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. 2025 Jun 5;15(6):234.
doi: 10.3390/jpm15060234.

Spinal Arachnoid Cysts: A Single-Center Preliminary Surgical Experience with a Rare and Challenging Disease

Alessio Iacoangeli  1   2 , Love Chibuzor Ilochonwu  1 , Giulia Mazzanti  1 , Gabriele Polonara  3 , Lauredana Ercolani  4 , Alessandra Marini  2 , Michele Luzi  2 , Roberto Trignani  2 , Stefano Bruni  5 , Edoardo Barboni  6 , Maurizio Gladi  1 , Maurizio Iacoangeli  1 , Denis Aiudi  1
Affiliations

Spinal Arachnoid Cysts: A Single-Center Preliminary Surgical Experience with a Rare and Challenging Disease

Alessio Iacoangeli et al. J Pers Med. .

Abstract

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1-2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences.

Keywords: adhesiolysis; arachnoid cyst; arachnoiditis; arachnoidolysis; intradural cyst; intramedullary cyst.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Case 1: pre-operative MRI (left) and post-operative MRI (right).
Figure 2
Figure 2
Case 2: pre-operative MRI (left) and post-operative MRI (right).
Figure 3
Figure 3
Case 2: pre- and post-operative MRI showing reduction in the myelopathy area.
Figure 4
Figure 4
Case 3: pre-operative MRI showing an intradural and extramedullary cyst: pre-operative T2 sagittal view (left) and pre-operative T2 axial view (right).
Figure 5
Figure 5
Case 3: post-operative MRI showing the absence of a recurrent cystic formation: post-operative T2 axial view (left) and post-operative T2 sagittal view (right).
Figure 6
Figure 6
Case 4: pre-operative MRI illustrating a ventral intradural cyst.
Figure 7
Figure 7
Case 4: syringoperitoneal shunt placement and adhesion lysis: scar and arachnoid adhesions(left); adhesion lysis and syringoperitoneal catheter draining the syringomyelic cavity (right).
Figure 8
Figure 8
Case 4: post-operative MRI showing the reduction in syringomielic size: pre-operative (left) and post-operative (right).
Figure 9
Figure 9
Case 5: pre-operative MRI (left) and post-operative MRI (right).
See this image and copyright information in PMC

References

    1. Eroglu U., Bozkurt M., Kahilogullari G., Dogan I., Ozgural O., Shah K.J., Zaimoglu M., Al-Beyati E.S., Ugur H.C., Cohen-Gadol A.A. Surgical Management of Spinal Arachnoid Cysts in Adults. World Neurosurg. 2019;122:e1146–e1152. doi: 10.1016/j.wneu.2018.11.005. - DOI - PubMed
    1. Epstein N.E. Review/Perspective on the Diagnosis and Surgical Management of Spinal Arachnoid Cysts. Surg. Neurol. Int. 2022;13:98. doi: 10.25259/SNI_153_2022. - DOI - PMC - PubMed
    1. Naito K., Yamagata T., Ohata K., Takami T. Safety and Efficacy of Syringoperitoneal Shunting with a Programmable Shunt Valve for Syringomyelia Associated with Extensive Spinal Adhesive Arachnoiditis: Technical Note. World Neurosurg. 2019;132:14–20. doi: 10.1016/j.wneu.2019.08.103. - DOI - PubMed
    1. Jones B., Behr S., Shaw T., Cappello R., Jeffery N., Liebel F.X., Harcourt-Brown T. Surgical techniques used in the management of intra-arachnoid diverticula in dogs across four referral centres and their immediate outcome. J. Small Anim. Pract. 2022;63:520–525. doi: 10.1111/jsap.13486. - DOI - PMC - PubMed
    1. Abou Fakhr F.S., Kanaan S.V., Youness F.M., Hourani M.H., Haddad M.C. Thoracic spinal intradural arachnoid cyst: Report of two cases and review of literature. Eur. Radiol. 2002;12:877–882. doi: 10.1007/s003300100995. - DOI - PubMed

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