Extensive intradural arachnoid cyst of the lumbar spinal canal: case report

doi:10.1016/S0090-3019(03)00150-2

Surgical Neurology

Volume 60, Issue 1, July 2003, Pages 57-59

https://doi.org/10.1016/S0090-3019(03)00150-2 Get rights and content

Abstract

Background

Spinal intradural arachnoid cysts are rare outpouchings of arachnoid lining occurring mainly in the thoracic and cervical regions. MRI is considered the diagnostic procedure of choice; however, some arachnoid cysts have been reported to elude diagnosis by MRI due to the similar signal intensity of the cyst and the subarachnoid space.

Case description

We present a case of a 41-year-old woman with an intradural arachnoid cyst of the lumbar spinal canal. Diagnostic studies demonstrated a herniated L4-5 disk, which led to two operations. Despite intractable pain postoperatively, the MRI failed to reveal further focal compression of the nerve root. A myelogram suggested compression of the thecal sac by a dorsal mass lesion. The patient underwent a midline durotomy that revealed two large arachnoid cysts with the nerve roots beneath them pushed ventrally and to the right. Removal of the arachnoid layer resulted in complete fenestration of the cyst and allowed the nerve roots to freely float in the spinal fluid.

Conclusion

In retrospect, the abnormality could be appreciated on multiple prior scans performed at another institution, demonstrating that in the patient with low back pain, degenerative disc disease is not the only diagnosis to consider.

Section snippets

Case presentation

We report the case of a 41-year-old woman with an extensive intradural arachnoid cyst of the lumbar spinal canal. Following her initial onset of pain while she was lifting a heavy object, she was treated nonsurgically for three years without improvement. Diagnostic studies demonstrated a herniated L4-5 disk, which led to a diskectomy. Failure to improve prompted a second operation shortly after the first in an attempt to further decompress the nerve root. Despite intractable pain

Discussion

Large arachnoid cysts of the lumbar spine such as this are quite uncommon. Most spinal intradural arachnoid cysts are thought to be congenital [3] but acquired arachnoid cysts have also been reported as a result of trauma, hemorrhage, or infection [2]. Although clinical presentation often varies with the cyst’s size and location in addition to the patient’s age, many arachnoid cysts are discovered incidentally; thus, the exact incidence of these lesions remains unknown. Anecdotally, this

References (4)

T.C. Kriss et al.
Symptomatic spinal intradural arachnoid cyst development after lumbar myelography. Case report and review of the literature
Spine
(1997)
H.J. Lee et al.
Symptomatic spinal intradural arachnoid cysts in the pediatric age groupdescription of three new cases and review of the literature
Pediatr Neurosurg
(2001)

There are more references available in the full text version of this article.

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Arachnoid cysts are dural diverticula with liquid content similar to cerebrospinal fluid, with 1% occurring in the spinal cord. They locate mainly in the dorsal region of the thoracic spine, and are unusual causes of spinal cord compression.
The case is presented of a previously healthy 15-year-old boy, with a 20-month history of spastic paraparesis that started apparently after epidural block for ankle osteosynthesis. There was decreased sensitivity and strength of the pelvic limbs and gradually presented with anaesthesia from T12 to L4 dermatomes, L5 and S1 bilateral hypoaesthesia and 4+/5 bilateral strength, in the L2 root and 2+/5 in L3, L4, L5, S1, hyperreflexia, Babinski and clonus, but with no alteration in the sacral reflexes. In the magnetic resonance it was diagnosed as an extradural arachnoid cyst from T6 to T9. The patient underwent a T6 to T10 laminotomy, cyst resection, dural defect suture, and laminoplasty. One year after surgery, the patient had recovered sensitivity, improvement of muscle strength up to 4+/5 in L2 to S1, and normal reflexes.
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SpineExtensive intradural arachnoid cyst of the lumbar spinal canal: case report

Abstract

Background

Case description

Conclusion

Section snippets

Case presentation

Discussion

Symptomatic spinal intradural arachnoid cyst development after lumbar myelography. Case report and review of the literature

Spine

Symptomatic spinal intradural arachnoid cysts in the pediatric age groupdescription of three new cases and review of the literature

Pediatr Neurosurg

Spine
Extensive intradural arachnoid cyst of the lumbar spinal canal: case report