Surgical Treatment of Spinal Arachnoid Cysts: Cyst Excision or Fenestration?

To examine a series of surgically treated spinal arachnoid cysts in light of the literature.

This was a retrospective study of patients treated in the Istanbul Umraniye Training and Research Hospital Neurosurgery Clinic. A total of 18 patients with spinal arachnoid cysts underwent surgical treatment between January 2012 and December 2019. All patients were assessed before and after surgery for muscle strength, pain, sensory changes, and bowel? bladder symptoms. All patients underwent magnetic resonance imaging and computed tomography for diagnosis and treatment.

Among the 18 patients, 8 were men and 10 were women, with a mean age of 43.7 (25?66) years. Congenital conditions were discovered in 15 of the patients, 2 after lumbar drainage and 1 after spinal anesthesia. Intradural extramedullary and intraextradural cysts were found in 17 patients and 1 patient, respectively. The cyst was smaller than level 3 in 14 patients and greater than level 3 in 4 patients. Cyst excision and cyst fenestration were performed in 11 and 7 patients, respectively. Cyst excision was performed in four of the patients who underwent cyst fenestration because their complaints did not improve.

Surgery should be considered in patients with symptomatic spinal arachnoid cysts. Fenestration may be a suitable alternative, especially if magnetic resonance imaging reveals no intracystic adhesion or trabeculation. Residual and recurrence rates are high in patients with a history of intradural intervention, adhesions, or trabeculation. When there is trabeculation, the best option is cyst removal.