Resection of an incidentally discovered spinal arachnoid web: illustrative case
Background:
Spinal arachnoid webs (SAWs) are rare pathologies of the spinal meninges often associated with syringomyelia and the radiographic "scalpel sign." Patients can experience pain, numbness, gait disturbances, or no symptoms at all. They are typically diagnosed via magnetic resonance imaging and treated with laminectomy and excision.
Observations:
A 61-year-old male presented after a mechanical fall and had an incidentally discovered SAW on imaging. He was initially asymptomatic and was therefore conservatively managed. Several years later, however, the patient experienced new-onset back pain, paresthesia, and balance problems, with interval imaging demonstrating worsening of the edema surrounding his SAW. The patient subsequently underwent resection of the SAW, which led to significant resolution of his symptoms.
Lessons:
An SAW can be asymptomatic or can manifest with a wide variety of symptoms. When this condition is incidentally discovered in asymptomatic patients, neurosurgeons should guide these patients to follow-up urgently if they develop any neurological symptoms. At that time, further imaging can be performed to determine if surgical treatment is indicated. Although SAW is rare, clinicians should be aware of the signs and symptoms, because prompt surgical intervention can significantly improve neurological symptoms.
Insights
Spinal arachnoid webs (SAWs) can be asymptomatic or cause various symptoms. Prompt surgical intervention for symptomatic SAWs can significantly improve neurological function, even if initially discovered incidentally.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Spinal arachnoid webs (SAWs) are rare spinal meninges pathologies.
- They are often associated with syringomyelia and the radiographic "scalpel sign."
- SAWs can be asymptomatic or present with diverse neurological symptoms.
Purpose of the Study:
- To highlight the varied clinical presentations of spinal arachnoid webs.
- To emphasize the importance of monitoring incidentally discovered SAWs.
- To underscore the benefits of timely surgical intervention for symptomatic SAWs.
Main Methods:
- Case report of a 61-year-old male with an incidentally discovered SAW.
- Initial conservative management followed by surgical resection due to symptom progression.
- Magnetic resonance imaging (MRI) used for diagnosis and monitoring.
Main Results:
- The patient initially asymptomatic, later developed back pain, paresthesia, and balance issues.
- Interval imaging showed worsening edema surrounding the SAW.
- Surgical resection led to significant symptom resolution.
Conclusions:
- SAWs require vigilant follow-up, especially when incidentally found.
- Neurosurgeons should advise urgent evaluation if neurological symptoms develop.
- Prompt surgical treatment can substantially improve neurological outcomes in symptomatic patients.
