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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2023; 12(01): 003-009
DOI: 10.1055/s-0041-1731623
Review Article

Clinical Profile and Treatment Outcome of Spinal Epidural Arachnoid Cysts: A Systematic Review of Case Studies and Reports

Aditya K. Patil
1   Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Srikant K. Swain
1   Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Suresh Sharma
2   College of Nursing, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Rajnish Kumar Arora
1   Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Achal Sharma
3   Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
,
Poonam Arora
4   Department of Emergency Medicine, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
,
Radhey S. Mittal
1   Department of Neurosurgery, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
› Author Affiliations Funding None.
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Abstract

Background A spinal epidural arachnoid cyst (SEAC) is a rare clinical entity. We performed a systematic review of the literature to obtain information regarding demographics, clinical presentation, treatment modalities, and outcome of SEACs.

Methods A literature search was performed by using the databases PubMed/Medline, PubMed Central, Embase, Cochrane Library, Ovid MEDLINE, and Ovid Medline In-Process. A total of 170 articles were found on literature search. We found 575 cases of SEAC since 1904 for inclusion in the review including three cases which were operated by us. We studied the patient characteristics, clinical features, and management strategies, and evaluated their outcome.

Results The average age of presentation was 30 years with a male:female ratio of 1.03:1. They are commonly seen in the thoracic region (42.3%). The length of cyst was more than two vertebral levels in 85.81%. Mean symptom duration was 29 months, with most common presentation being that of compressive myelopathy. A good clinical outcome was present in symptomatic patients who had a shorter symptom duration and underwent complete surgical excision of the SEAC. Age, sex, length of lesion, and presence of dural defect did not have a bearing on the surgical outcome.

Conclusion For thoracic compressive myelopathy in a young patient, SEAC should be kept as a differential diagnosis. Surgical complete excision of the cyst with meticulous closure of the dural defect is the standard in management for a good clinical outcome.

