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. 2023 Aug 7;6(6):CASE23217.
doi: 10.3171/CASE23217. Print 2023 Aug 7.

Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case

Victoria Jane Horak  1   2 , Med Jimson D Jimenez  2 , Melissa A LoPresti  1 , Jeffrey S Raskin  1
Affiliations

Pediatric intraspinal arachnoid cyst: successful endoscopic fenestration. Illustrative case

Victoria Jane Horak et al. J Neurosurg Case Lessons. .

Abstract

Background: Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis.

Observations: The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old.

Lessons: Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.

Keywords: endoscopy; fenestration; pediatric; spinal arachnoid cyst; spinal cyst.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Preoperative sagittal (left) and axial (right) T2-weighted MRI showed a cystic cervical spinal canal lesion 4 cm in size extending from C0 to C6. The spinal cord measured 3.6 mm in its narrowest dimension when measured on sagittal T1-weighted imaging, and its caliber normalized at the cervicothoracic junction. The localizer for the axial image is indicated by the line in the left panel.
FIG. 2.
FIG. 2.
Postoperative day 1 sagittal (left) and axial (right) T2-weighted MRI of the patient’s cervical spine identified laminectomies at C4–6 with persistent but improved narrowing of the spinal cord within the cervical spine, now measuring 4.7 mm at its narrowest when measured on sagittal T1-weighted imaging. The localizer for the axial image is indicated by the line in the left panel.
FIG. 3.
FIG. 3.
Ten-month postoperative sagittal (left) and axial (right) T2-weighted MRI of the patient’s cervical spine showed postsurgical changes of a C4–6 laminectomy and a gradual decrease in the size of the ventral thecal sac. The size of the sac was measured as 3.4 × 0.9 × 1.8 cm, spanning from C2 to C5, with stable flattening of the cervical spinal cord seen in the previous imaging. The localizer for the axial image is indicated by the line in the left panel.
See this image and copyright information in PMC

References

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