Updated assessment and current classification of spinal meningeal cysts

Michael W. Nabors Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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T. Glenn Pait Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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Edward B. Byrd Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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Najmaldin O. Karim Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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David O. Davis Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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Arthur I. Kobrine Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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Hugo V. Rizzoli Departments of Neurosurgery and Radiology, The George Washington University Medical Center, Washington, DC.

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✓ The classification of spinal meningeal cysts (MC's) in the literature is indistinct, confusing, and in certain categories histologically misleading. Based on a series of 22 cases, the authors propose a classification comprising three categories: spinal extradural MC's without spinal nerve root fibers (Type I); spinal extradural MC's with spinal nerve root fibers (Type II); and spinal intradural MC's (Type III). Although water-soluble myelography may disclose a filling defect for all three categories, computerized tomographic myelography (CTM) is essential to reveal communication between the cyst and the subarachnoid space. Communication demonstrated by CTM allows accurate diagnosis of a spinal MC and rules out other mass lesions. Magnetic resonance imaging appears useful as an initial study to identify an intraspinal cystic mass. Final characterization is based on operative inspection and histological examination for all three categories.

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