Diagnosis and treatment of noncommunicating extradural spinal thoracolumbar arachnoid cyst

Background: Noncommunicating extradural spinal arachnoid cysts are extremely rare. They are believed to arise from congenital defects in the dura mater and become enlarged as a consequence of increased cerebro-spinal fluid (CSF) pressure within the subarachnoid space. Most retain a communicating pedicle through which the extradural cyst maintains connection with the subarachnoid space, and only rarely does this communication become sealed. The optimal treatment consists of complete surgical removal of the cyst with ligation of the communicating pedicle. Case Description: A 29-year-old male presented with a progressive spastic paraparesis of 6 months’ duration. The MRI showed a circumscribed intradural extramedullary cystic lesion located from D11-L2. Notably, peroperatively, the cyst appeared to be entirely extradural, without a communicating intradural pedicle. Further, no CSF leak was observed even after Valsalva maneuvers. Following surgical extirpation of the cyst, the patient sustained an uneventful recovery within 1 postoperative month. Conclusion: Noncommunicating extradural arachnoid cysts are extremely rare causes of spinal cord compression and should be fully excised.

Spinal Extradural Arachnoid Cyst: A Case Report

Spinal extradural arachnoid cyst is a rare cause of spinal cord compression resulting in spinal myelopathy. We report a case of 12-year-old boy diagnosed with extradural thoracolumbar spinal arachnoid cyst presenting with back and leg pain, progressive left leg weakness, mild muscular atrophy and difficulty in walking. The boy presented with progressive weakness of distal left lower limb and intermittent claudication. MRI-scan revealed an extramedullary non-enhancing fluid signal intensity lesion with cord compression. The patient underwent zip laminectomy from T9 - L2 level using electric drill and total excision of the extradural cyst, microsurgical repair of the dural defect, followed by laminoplasty, using ethibond sutures was done. Intraoperative finding revealed an elongated 10 cm long cystic lesion with finger-like projections extending in the extradural space from T9 - L2 level, causing significant compression and displacement of the cord. The cyst was in communication with intradural subarachnoid space with a small ovoid-shaped arachnoid opening at T12 level on the left side adjacent to T11 nerve root. The postoperative course was uneventful and patient was discharged on postoperative day seven. Neurologically, the patient showed some improvement. On one-month follow-up, there was remarkable improvement in movement of the lower limbs. He was able to walk independently without limping gait; however, he still had mild weakness in his left leg (4+/5).Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, Page: 49-54

Extradural cyst causing spinal cord compression in osteoporotic compression fracture

Intraspinal cystic lesions with different pathogeneses have been reported to cause neurological deficits; however, no one has focused on the intraspinal extradural cysts that develop after osteoporotic compression fracture. The reported case features a 66-year-old woman presenting with progressive neurological deficit, back pain, and no history of additional trauma after undergoing conservative treatment for an osteoporotic fracture of L-1. The authors present serial radiographs and MR images demonstrating an epidural cyst successfully treated via a single posterior approach. This appears to be the first such case reported in the literature.

Extradural developmental dural root sleeve cyst presenting as a lumbar paraspinal mass with renal compression in an infant

Spinal extradural cysts do not normally present as a visible paraspinal mass or cause compression of the abdominal organs. The authors describe the case of a 9-month-old boy with multiple spinal extradural cysts. The largest of these cysts was along the right L-2 nerve root with significant extraspinal extension resulting in a visible slow-growing swelling in the right paraspinal region and radiological evidence of compression of the right kidney with hydronephrosis. Another large cyst along the left T-12 root caused radiologically evident compression of the left kidney but to a lesser degree. The patient also had monoparesis of the left lower limb and phenotypic features of Noonan syndrome. The authors performed marsupialization of the cysts, as well as repair of the fistula between the subarachnoid space and the cyst on the right side along the L-2 root and on the left side along the T-12 root. At 1-year follow-up, there was no paraspinal mass and the lower limbs exhibited normal power. Magnetic resonance imaging confirmed marked reduction in the size of the cysts and relief of the renal compression. To the authors' knowledge, their patient is the youngest reported in literature to have a spinal extradural cyst and also the first with the cyst presenting as a paraspinal mass.

Extradural Endodermal Cyst of Posterior Fossa: Case Report, Review of the Literature, and Embryogenesis

ABSTRACT OBJECTIVE AND IMPORTANCE Posterior fossa endodermal cysts are rare. They are located in the midline, in ventral or ventrolateral locations, or intrinsic to the neural axis. Accordingly, various theories of embryogenesis have been proposed. We report the first case of an extradural, dorsolaterally situated endodermal cyst. CLINICAL PRESENTATION An adult male patient presented with a short history of headache and cerebellar ataxia. Neuroimaging revealed an extra-axial cystic posterior fossa mass. INTERVENTION An entirely extradural cyst was found and was totally excised. Immunohistochemistry confirmed the diagnosis of endodermal cyst. CONCLUSION The extradural, dorsal location of the endodermal cyst suggests gaps at the cranial end of the notochord causing ectodermal-endodermal adhesions during early gastrulation and the persistence of endodermal remnants in the dorsal mesenchyme of the blastemal cranium. The literature is reviewed, and proposed theories of embryogenesis are discussed.