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Paul C. McCormick

Dorsal thoracic arachnoid web is a rare but often overlooked cause of progressive myelopathy. Syringomyelia, either above or below the compressive arachnoid band, may also be present. Dorsal arachnoid cyst and ventral spinal cord herniation may be mistaken for this condition. This video demonstrates the microsurgical identification and techniques of resection of a dorsal arachnoid band producing a progressive myelopathy in a 63-year-old man.

The video can be found here: http://youtu.be/KDNTqiyW6yo.

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Christopher G. Paramore

below the level of the most severe compression. At operation both patients were found to have focal arachnoidwebs,” which blocked the dorsal subarachnoid space in the area in which the spinal cord was most compressed; however, no cyst was found. A search of the literature did not disclose reports of similar lesions. The radiographic appearance of this unusual lesion and a proposed mechanism for its pathophysiological characteristics are discussed. Case Reports Case 1 This 54-year-old man presented with a several-year history of back and left leg pain

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Molly E. Hubbard, Matthew A. Hunt, Kristen E. Jones and David W. Polly

P atients with a hemivertebra leading to scoliosis require fusion if imaging reveals progression of the scoliotic curve. In this case report, we describe a patient who, 41 years after his initial fusion, developed worsening symptoms of myelopathy below the level of a known hemivertebra. His fusion mass appeared stable, but he was found to have an arachnoid web at the level of the hemivertebra. We describe the surgical approach performed in an attempt to halt progression of his symptoms. Case Report History and Examination A 53-year-old gentleman presented with

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Randall Schultz Jr., Andrew Steven, Aaron Wessell, Nancy Fischbein, Charles A. Sansur, Dheeraj Gandhi, David Ibrahimi and Prashant Raghavan

D orsal arachnoid webs (DAWs) and idiopathic spinal cord herniation (SCH) are uncommon abnormalities affecting the thoracic spinal cord that can result in syringomyelia and significant neurological morbidity if left untreated. 11 , 12 DAWs are transverse bands of thickened arachnoid membrane that compress the dorsal aspect of the cord. 11 , 12 SCHs are focal ventral or, less commonly, lateral protrusions of a portion, usually a short segment, of the spinal cord through a dural defect 7 ( Fig. 1 ). Differentiating these 2 entities on the basis of clinical

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Han Soo Chang, Atsushi Nagai, Soichi Oya and Toru Matsui

A n arachnoid web is an abnormal formation of the arachnoid membrane in the spinal subarachnoid space that blocks the relatively fast components of CSF movement in the longitudinal direction. 3 , 13 , 18 , 21 It is one of several causes of syringomyelia associated with the blockage of CSF flow, along with arachnoid cyst 11 , 14 and septum formation. 8 Somewhat confusingly, there are several terms for similar pathologies, each referring to slightly different entities with possible overlap: “idiopathic syringomyelia,” 1 “primary syringomyelia,” 10

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Osmond C. Wu and Manish K. Kasliwal

TO THE EDITOR: We read with great interest the article published by Schultz et al. 4 ( Schultz R Jr, Steven A, Wessell A, et al: Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography. J Neurosurg Spine 26:754–759, June 2017 ) regarding the use of MRI and CT myelograms to reliably distinguish between spinal cord herniation (SCH) and dorsal arachnoid webs (DAWs). In their retrospective series, the authors demonstrate that indirect radiographic findings such as the “scalpel sign” described by Reardon et al. 3

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Robert P. Naftel, R. Shane Tubbs, Joshua Y. Menendez, John C. Wellons III, Ian F. Pollack and W. Jerry Oakes

to resect the tonsils. In cases in which the aperture into the fourth ventricle was still restricted after attempts to further open it, a fourth ventricle–to–subarachnoid space shunt was inserted. For the dural grafts, a pericranial graft was used in 4 children and a synthetic graft was used in 7. In each case, a structural cause for the failed primary Chiari decompression (for example, extensive scarring, suture involving the obex, arachnoid web, residual C-1 lamina, and no duraplasty) was identified. Clinically, of the 11 children undergoing secondary Chiari

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Satoshi Yamaguchi, Kazutoshi Hida, Masaaki Takeda, Takafumi Mitsuhara, Mizuki Morishige, Naoto Yamada and Kaoru Kurisu

demonstrate flow disturbance or blockage of CSF along the spinal cord. 6 , 9 However, a method of intraoperative evaluation of regional CSF flow around the arachnoid lesion has not been described before. In the present article, we introduce a simple technique to visualize regional CSF flow with the aid of a gentian violet solution. We report our use of and limited experience with this dye injection technique. Surgical Technique Between October 2007 and September 2013, 2 cases of a surgically confirmed dorsal arachnoid web (DAW) and 1 case of focal arachnoiditis

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Florian Roser, Florian H. Ebner, Søren Danz, Felix Riether, Rainer Ritz, Klaus Dietz, Thomas Naegele and Marcos S. Tatagiba

-gated cine MR imaging studies showed a blocked CSF flow at the level of suggested arachnoid scarring, as seen on CISS MR imaging ( Fig. 1 ). F ig . 1. Thoracic syringomyelia. Sagittal (A) and axial (C) T2-weighted MR images demonstrating subarachnoid space with flow-void phenomenon and no signs of pathological adhesions. Sagittal and axial 3D CISS images visualizing a dorsolateral arachnoid web (B, white arrowheads ) and dorsal root displacement due to a subarachnoid cyst (D, black arrowheads ). Cine MR images (E and F) obtained during cardiac-gated CSF pulsation

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Anil K. Roy, Nicholas P. Slimack and Aruna Ganju

, or postlaminectomy adhesions. We did not have a minimal syrinx diameter for inclusion, given the overall paucity of syringes that were idiopathic. We also did not exclude patients with arachnoid webs, adhesions, or cysts, consistent with other studies on IS. 27 , 28 PubMed/Medline searches using the key words “idiopathic syringomyelia,” “pathophysiology of syringomyelia,” “classification of syringomyelia,” and “management of syringomyelia” resulted in 130 articles, which were independently analyzed by 2 authors (A.K.R. and N.P.S.). This group was further screened