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

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

Publication History

Article published online:
13 January 2022

• 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
• 2 Woo JB, Son DW, Kang KT. et al. Spinal extradural arachnoid cyst. Korean J Neurotrauma 2016; 12 (02) 185-190
• 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
• 4 Liu JK, Cole CD, Kan P, Schmidt MH. Spinal extradural arachnoid cysts: clinical, radiological, and surgical features. Neurosurg Focus 2007; 22 (02) E6
• 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
• 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
• 7 Cloward RB. Congenital spinal extradural cysts: case report with review of literature. Ann Surg 1968; 168 (05) 851-864
• 8 Ergun T, Lakadamyali H. Multiple extradural spinal arachnoid cysts causing diffuse myelomalacia of the spinal cord. Neurologist 2009; 15 (06) 347-350
• 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
• 10 Ogura Y, Fujibayashi S, Iida A. et al. A novel FOXC2 mutation in spinal extradural arachnoid cyst. Hum Genome Var 2015; 2: 15032
• 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
• 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
• 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
• 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
• 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
• 16 Thakar S, Kiran NAS, Hegde AS. A sacral arachnoid cyst causing holocord syringomyelia. J Neurosurg Pediatr 2011; 8 (03) 299-302
• 17 Muthukumar N, Santhanakrishnan AG, Sivakumar K. Arachnoid cyst masquerading as obstetric brachial plexus palsy. J Neurosurg Pediatr 2012; 10 (01) 62-63
• 18 Habibi Z, Hanaei S, Nejat F. Sacral extradural arachnoid cyst in association with split cord malformation. Spine J 2016; 16 (09) 1109-1115
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 29 Lee TP, Twydell P, Li Y. Anterior spinal extradural cyst mimicking hirayama disease and amyotrophic lateral sclerosis. RRNMF Neuromuscul J 2020;1(1)
• 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
• 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
• 32 Kunz U, Mauer UM, Waldbaur H. Lumbosacral extradural arachnoid cysts: diagnostic and indication for surgery. Eur Spine J 1999; 8 (03) 218-222
• 33 Hughes G, Ugokwe K, Benzel EC. A review of spinal arachnoid cysts. Cleve Clin J Med 2008; 75 (04) 311-315
• 34 Kendall BE, Valentine AR, Keis B. Spinal arachnoid cysts: clinical and radiological correlation with prognosis. Neuroradiology 1982; 22 (05) 225-234