clinical features and the optimal treatment modalities of secondary spinal arachnoid cysts compared to primary spinal arachnoid cysts STUDY DESIGN: Systematic review PATIENT SAMPLE: Systematic review identified 103 secondary cases from 80 studies and reports; OUTCOME MEASURES: Condition of symptom relief and duration of treatment response were analyzed. METHOD An electronic literature search of the PubMed database was conducted for studies on secondary spinal arachnoid cysts between 1990 to 2022. Non-English publications, non-human studies, reports of a primary cyst, studies not including case details, and studies of non-symptomatic cases were excluded. RESULTS This systematic review included 103 secondary cases. The most commonly reported etiologies were iatrogenic factors, trauma, and subarachnoid hemorrhage, accounting for 88 intradural extramedullary, 11 extradural, 1 intradural/extradural, 1 interdural, and 1 intramedullary spinal arachnoid cyst after a median duration of 30, 12, and 9 months, respectively. Extradural cysts were more prone to occur at dorsal locations and affect thoracic segments (mean cyst length: 3.4 segments). Intradural cysts showed a relatively higher ventral/dorsal ratio (1:1.09, 1.75:1, and 3.50:1 for cysts occurring from iatrogenic factors, trauma, and subarachnoid hemorrhage, respectively) and thoracic distribution, with a mean cyst length of 4.3 segments (5.1 for ventral and 3.5 for dorsal cysts). For intradural cysts, recurrence risk was lower after surgical resection than after fenestration/marsupialization (12-month recurrence risk: 21.43% vs. 50.72%, log-rank test: P = 0.0248, Gehan-Breslow-Wilcoxon test: P = 0.0126). In cases treated with shunting, one recurrence (1/8 cases) was noted after external shunting and two recurrences (2/5 cases) after internal shunting at a median follow-up of 12 months. CONCLUSION Secondary spinal arachnoid cysts, particularly intradural cysts, are rarer and more challenging to treat than primary spinal cysts. Although fenestration/marsupialization is the commonly adopted treatment, the recurrence rate is high. For unresectable cysts, shunting procedures, particularly shunting into a body cavity (e.g., pleural or peritoneal cavity) away from the subarachnoid space, could be a therapeutic alternative besides fenestration/marupialization, yet its efficacy requires confirmation by more data.
Collapse
Affiliation(s)
- Yu-Bo Wang
- Department of Oncological Neurosurgery, First Hospital of Jilin University
| | - Dan-Hua Wang
- Department of Pathology, First Hospital of Jilin University
| | - Shuang-Lin Deng
- Department of Oncological Neurosurgery, First Hospital of Jilin University.
| |
Collapse
|
2
|
Lee HG, Kang MS, Na YC, Jin BH. Spinal intradural arachnoid cyst as a complication of insertion of an interspinous device. Br J Neurosurg 2019:1-5. [DOI: 10.1080/02688697.2019.1668541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Han Gyu Lee
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Moo Sung Kang
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Young Chul Na
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Byung Ho Jin
- Department of Neurosurgery, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| |
Collapse
|
3
|
KrishnanKutty R, Sreemathyamma SB, Sivanandapanicker JL, Asher P, Prabhakar RB, Peethambaran A. Hemilaminectomy for Spinal Cord Intradural Tumors: An Institutional Experience. Asian J Neurosurg 2018; 13:760-765. [PMID: 30283540 PMCID: PMC6159102 DOI: 10.4103/ajns.ajns_106_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Laminectomy is the workhorse of spinal cord tumor surgery. This procedure is not without the debilitating sequelae of postoperative pain and delayed kyphosis. Hemilaminectomy is an alternate option to laminectomy which offers the advantage of preserving the posterior supporting structures of the spine on the contralateral side. In this study, we analyze the outcome of hemilaminectomy clinically with improvement in pain scores and Nurick's grade as well as radiologically by assessing for the development of delayed kyphosis. We also discuss the technique and operative nuances of hemilaminectomy in intradural extramedullary tumors of the spinal cord. Materials and Methods: All patients with intradural spinal cord tumors were included in the study. All patients underwent unilateral hemilaminectomy (UHL) depending on the laterality of the tumor on the preoperative magnetic resonance imaging. Preoperative neurologic status was assessed with Nurick's grade for tumors involving the cervicothoracic region tumors, and visual analog scale scores were recorded for tumors of Thoracic, Lumbar and Lumbosacral regions. The postoperative outcomes were assessed by improvement in respective scales on follow-up. The occurrence of delayed spinal deformity was assessed by follow-up X-rays. Any complications whether intraoperative or postoperative were recorded. Results: There were a total of 34 cases of intradural extramedullary tumors in this study. Patient population consisted of 11 males and 23 females. Total excision was achieved in 31 patients. In three patients, we were unable to achieve complete removal through UHL. In these patients the procedure was converted to total laminectomy. They were excluded from analysis. The distribution of the tumors was in cervical, cervicothoracic, thoracic, lumbar, and lumbosacral region. All patients presented with pain or varying degrees or neurologic deficits. Sixteen patients underwent UHL from the right side, while 18 from the left. There were no intraoperative complications. The neurological status and pain scores of all patients improved postoperatively at 3 and 6 months of follow-up. There was no radiological evidence of kyphosis of the involved segment. Conclusion: With a small learning curve, UHL is a good corridor for the removal of intradural extramedullary spinal cord tumors. This approach offers the advantage of less postoperative pain and no postoperative deformity.