Keywords

spinal epidural arachnoid cyst - spinal extradural - dural defect repair

Supplementary Material



Publication History

Article published online:
13 January 2022

© 2021. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Lee SW, Foo A, Tan CL. et al. Spinal extradural cyst: case report and review of literature. World Neurosurg 2018; 116: 343-346
    CrossrefPubMedGoogle Scholar
  • 2 Woo JB, Son DW, Kang KT. et al. Spinal extradural arachnoid cyst. Korean J Neurotrauma 2016; 12 (02) 185-190
    CrossrefPubMedGoogle Scholar
  • 3 Lee C-H, Hyun S-J, Kim K-J, Jahng T-A, Kim H-J. What is a reasonable surgical procedure for spinal extradural arachnoid cysts: is cyst removal mandatory? Eight consecutive cases and a review of the literature. Acta Neurochir (Wien) 2012; 154 (07) 1219-1227
    CrossrefPubMedGoogle Scholar
  • 4 Liu JK, Cole CD, Kan P, Schmidt MH. Spinal extradural arachnoid cysts: clinical, radiological, and surgical features. Neurosurg Focus 2007; 22 (02) E6
    PubMedGoogle Scholar
  • 5 Funao H, Nakamura M, Hosogane N. et al. Surgical treatment of spinal extradural arachnoid cysts in the thoracolumbar spine. Neurosurgery 2012; 71 (02) 278-284 , discussion 284
    CrossrefPubMedGoogle Scholar
  • 6 Netra R, Min L, Shao M Hui, Wang JC, Bin Y, Ming Z. Spinal extradural meningeal cysts: an MRI evaluation of a case series and literature review. J Spinal Disord Tech 2011; 24 (02) 132-136
    CrossrefPubMedGoogle Scholar
  • 7 Cloward RB. Congenital spinal extradural cysts: case report with review of literature. Ann Surg 1968; 168 (05) 851-864
    CrossrefPubMedGoogle Scholar
  • 8 Ergun T, Lakadamyali H. Multiple extradural spinal arachnoid cysts causing diffuse myelomalacia of the spinal cord. Neurologist 2009; 15 (06) 347-350
    CrossrefPubMedGoogle Scholar
  • 9 Rengachary SS, O'Boynick P, Karlin CA, Batnitzky S, Price H. Intrasacral extradural communicating arachnoid cyst: cases report. Neurosurgery 1981; 8 (02) 236-240
    CrossrefPubMedGoogle Scholar
  • 10 Ogura Y, Fujibayashi S, Iida A. et al. A novel FOXC2 mutation in spinal extradural arachnoid cyst. Hum Genome Var 2015; 2: 15032
    CrossrefPubMedGoogle Scholar
  • 11 Cho KH, Jin ZW, Abe H, Shibata S, Murakami G, Rodríguez-Vázquez JF. Neural-dural transition at the thoracic and lumbar spinal nerve roots: a histological study of human late-stage fetuses. BioMed Res Int 2016; 2016: 8163519
    PubMedGoogle Scholar
  • 12 Bond AE, Zada G, Bowen I, McComb JG, Krieger MD. Spinal arachnoid cysts in the pediatric population: report of 31 cases and a review of the literature. J Neurosurg Pediatr 2012; 9 (04) 432-441
    CrossrefPubMedGoogle Scholar
  • 13 Morizane K, Fujibayashi S, Otsuki B. et al. Clinical and radiological features of spinal extradural arachnoid cysts: valve-like mechanism involving the nerve root fiber as a possible cause of cyst expansion. J Orthop Sci 2018; 23 (03) 464-469
    CrossrefPubMedGoogle Scholar
  • 14 Marbacher S, Barth A, Arnold M, Seiler RW. Multiple spinal extradural meningeal cysts presenting as acute paraplegia. Case report and review of the literature. J Neurosurg Spine 2007; 6 (05) 465-472
    CrossrefPubMedGoogle Scholar
  • 15 Sangala JR, Uribe JS, Park P, Martinez C, Vale FL. Nerve root prolapse into a spinal arachnoid cyst–an unusual cause of radiculopathy. Clin Neurol Neurosurg 2009; 111 (05) 460-464
    CrossrefPubMedGoogle Scholar
  • 16 Thakar S, Kiran NAS, Hegde AS. A sacral arachnoid cyst causing holocord syringomyelia. J Neurosurg Pediatr 2011; 8 (03) 299-302
    CrossrefPubMedGoogle Scholar
  • 17 Muthukumar N, Santhanakrishnan AG, Sivakumar K. Arachnoid cyst masquerading as obstetric brachial plexus palsy. J Neurosurg Pediatr 2012; 10 (01) 62-63
    CrossrefPubMedGoogle Scholar
  • 18 Habibi Z, Hanaei S, Nejat F. Sacral extradural arachnoid cyst in association with split cord malformation. Spine J 2016; 16 (09) 1109-1115
    CrossrefPubMedGoogle Scholar
  • 19 Park S-H, Kuh S-U, Lim BJ. Retroperitoneal spinal extradural arachnoid cyst combined with congenital hemivertebrae. J Korean Neurosurg Soc 2012; 52 (03) 257-260
    CrossrefPubMedGoogle Scholar
  • 20 Rimmelin A, Clouet PL, Salatino S. et al. Imaging of thoracic and lumbar spinal extradural arachnoid cysts: report of two cases. Neuroradiology 1997; 39 (03) 203-206
    CrossrefPubMedGoogle Scholar
  • 21 Boisserie-Lacroix M, Bouin H, Joullie M. et al. The value of MRI in the study of spinal extradural arachnoid cysts. Comput Med Imaging Graph 1990; 14 (03) 221-223
    CrossrefPubMedGoogle Scholar
  • 22 Doita M, Nishida K, Miura J, Takada T, Kurosaka M, Fujii M. Kinematic magnetic resonance imaging of a thoracic spinal extradural arachnoid cyst: an alternative suggestion for exacerbation of symptoms during straining. Spine 2003; 28 (12) E229-E233
    CrossrefPubMedGoogle Scholar
  • 23 Ishibe T, Senzoku F, Ikeda N, Kamba Y, Mikawa Y. Detection of the communicating hole(s) of spinal extradural arachnoid cysts using time-spatial labeling inversion pulse magnetic resonance imaging. Spine 2014; 39 (23) E1394-E1397
    CrossrefPubMedGoogle Scholar
  • 24 Neo M, Koyama T, Sakamoto T, Fujibayashi S, Nakamura T. Detection of a dural defect by cinematic magnetic resonance imaging and its selective closure as a treatment for a spinal extradural arachnoid cyst. Spine 2004; 29 (19) E426-E430
    CrossrefPubMedGoogle Scholar
  • 25 Kanetaka M, Sugita S, Chikuda H. et al. Use of Doppler ultrasonography to detect an elusive communication of a spinal extradural arachnoid cyst. J Clin Neurosci 2011; 18 (06) 863-864
    CrossrefPubMedGoogle Scholar
  • 26 Bellavia R, King JT Jr, Naheedy MH, Lewin JS. Percutaneous aspiration of an intradural/extradural thoracic arachnoid cyst: use of MR imaging guidance. J Vasc Interv Radiol 2000; 11 (03) 369-372
    CrossrefPubMedGoogle Scholar
  • 27 Uemura K, Yoshizawa T, Matsumura A, Asakawa H, Nakamagoe K, Nose T. Spinal extradural meningeal cyst. Case report. J Neurosurg 1996; 85 (02) 354-356
    CrossrefPubMedGoogle Scholar
  • 28 James HE, Postlethwait R. Spinal peritoneal shunts for conditions other than hydrocephalus and pseudotumor cerebri: a clinical report. Pediatr Neurosurg 2007; 43 (06) 456-460
    CrossrefPubMedGoogle Scholar
  • 29 Lee TP, Twydell P, Li Y. Anterior spinal extradural cyst mimicking hirayama disease and amyotrophic lateral sclerosis. RRNMF Neuromuscul J 2020;1(1)
    PubMedGoogle Scholar
  • 30 Kikuta K, Hojo M, Gomi M, Hashimoto N, Nozaki K. Expansive duraplasty for the treatment of spinal extradural arachnoid cysts: case report. J Neurosurg Spine 2006; 4 (03) 251-255
    CrossrefPubMedGoogle Scholar
  • 31 Tsuchimochi K, Morioka T, Murakami N, Yamashita F, Kawamura N. Huge multiple spinal extradural meningeal cysts in infancy. Childs Nerv Syst 2019; 35 (03) 535-540
    CrossrefPubMedGoogle Scholar
  • 32 Kunz U, Mauer UM, Waldbaur H. Lumbosacral extradural arachnoid cysts: diagnostic and indication for surgery. Eur Spine J 1999; 8 (03) 218-222
    CrossrefPubMedGoogle Scholar
  • 33 Hughes G, Ugokwe K, Benzel EC. A review of spinal arachnoid cysts. Cleve Clin J Med 2008; 75 (04) 311-315
    CrossrefPubMedGoogle Scholar
  • 34 Kendall BE, Valentine AR, Keis B. Spinal arachnoid cysts: clinical and radiological correlation with prognosis. Neuroradiology 1982; 22 (05) 225-234
    CrossrefPubMedGoogle Scholar