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Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres

  • Original Article - Spine - Other
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Abstract

Purpose

Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC).

Methods

Cases were identified from electronic records of two major neurosurgical centres in London over the last 10 years (October 2009–October 2019) that have been surgically treated in both institutions. Clinical findings, surgical technique, and recurrence by procedure were statistically analysed. Statistical analysis was performed with STATA 13.1 Software.

Results

A total of 42 patients with SIAC were identified for this study with a mean age at the time of surgery of 53.6 years and a male:female ratio of 8:13. There were 31 patients with primary SIACs and 11 with secondary SIACs. The most common presenting symptom was paraesthesia (n = 27). The most common location of the cyst was in the thoracic region (n = 33). Syrinx was present in 26.2% of SIACs (n = 11). Resection was associated with significantly better postoperative pain compared to other surgical techniques (p = 0.01), significantly poorer postoperative urinary function (p = 0.029), and lower rates of sensory recovery in patients who presented preoperatively with sensory deficit (p = 0.041). No significant difference was seen in symptomatic outcomes between patients with primary and secondary SIACs.

Conclusion

Resection and drainage are both effective methods of managing SIACs. In this observational study, resection was associated with significantly reduced pain postoperatively when compared with drainage, however also with significantly less improvement in postoperative urinary function. Therefore, resection should be the gold standard management option for SIACs, with drainage as an option where resection is unsafe, and drainage should also be considered in patients presenting with urinary dysfunction.

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Abbreviations

CSF:

Cerebrospinal fluid

CCI:

Charlson Comorbidity Index

CTM:

Computerised tomography myelogram

MDT:

Multidisciplinary team

SIAC:

Spinal intradural arachnoid cyst

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Authors and Affiliations

  1. Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK

    Asfand Baig Mirza, James Bartram, Siddharth Sinha, Amisha Vastani, Jose Pedro Lavrador, Ahilan Kailaya Vasan & Gordan Grahovac

  2. Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

    Axumawi Gebreyohanes, Edward Dyson, Vittorio Russo & David Choi

  3. King’s College London School of Medicine, Great Maze Pond, London, UK

    Timothy Boardman

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  1. Asfand Baig Mirza
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Correspondence to Asfand Baig Mirza.

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Baig Mirza, A., Bartram, J., Sinha, S. et al. Surgical management and outcomes in spinal intradural arachnoid cysts: the experience from two tertiary neurosurgical centres. Acta Neurochir 164, 1217–1228 (2022). https://doi.org/10.1007/s00701-021-05027-3

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