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. 2024 Feb 5;7(6):CASE23660.
doi: 10.3171/CASE23660. Print 2024 Feb 5.

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case

Omar Hussain, Randall Treffy, Hope M Reecher, Andrew L DeGroot, Peter Palmer, Mohamad Bakhaidar, Saman Shabani

Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case

Omar Hussain et al. J Neurosurg Case Lessons. .

Abstract

Background: Spontaneous spinal subarachnoid hemorrhage is a rare pathological entity with a variety of presentations depending on the underlying etiology, which often remains cryptogenic. The literature is sparse regarding the most efficacious treatment or management option, and there is no consensus on follow-up time or modalities. Additionally, there are very few reports that include operative videos, which is provided herein.

Observations: The authors present a case of spontaneous spinal subarachnoid hemorrhage without an underlying etiology in a patient with progressive myelopathy, back pain, and lower-extremity paresthesias. She presented to our institution, and because of progressive worsening of her symptoms and the development of compressive arachnoid cysts, she underwent thoracic laminectomies for evacuation of subdural fluid, fenestration of the arachnoid cysts, and lysis of significant arachnoid adhesions. Her clinical course was further complicated by the recurrence of worsening myelopathy and the development of a large compressive arachnoid cyst with further arachnoiditis. The patient underwent repeat surgical intervention for cyst decompression with an improvement in symptoms.

Lessons: This case highlights the importance of long-term follow-up for these complicated cases with an emphasis on repeat magnetic resonance imaging. Unfortunately, surgical intervention is associated with short-term relief of the symptoms and no significant nonoperative management is available for these patients.

Keywords: myelopathy; spinal arachnoid cyst; spinal arachnoid cyst fenestration; spinal arachnoiditis; spontaneous spinal subarachnoid hemorrhage.

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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 MRI of the thoracic spine. Sagittal T2-weighted (A), T1-weighted (B), and short-tau inversion recovery (STIR; C) sequences and axial T2-weighted sequence (D) at the level of T10, demonstrating ventral displacement of the cord.
FIG. 2
FIG. 2
Thoracic spine MRI following initial thoracic laminectomy with durotomy for spinal cord decompression and lysis. Sagittal T2-weighted (A), T1-weighted (B), and STIR (C) sequences and axial T2-weighted sequence (D) at the level of T10, demonstrating a more normalized position of the spinal cord.
FIG. 3
FIG. 3
Thoracic spine MRI with the development of an arachnoid cyst spanning T6–11. Sagittal T2-weighted (A), T1-weighted (B), and STIR (C) sequences and axial T2-weighted sequence (D) demonstrating recurrent ventral displacement of the spinal cord.
FIG. 4
FIG. 4
MRI after the second operation involving the lysis of adhesions and decompression of the arachnoid cyst. Sagittal T2-weighted (A), T1-weighted (B), and STIR (C) sequences and axial T2-weighted sequence (D) demonstrating normal positioning of the spinal cord at T10 after the second operation.
See this image and copyright information in PMC

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