Update: Spinal arachnoid cyst

Spinal arachnoid cyst

Epidemiology

Almost always dorsal, most common in the thoracic spine.

Most are extradural and these are sometimes referred to as arachnoid diverticula – these may be associated with kyphoscoliosis in juveniles or with spinal dysraphism.

Etiology

Intradural arachnoid cysts may be congenital or may follow infection or trauma.

Clinical features

Usually asymptomatic, even if large.

Differential diagnosis

Vith a ventral cyst, consider a neurenteric cyst.

Treatment

When indicated, treatment options include:

1. percutaneous procedures: may be done under MRI 1). or CT guidance. CT guidance usually requires use of intrathecal contrast to delineate the cyst

A. needle aspiration.

B. needle fenestration.

2. open surgical resection or fenestration

Case report

Takahashi et al. describe the case of a high cervical, intradural extramedullary cyst located anterior to the spinal cord in a 13-year-old boy. The lesion was fenestrated percutaneously by using real-time magnetic resonance (MR) imaging guidance and a local anesthetic agent. The patient’s symptom, severe exercise-induced headache, immediately resolved after treatment. Nine months later, complete disappearance of the cyst was confirmed on MR imaging and computerized tomography myelography. Magnetic resonance imageing-guided fenestration can be considered a minimally invasive option for intradural cystic lesions 2).

1) , 2) Takahashi S, Morikawa S, Egawa M, Saruhashi Y, Matsusue Y. Magnetic resonance imaging-guided percutaneous fenestration of a cervical intradural cyst. Case report. J Neurosurg. 2003 Oct;99(3 Suppl):313-5. PubMed PMID: 14563151.

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