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Review
. 2022 Jun 15:2:100904.
doi: 10.1016/j.bas.2022.100904. eCollection 2022.

Spinal arachnoid cysts: A case series & systematic review of the literature

Pratipal Kalsi  1   2 , Nader Hejrati  1   2   3 , Anastasios Charalampidis  1   2 , Pang Hung Wu  1   2 , Michel Schneider  1   2 , Jamie Rf Wilson  1   2 , Andrew F Gao  4   5 , Eric M Massicotte  1   2   6 , Michael G Fehlings  1   2   3   6
Affiliations
Review

Spinal arachnoid cysts: A case series & systematic review of the literature

Pratipal Kalsi et al. Brain Spine. .

Abstract

Introduction: Spinal arachnoid cysts (SACs) are rare lesions with challenging and controversial management.

Research question: We analyzed our experiences from a case series and provide a systematic review to determine 1) Demographic and clinical features of SACs, 2) Optimal imaging for diagnosis and operative planning, 3) Optimal management of SACs, and 4) Clinical outcomes following surgery.

Materials and methods: A single-institution, ambispective analysis of patients with symptomatic SACs surgically managed between May 2005 and May 2019 was performed. Data were collected as per local ethics committee stipulations. A systematic review of SACs in adults was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and a preapproved protocol.

Results: Our series consisted of 11 patients, M:F 8:3, mean age 47.8 years (range 18-73 years). Mean follow-up was 19 months (range 5-36 months). SACs were excised or marsupialised (7), fenestrated (3) or partially excised (1). Eight patients had expansile duroplasty, 3 primary dural closure. One patient had a cystoperitoneal shunt. All patients were AIS D preoperatively; 4 remained unchanged and 7 improved to AIS E at follow-up. Our systematic search retrieved 725 citations. Fourteen case series met the inclusion criteria. There was no evidence to support superiority of one surgical strategy over another. Surgery for symptomatic patients resulted in positive clinical outcomes.

Discussion and conclusions: Symptomatic SACs require surgical intervention. Limited evidence suggests that decompressing the cord, breakdown of arachnoid adhesions, and establishing CSF flow by consideration of expansile duroplasty are important for positive outcomes.

Keywords: Case series; Spinal arachnoid cysts; Spine; Surgical decompression; Systematic review.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing results of literature search.
Fig. 2
Fig. 2
Sagittal T2 MRI images demonstrating a dorsally placed intradural arachnoid cyst (arrow).
Fig. 3
Fig. 3
Sagittal ultrasound image demonstrating a dorsal arachnoid cyst (AC) compressing the spinal cord (SC) prior to dural (D) opening.
Fig. 4
Fig. 4
Intraoperative image of the thoracic spinal cord (SC). The dura (D) has been opened in the midline and hitched back. The dorsally placed arachnoid cyst with associated arachnoid band (A), which is tethering the spinal cord, is being carefully dissected from the spinal cord. This photo was obtained by the authors of this manuscript.
Fig. 5
Fig. 5
Histopathology of an Arachnoid Cyst (AC). The histopathological examination shows a cyst wall, which is composed of connective tissue lined by meningothelial cells, diagnostic of AC. Hematoxylin and eosin (H&E) stain. This image was obtained by the authors of this manuscript.
Fig. 6
Fig. 6
Decision tree for the diagnostic and therapeutic management of spinal arachnoid cysts.
See this image and copyright information in PMC

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