Adhesive arachnoiditis after percutaneous fibrin glue treatment of a sacral meningeal cyst

Case report

Kazunori Hayashi M.D., Junji Nagano M.D., and Satoshi Hattori M.D., Ph.D.
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  • Department of Orthopedic Surgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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The authors present the case of a 64-year-old woman who was referred for severe sacral pain. She reported that her pain had been longstanding, and had greatly increased after percutaneous fibrin glue placement therapy for a sacral meningeal cyst 2 months earlier at a different hospital. An MRI scan obtained immediately after fibrin glue placement at that hospital suggested that fibrin glue had migrated superiorly into the subarachnoid space from the sacral cyst to the level of L-4. On admission to the authors' institution, physical examination demonstrated no abnormal findings except for perianal hypesthesia. An MRI study obtained at admission demonstrated a cystic lesion in the peridural space from the level of S-2 to S-4. Inhomogeneous intensity was identified in this region on T2-weighted images. Because the cauda equina and nerve roots appeared to be compressed by the lesion, total cyst excision was performed. The cyst cavity was filled with fluid that resembled CSF, plus gelatinous material. Histopathological examination revealed that the cyst wall was composed of hyaline connective tissue with some calcification. No nervous tissue or ganglion cells were found in the tissue. The gelatinous material was acellular, and appeared to be degenerated fibrin glue. Sacral pain persisted to some extent after surgery. The authors presumed that migrated fibrin glue caused the development of adhesive arachnoiditis.

The risk of adhesive arachnoiditis should be considered when this therapy is planned. Communication between a cyst and the subarachnoid space should be confirmed to be sufficiently narrow to prevent the migration of injected fibrin glue.

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  • 1

    Bartels RH, & van Overbeeke JJ: Lumbar cerebrospinal fluid drainage for symptomatic sacral nerve root cysts: an adjuvant diagnostic procedure and/or alternative treatment? Technical case report. Neurosurgery 40:861865, 1997

    • Search Google Scholar
    • Export Citation
  • 2

    Mitra R, , Kirpalani D, & Wedemeyer M: Conservative management of perineural cysts. Spine (Phila Pa 1976) 33:E565E568, 2008

  • 3

    Mummaneni PV, , Pitts LH, , McCormack BM, , Corroo JM, & Weinstein PR: Microsurgical treatment of symptomatic sacral Tarlov cysts. Neurosurgery 47:7479, 2000

    • Search Google Scholar
    • Export Citation
  • 4

    Murphy K, , Wyse G, , Schnupp S, , Gailloud P, , Woodworth GF, & Sciubba DM, et al.: Two-needle technique for the treatment of symptomatic Tarlov cysts. J Vasc Interv Radiol 19:771773, 2008. (Erratum in J Vasc Interv Radiol 19: 1525, 2008)

    • Search Google Scholar
    • Export Citation
  • 5

    Murphy KJ, , Nussbaum DA, , Schnupp S, & Long D: Tarlov cysts: an overlooked clinical problem. Semin Musculoskelet Radiol 15:163167, 2011

  • 6

    Patel MR, , Louie W, & Rachlin J: Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine. AJR Am J Roentgenol 168:367370, 1997

    • Search Google Scholar
    • Export Citation
  • 7

    Paulsen RD, , Call GA, & Murtagh FR: Prevalence and percutaneous drainage of cysts of the sacral nerve root sheath (Tarlov cysts). AJNR Am J Neuroradiol 15:293299, 1994

    • Search Google Scholar
    • Export Citation
  • 8

    Ross JS, , Masaryk TJ, , Modic MT, , Delamater R, , Bohlman H, & Wilbur G, et al.: MR imaging of lumbar arachnoiditis. AJR Am J Roentgenol 149:10251032, 1987

    • Search Google Scholar
    • Export Citation
  • 9

    Siedentop KH, , Harris DM, & Sanchez B: Autologous fibrin tissue adhesive. Laryngoscope 95:10741076, 1985

  • 10

    Tanaka M, , Nakahara S, , Ito Y, , Nakanishi K, , Sugimoto Y, & Ikuma H, et al.: Surgical results of sacral perineural (Tarlov) cysts. Acta Med Okayama 60:6570, 2006

    • Search Google Scholar
    • Export Citation
  • 11

    Tarlov IM: Spinal perineurial and meningeal cysts. J Neurol Neurosurg Psychiatry 33:833843, 1970

  • 12

    Voyadzis JM, , Bhargava P, & Henderson FC: Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg 95:1 Suppl 2532, 2001

    • Search Google Scholar
    • Export Citation
  • 13

    Zhang T, , Li Z, , Gong W, , Sun B, , Liu S, & Zhang K, et al.: Percutaneous fibrin glue therapy for meningeal cysts of the sacral spine with or without aspiration of the cerebrospinal fluid. J Neurosurg Spine 7:145150, 2007

    • Search Google Scholar
    • Export Citation

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