Diffuse leptomeningeal melanomatosis of the spinal cord: a case report

A rare case of diffuse leptomeningeal melanosis presenting with symptoms of spinal cord compression due to the presence of anterolateral arachnoid cyst and treated with Spetzler's drainage system is reported. The diagnosis of diffuse melanosis of the leptomeninges is rarely possible during life. In the present case MRI was of great help in the definition of the limits of the pathological process and the presence of the anterior compressing cyst. After laminectomy and a biopsy of the pathological tissue which achieved the histological diagnosis, an external drainage was inserted to reduce the cyst extension and to exclude the presence of melanocytes in the cystic fluid before a peritoneal shunt was placed. At 8th month of follow-up the patient is doing well with a dramatic reduction of symptoms and a significant reduction of spinal cord compression. The diagnostic role of MRI and the relationship between leptomeningeal melanosis and arachnoid cyst are discussed.