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Spinal Arachnoid Cysts: Presentation, management and pathophysiology.

Ahmed-Ramadan Sadek1, Ali Nader-Sepahi2

  • 1Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom; Division of Clinical Neurosciences, School of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom.

Clinical Neurology and Neurosurgery
|April 6, 2019
PubMed
Summary

Surgical marsupialisation of spinal arachnoid cysts effectively treats symptoms like pain and weakness. This procedure offers significant improvement in neurological function and quality of life for affected patients.

Keywords:
ArachnoidCystsIntraduralSeptum posticumSpine

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Intradural arachnoid cysts (SAC) are rare, often presenting with debilitating neurological deficits.
  • Common symptoms include paraesthesia, neuropathic pain, and gait disturbance, impacting patient quality of life.

Purpose of the Study:

  • To evaluate the clinical presentation and surgical outcomes of marsupialisation for spinal arachnoid cysts.
  • To propose a hypothesis regarding the pathogenesis of these cysts.

Main Methods:

  • Retrospective review of 17 patients with dorsal thoracic arachnoid cysts.
  • Surgical marsupialisation followed by standardized post-operative clinical and radiographic assessment.
  • Spinal multidisciplinary team discussion informed pre-operative management.

Main Results:

  • Patients commonly presented with paraesthesia (76%), neuropathic pain (76%), and gait issues (76%).
  • Marsupialisation led to improvement in at least one symptom/sign in all patients by 6 months post-surgery.
  • Significant cord volume increase (45%) correlated with clinical improvement, though neuropathic pain resolution was less common (29%).

Conclusions:

  • Marsupialisation of spinal arachnoid cysts provides immediate and sustained symptomatic relief.
  • Spinal arachnoid cysts may originate from septum posticum dissection, causing cord compression due to altered cerebrospinal fluid dynamics.