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Updated: Jan 20, 2026
Laminotomy for Targeted Injection into the Lumbar Dorsal Root Ganglion in a Pig Model
Published on: August 28, 2025
Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an
Balaji Srinivas1, Vivek Joseph, Geeta Chacko
1Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Insights
This study reports the youngest patient with spinal extradural cysts presenting as a paraspinal mass. Surgical intervention successfully resolved the cysts, paraspinal mass, and associated kidney compression.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Developmental Pediatrics
Background:
- Spinal extradural cysts are rare, typically asymptomatic, and do not present as visible masses or cause organ compression.
- Multiple spinal extradural cysts are exceptionally uncommon, particularly in infants.
Observation:
- A 9-month-old boy presented with multiple spinal extradural cysts, a visible paraspinal mass, and kidney compression (hydronephrosis).
- The patient also exhibited left lower limb monoparesis and features of Noonan syndrome.
- This case represents the youngest reported infant with spinal extradural cysts and the first with a paraspinal mass presentation.
Findings:
- Surgical marsupialization of the cysts and fistula repair were performed.
- At 1-year follow-up, the paraspinal mass resolved, lower limb power normalized, and imaging showed cyst size reduction and relieved renal compression.
Implications:
- This case highlights the potential for spinal extradural cysts to present atypically in infants, including as a paraspinal mass with significant complications.
- Early diagnosis and surgical management are crucial for favorable outcomes in pediatric patients with complex spinal extradural cysts.
- The association with Noonan syndrome warrants further investigation into potential underlying genetic factors.
Abstract:
Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.
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