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Spinal arachnoid cysts in the pediatric age group: an association with neural tube defects
C H Rabb1, J G McComb, C Raffel
1Division of Neurosurgery, Childrens Hospital, Los Angeles, California.
Insights
Spinal arachnoid cysts, often associated with neural tube defects, can cause progressive neurological issues. Surgical treatment, including fenestration or shunting, effectively improves or halts symptom progression in pediatric patients.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Spinal Cord Disorders
Background:
- Spinal arachnoid cysts are rare, potentially causing significant neurological deficits.
- Their association with congenital anomalies like myelomeningocele warrants further investigation.
Purpose of the Study:
- To analyze the clinical presentation, treatment, and outcomes of spinal arachnoid cysts in pediatric patients.
- To determine the relationship between spinal arachnoid cysts and neural tube defects.
Main Methods:
- Retrospective review of 11 pediatric patients diagnosed with spinal arachnoid cysts between 1979 and 1991.
- Evaluation of cyst location, presenting symptoms, surgical interventions (fenestration, resection, shunting), and patient outcomes.
Main Results:
- Eleven patients (aged 19 months to 18 years) presented with various neurological symptoms or were asymptomatic.
- Six patients had myelomeningocele, and one had diastematomyelia; four cysts were intradural and anterior.
- Surgical treatment led to improvement or stabilization of symptoms in all patients.
Conclusions:
- Spinal arachnoid cysts are a treatable cause of progressive neurological deficits in children.
- A significant proportion of pediatric spinal arachnoid cysts occur in patients with underlying neural tube defects.
Abstract:
Between 1979 and 1991, spinal arachnoid cysts were found in 11 patients aged 19 months to 18 years (mean age 5 1/2 years). Of the 11 patients, six had a myelomeningocele and one diastematomyelia. The presenting symptoms included radicular pain (one patient), progressive weakness (three), increasing scoliosis (one), worsening spasticity (three), and recurrent urinary tract infections and progressive constipation (one). Two patients showed no symptoms from the spinal arachnoid cyst. The distribution of lesions was as follows: cervicomedullary (one patient), cervical (one), cervicothoracic (two), thoracic (four), lumbar (two), and sacral (one). Four of the 11 arachnoid cysts (all intradural) were located anterior to the spinal cord, three of which were in children with a myelomeningocele. Only two of the cysts were extradural; both were found in the lumbosacral region, and one was associated with diastematomyelia. Eight patients were treated with fenestration and/or resection of the cyst wall. Three patients with anterior cysts were treated with shunts, a cyst-to-pleural space shunt in two and a cyst-to-subarachnoid space shunt in one. All of the patients either improved or exhibited an arrest in the progression of their symptoms. Spinal arachnoid cysts are a treatable cause of progressive neurological deficits and, in this series, were frequently found in patients with neural tube defects.