Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac
Introduction and Study Design: Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the extradural region is a rare location. The exact pathogenesis in the existence of these cysts in the ext...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2019-01-01
|
| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=1;spage=64;epage=71;aulast=Singh |
| _version_ | 1811283276151652352 |
|---|---|
| author | Suyash Singh Kamlesh Singh Bhaisora Jayesh Sardhara Kuntal Kanti Das Gagandeep Attri Anant Mehrotra Arun Kumar Srivastava Awadesh Kumar Jasiwal Sanjay Behari |
| author_facet | Suyash Singh Kamlesh Singh Bhaisora Jayesh Sardhara Kuntal Kanti Das Gagandeep Attri Anant Mehrotra Arun Kumar Srivastava Awadesh Kumar Jasiwal Sanjay Behari |
| author_sort | Suyash Singh |
| collection | DOAJ |
| description | Introduction and Study Design: Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the extradural region is a rare location. The exact pathogenesis in the existence of these cysts in the extradural region is still debated. In this article, we have retrospectively analyzed the clinical profile of the rare extradural arachnoid cyst (EDAC).
Methodology: In this study, 19 patients of EDAC operated at our institute between January 2006 to June 2016 are analyzed. All patients with the Oswestry disability index score of >20 were managed surgically (open laminectomy and cyst excision). The clinical outcome was assessed at using 5-point satisfaction scale and McCormick grading.
Results: All 13 operated patients had EDACs with communication with the intradural compartment. In 11 (84.6%) patients, cyst wall was excised completely, in 2 (15.3%) patients underwent partial excision of cyst wall; dural communication was closed in all patients (n = 13). None of the patients had clinical deterioration or radiological recurrence till the last follow-up. Mean follow-up was 52.2 months (range 1–160); all patients were satisfied after surgery (median score was 3).
Discussion: Symptomatic EDACs account <2% of all spinal tumors. The EDACs have communication with the intradural compartment. In our article, we have discussed the approach and management of EDAC, including minimally invasive percutaneous procedures.
Conclusion: One should aim for preoperative or intraoperative localization of dural communication and try to disconnect the extradural cyst from the intradural connection to prevent recurrence. Surgical treatment is complete excision of the cyst. |
| first_indexed | 2024-04-13T02:08:33Z |
| format | Article |
| id | doaj.art-b34adf653dcb432f960e81fffa3e3e29 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-04-13T02:08:33Z |
| publishDate | 2019-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-b34adf653dcb432f960e81fffa3e3e292022-12-22T03:07:22ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372019-01-01101647110.4103/jcvjs.JCVJS_12_19Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sacSuyash SinghKamlesh Singh BhaisoraJayesh SardharaKuntal Kanti DasGagandeep AttriAnant MehrotraArun Kumar SrivastavaAwadesh Kumar JasiwalSanjay BehariIntroduction and Study Design: Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the extradural region is a rare location. The exact pathogenesis in the existence of these cysts in the extradural region is still debated. In this article, we have retrospectively analyzed the clinical profile of the rare extradural arachnoid cyst (EDAC). Methodology: In this study, 19 patients of EDAC operated at our institute between January 2006 to June 2016 are analyzed. All patients with the Oswestry disability index score of >20 were managed surgically (open laminectomy and cyst excision). The clinical outcome was assessed at using 5-point satisfaction scale and McCormick grading. Results: All 13 operated patients had EDACs with communication with the intradural compartment. In 11 (84.6%) patients, cyst wall was excised completely, in 2 (15.3%) patients underwent partial excision of cyst wall; dural communication was closed in all patients (n = 13). None of the patients had clinical deterioration or radiological recurrence till the last follow-up. Mean follow-up was 52.2 months (range 1–160); all patients were satisfied after surgery (median score was 3). Discussion: Symptomatic EDACs account <2% of all spinal tumors. The EDACs have communication with the intradural compartment. In our article, we have discussed the approach and management of EDAC, including minimally invasive percutaneous procedures. Conclusion: One should aim for preoperative or intraoperative localization of dural communication and try to disconnect the extradural cyst from the intradural connection to prevent recurrence. Surgical treatment is complete excision of the cyst.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=1;spage=64;epage=71;aulast=SinghArachnoid cystball valve mechanismCore Outcome Measures Indexextraduralminimally invasive approach |
| spellingShingle | Suyash Singh Kamlesh Singh Bhaisora Jayesh Sardhara Kuntal Kanti Das Gagandeep Attri Anant Mehrotra Arun Kumar Srivastava Awadesh Kumar Jasiwal Sanjay Behari Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac Journal of Craniovertebral Junction and Spine Arachnoid cyst ball valve mechanism Core Outcome Measures Index extradural minimally invasive approach |
| title | Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac |
| title_full | Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac |
| title_fullStr | Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac |
| title_full_unstemmed | Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac |
| title_short | Symptomatic extradural spinal arachnoid cyst: More than a simple herniated sac |
| title_sort | symptomatic extradural spinal arachnoid cyst more than a simple herniated sac |
| topic | Arachnoid cyst ball valve mechanism Core Outcome Measures Index extradural minimally invasive approach |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=1;spage=64;epage=71;aulast=Singh |
| work_keys_str_mv | AT suyashsingh symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT kamleshsinghbhaisora symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT jayeshsardhara symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT kuntalkantidas symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT gagandeepattri symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT anantmehrotra symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT arunkumarsrivastava symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT awadeshkumarjasiwal symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac AT sanjaybehari symptomaticextraduralspinalarachnoidcystmorethanasimpleherniatedsac |