Extradural arachnoid cyst with bony erosion: a rare case report

The authors present the case of an otherwise healthy 38-year-old female with an atypical extradural arachnoid cyst with multi-level involvement in the lumbar spine leading to left quadriceps weakness and dysesthesia. Upon presentation, a lumbar spine MRI with contrast and plain radiographs revealed extensive L4 bony erosion. An MR angiogram and cervical spine MRI with contrast were then obtained in order to rule out any aortic root or cervical spine pathology. With no other apparent clinically relevant pathology revealed by these additional tests, an L3-5 posterior decompression and fusion procedure was performed. Her preoperative symptoms were successfully resolved following the procedure, with no resultant surgical complications. The cyst is atypical not only due to its size and location, but also due of the significant bony erosion of the left L4 pedicle and vertebral body. To the authors' knowledge, this is the first reported case of an extradural arachnoid cyst in the lumbar spine with bony erosion of the pedicle and vertebral body. In cases such as this, a CT myelogram may be useful in planning the operative approach through visualization of the exact communication between cyst and dura. This approach may also aid in diagnosing and identifying atypical cyst presentations such as the one presented here.