Collapse
Affiliation(s)
- Raja KrishnanKutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | | | - Prasanth Asher
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| |
Collapse
|
4
|
Umerani MS, Mostafa GA, Nada MAF, Darwish AAQ. Postepidural Spinal Intradural Arachnoid Cyst: A Rare Case Report. J Neurosci Rural Pract 2017; 8:677-679. [PMID: 29204040 PMCID: PMC5709903 DOI: 10.4103/jnrp.jnrp_335_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Compression of the neural structures in spine by an intradural arachnoid cyst is a rare entity. At times such a cyst is an incidental finding. Spinal epidural injection is one of the few rare etiological factors for its development. Symptomatic cysts can present with variable neurological manifestations depending on the spinal level involved. This includes back pain, lower limb weakness, and sphincteric dysfunction. If asymptomatic, they can be followed radiologically. Surgical decompression along with a histological diagnosis is reserved for cysts that are enlarging, symptomatic or the ones for whom the diagnosis is uncertain. Incomplete excision of cyst wall or simple fenestration and decompression mandates close follow-up, clinically and radiologically for further recurrences.
Collapse
Affiliation(s)
| | - Gabr Ahmed Mostafa
- Department of Clinical Neurosciences, King Fahd Military Medical Complex, Dhahran, KSA
| | - Mona A F Nada
- Department of Clinical Neurosciences, King Fahd Military Medical Complex, Dhahran, KSA
| | | |
Collapse
|
5
|
Domenicucci M, Mancarella C, Santoro G, Dugoni DE, Ramieri A, Arezzo MF, Missori P. Spinal epidural hematomas: personal experience and literature review of more than 1000 cases. J Neurosurg Spine 2017; 27:198-208. [PMID: 28574329 DOI: 10.3171/2016.12.spine15475] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes. METHODS The authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results. Statistical analysis was also performed in 720 (71.3%) cases to study the incidence of etiological factors that favor SEH formation: coagulopathy, trauma, spinal puncture, pregnancy, and multifactorial disorders. The clinical status at admission and long-term outcome were studied for each group. Clinical status was assessed using the Neuro-Grade (NG) scale. RESULTS The mean patient age was 47.97 years (range 0-91 years), and a significant proportion of patients were male (60%, p < 0.001). A bimodal distribution has been reported for age at onset with peaks in the 2nd and 6th decades of life. The cause of the SEH was not reported in 42% of cases. The etiology concerned mainly iatrogenic factors (18%), such as coagulopathy or spinal puncture, rather than noniatrogenic factors (29%), such as genetic or metabolic coagulopathy, trauma, and pregnancy. The etiology was multifactorial in 11.1% of cases. The most common sites for SEH were C-6 (n = 293, 31%) and T-12 (n = 208, 22%), with maximum extension of 6 vertebral bodies in 720 cases (75%). At admission, 806 (84%) cases had moderate neurological impairment (NG 2 or 3), and only lumbar hematoma was associated with a good initial clinical neurological status (NG 0 or 1). Surgery was performed in 767 (80%) cases. Mortality was greater in patients older than 40 years of age (9%; p < 0.01). Sex did not influence any of these data (p > 0.05). CONCLUSIONS Factors that contribute to the formation of acute SEH are iatrogenic, not iatrogenic, or multifactorial. The treatment of choice is surgery, and the results of treatment are influenced by the patient's clinical and neurological status at admission, age, and the craniocaudal site.
Collapse
Affiliation(s)
| | | | | | | | | | - Maria Felice Arezzo
- Department of Methods and Models for Economics, Territory and Finance, "Sapienza" University of Rome; and
| | - Paolo Missori
- Department of Neurology and Psychiatry, Neurosurgery, and
| |
Collapse
|
6
|
Griessenauer CJ, Bauer DF, Moore TA, Pritchard PR, Hadley MN. Surgical manifestations of thoracic arachnoid pathology: series of 28 cases. J Neurosurg Spine 2014; 20:30-40. [DOI: 10.3171/2013.9.spine1323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology.
Methods
The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported.
Results
Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion.
Conclusions
Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.
