Related Experiment Video
Updated: Jul 22, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Successful detection of multiple communicating holes in multiple spinal extradural arachnoid cysts by using
Yusuke Kagei1, Tatsuya Ishibe1, Yusuke Kanba2
11Shiga Spine Center, Hino Memorial Hospital, Shiga, Japan; and.
Background:
Spinal extradural arachnoid cysts (SEACs) communicate with the subarachnoid space through small communicating dural holes. The precise preoperative detection of all communicating holes, followed by minimally invasive dural closure, is the ideal treatment to prevent postoperative spinal deformities, especially in cases of multiple SEACs. However, standard imaging methods often fail to detect communicating hole locations. Although a few cases of successful single-hole detection via cinematic magnetic resonance imaging (MRI) have been reported, this modality's ability to detect multiple holes has not been demonstrated.
Observations:
The authors describe the case of a 14-year-old male with myelopathy due to multiple SEACs at T5-8 and T8-12. Myelography revealed a complete block at the T8 level; no cephalic cyst or communicating holes were identified. Time-spatial labeling inversion pulse (T-SLIP) MRI revealed cerebrospinal fluid flow into the cyst at T10 and T7. A limited laminectomy or hemilaminectomy was performed at T7 and T10, and two dural holes were closed without a total cystectomy. The patient's gait disturbance and rectal disorder disappeared. The cysts were confirmed to have completely disappeared on conventional MRI at 1 year postoperatively.
Lessons:
T-SLIP MRI, a cinematic MRI, is useful for detecting multiple communicating holes in SEACs.
