Surgical treatment of a thoracic ventral intradural arachnoid cyst associated with syringomyelia: case report

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The pathogenesis of thoracic ventral intradural spinal arachnoid cyst (ISAC) is unknown due to its extremely low incidence. In addition, its surgical treatment is complicated because of the ventral location, large craniocaudal extension, and frequent coexistence of syringomyelia. The optimal surgical strategy for thoracic ventral ISAC remains unclear and continues to be a matter of debate. In this report, the authors describe an extremely rare case presenting with a compressive thoracic ventral ISAC associated with syringomyelia that was successfully treated with a simple cyst-pleural shunt. The patient’s medical history revealed bacterial spinal meningitis along with an extensive spinal epidural abscess, suggesting the incidence of extensive adhesive arachnoiditis (AA) to be a plausible cause for this pathology. Thoracic ventral ISAC reportedly occurs secondary to AA and is commonly associated with syringomyelia. Placement of a cyst-pleural shunt is an effective, safe, and uncomplicated surgical strategy, which can provide sufficient cyst drainage regardless of the coexistence of AA, and thus should be considered as primary surgical treatment. Syrinx drainage could be reserved for a later attempt in case the cyst-pleural shunt fails to reduce the extent of syringomyelia.

ABBREVIATIONS AA = adhesive arachnoiditis; ISAC = intradural spinal arachnoid cyst.

Article Information

Correspondence Howard J. Ginsberg: St. Michael’s Hospital, University of Toronto, ON, Canada. ginsbergh@smh.ca.

INCLUDE WHEN CITING Published online November 23, 2018; DOI: 10.3171/2018.8.SPINE18223.

Disclosures Dr. Ginsberg reports being a consultant to Stryker.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal T2-weighted (A and C) and T1-weighted with contrast (B and D) MR images obtained in 2014, demonstrating diffuse leptomeningeal enhancement of the spinal cord and cauda equina associated with edema of the cervical cord, as well as a dorsal epidural fluid collection at the thoracic region (arrows).

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    A: Preoperative axial T2-weighted MR image at T7 showing a ventral intradural extramedullary cystic mass compressing the spinal cord. B: Preoperative axial T2-weighted MR image at T11 showing a massive intramedullary cystic lesion.

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    A and B: Preoperative sagittal T2-weighted MR images demonstrating a ventral intradural extramedullary arachnoid cyst at T4–9 (long arrow) and syrinx formation at T9–11 (short arrow). C and D: Postoperative sagittal T2-weighted MR images confirming the disappearance of the arachnoid cyst as well as significant reduction in the size of the syrinx.

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