Collapse
Affiliation(s)
| | | | - Thomas A. Moore
- 1Division of Neurosurgery and
- 2Department of Anesthesiology, University of Alabama at Birmingham, Alabama
| | | | | |
Collapse
|
7
|
Um DT, Heiner JD, Kang CS. Spinal arachnoid cyst as an atypical insidious cause of acute back pain. Am J Emerg Med 2010; 28:982.e1-3. [PMID: 20825826 DOI: 10.1016/j.ajem.2009.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 12/13/2009] [Indexed: 01/07/2023] Open
Affiliation(s)
- David T Um
- Department of Emergency Medicine, Madigan Army Medical Center, Fort Lewis, WA 98431, USA.
| | | | | |
Collapse
|
8
|
Endo T, Takahashi T, Jokura H, Tominaga T. Surgical treatment of spinal intradural arachnoid cysts using endoscopy. J Neurosurg Spine 2010; 12:641-6. [DOI: 10.3171/2009.12.spine09577] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Spinal intradural arachnoid cysts are a rare cause of spinal cord compression. Since 2000, the authors have treated patients using 2- or 3-level hemilaminectomy or laminectomy followed by partial cyst wall resection as well as endoscopic inspection and fenestration of the cyst wall. They evaluated the usefulness and reliability of endoscopic treatment for this clinical entity based on long-term follow-up results.
Methods
Between 1997 and 2003, 11 patients (3 males and 8 females) with spinal intradural arachnoid cysts were treated, and the authors conducted a retrospective review of these cases. Before 2000, 5 patients were surgically treated without the use of endoscopic techniques. During that time, more than 4 levels of hemilaminectomy were performed to expose and remove cyst walls that extended longitudinally over the spinal axis. Beginning in 2000, endoscopy was used in all 6 cases. Up to 3 levels of hemilaminectomy or 2 levels of laminectomy were performed, and the cyst wall was resected through the bone window. An endoscope was inserted into the cyst cavity and moved in the cranial and caudal direction to fenestrate the cyst wall, resulting in communication of the cyst cavity with the subarachnoid space.
Results
Postoperatively, the neurological symptoms of all patients improved. During long-term follow-up (mean 114.8 months), none of the patients treated with or without endoscopy experienced recurrent cyst formation.
Conclusions
Endoscopic techniques allow neurosurgeons to treat spinal intradural arachnoid cysts less invasively than with standard surgical approaches. Although the number of cases reviewed in this report is small, the data suggest that the use of endoscopy can be an important option in the surgical treatment of spinal arachnoid cysts.
Collapse
|
9
|
Petridis AK, Doukas A, Barth H, Mehdorn HM. Spinal cord compression caused by idiopathic intradural arachnoid cysts of the spine: review of the literature and illustrated case. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 19 Suppl 2:S124-9. [PMID: 19763637 DOI: 10.1007/s00586-009-1156-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/18/2009] [Accepted: 08/24/2009] [Indexed: 11/29/2022]
Abstract
Intradural spinal arachnoid cysts with cord compression are rare. When becoming symptomatic they cause variable symptoms involving gait disturbance, paraparesis or tetraparesis and neuropathic pain, decreasing significantly the patients' life quality. The extension of such cysts averages 3.7 vertebral bodies. The diagnosis is clinical and radiological with the use of MRI, CT myelography or a combination of both. The best treatment option is complete removal of the cyst. However, even when paresis is regressing there is no good recovery from neuropathic pain. Laminectomy approach can cause postoperative complications especially when the cyst(s) expand(s) in more than one level. Alternatively, a cyst fenestration can be performed, including the levels of the maximal spinal cord compression. The clinical outcome is as good as after the cyst resection enabling the patient to walk again. The neuropathic pain may persist and require medication. A clinical case is presented, and the literature is reviewed. In the present case we report a patient with intradural arachnoid cysts extending from T6 to L2 and causing severe gait ataxia as well as neuropathic pain and hypaesthesia. The spinal-cord was compressed at T8 and T12. Surgical treatment with partial cyst resection in the compressed levels with an interlaminar approach brought similar results as complete resection. The patient was able to walk without help which was not possible before surgery. The cysts' extension is impressive as well as the minimal operative procedure.
Collapse
Affiliation(s)
- Athanasios K Petridis
- Department of Neurosurgery, University of Schleswig Holstein, Campus Kiel, Schittenhelmstr 10, 24105 Kiel, Germany.
| | | | | | | |
Collapse
|
10
|
Ginanneschi F, Palma L, Rossi A. Arachnoid cyst and arachnoiditis following idiopathic spinal subarachnoid haemorrhage. Br J Neurosurg 2009; 22:578-9. [DOI: 10.1080/02688690701832118] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Anterior cysts of the spine. J Neurol 2008; 255:1662-9. [DOI: 10.1007/s00415-008-0951-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 02/15/2008] [Accepted: 03/25/2008] [Indexed: 12/16/2022]
|