Arachnoid Web Fenestration: Diagnostic and Surgical Nuances

Area of Science:

• Neurosurgery
• Neurology
• Radiology

Background:

• Arachnoid webs (AW) are rare congenital spinal anomalies.
• They often present with subtle radiographic findings and upper motor neuron signs.
• Previous literature primarily consists of small case reports.

Discussion:

• This report introduces advanced imaging techniques, including high-definition MRI, for preoperative diagnosis of AW.
• Intraoperative ultrasonography is demonstrated for precise identification of adhesions and the web.
• A detailed operative technique for AW fenestration is presented, including microscopic dissection and dural preservation.

Key Insights:

• Novel imaging and surgical approaches for arachnoid web fenestration are showcased.
• Successful surgical intervention led to marked improvement in patient's gait and neurological function.
• Postoperative imaging confirmed resolution of the syrinx and normalization of spinal cord contour.

Outlook:

• This work provides a valuable video resource for neurosurgeons managing arachnoid webs.
• The presented techniques may improve diagnostic accuracy and surgical outcomes for AW.
• Further research could explore the long-term efficacy of these advanced methods.