Ventral cervico-thoracic meningeal cyst resulting in myelopathy: Case report and literature review

Background: Spinal meningeal (dural) cysts rarely cause spinal cord compression and/or myelopathy. Case Description: A 38-year-old male presented with 6 weeks of worsening bilateral lower extremity paresthesias and an unsteady gait. Notably, the patient was involved in a snowmobile accident 7 years ago that resulted in trauma to his thoracic spine for which he had undergone a corpectomy and posterior fusion. A full spine MRI was obtained to evaluate his new paresthesias and myelopathy, which revealed a large extra-axial fluid collection consistent with a meningeal cyst extending from C2 to T4. This caused severe spinal cord compression, maximal at the T1-3 level. The patient underwent a T1-3 laminectomy initially accompanied by partial cyst resection/ drainage, but ultimately he returned and required a subsequent cystoperitoneal shunt. Following the final surgery, the patient’s symptoms gradually resolved over 6 months postoperatively. Conclusion: Spinal meningeal cysts rarely cause back pain and/or neurological symptoms. MRI is the diagnostic study of choice for defining this entity. Operative intervention must be tailored to the symptoms, location, extent, and type of the cyst. If cysts recur after partial resection and drainage, cystoperitoneal shunt placement is warranted.

Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients

Object The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH. Methods All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak. Results Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings. Conclusions The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH.

Rapidly progressive paraplegia due to an extradural lumbar meningocele mimicking a cyst

✓Unlike arachnoid meningoceles, arachnoid cysts frequently cause local pressure effects probably because there is no free communication between the cyst and the subarachnoid space. Following the first detailed description of cystic lesions of spinal nerve roots by Tarlov in 1938, a simplified classification of spinal meningeal cysts was developed in 1988, containing three major categories. The authors report on a lumbar intraspinal extradural meningocele that caused incomplete paraplegia in an otherwise healthy 31-year-old man in whom magnetic resonance imaging revealed stigmata of Scheuermann disease. Intraoperatively, the lesion was classified as a transitional-type lesion, in accordance with Type IA of the Nabors classification, because a communication with the subarachnoid space was observed. After complete removal of the meningocele, the patient's recovery was prompt and complete.