Atormac
briv
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 1328  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (531 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed3391    
    Printed64    
    Emailed1    
    PDF Downloaded57    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGE
Year : 2012  |  Volume : 60  |  Issue : 1  |  Page : 134-135

Giant thoracolumbar intradural multilobulated arachnoid cyst


Department of Neurosurgery, G B Pant Hospital, New Delhi, India

Date of Web Publication7-Mar-2012

Correspondence Address:
Daljit Singh
Room No. 529, Academic Block, G B Pant Hospital, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.93596

Rights and Permissions



How to cite this article:
Kumar S, Chauresia P, Singh D, Singh H. Giant thoracolumbar intradural multilobulated arachnoid cyst. Neurol India 2012;60:134-5

How to cite this URL:
Kumar S, Chauresia P, Singh D, Singh H. Giant thoracolumbar intradural multilobulated arachnoid cyst. Neurol India [serial online] 2012 [cited 2021 Apr 20];60:134-5. Available from: https://www.neurologyindia.com/text.asp?2012/60/1/134/93596


Cystic lesions in the spine are mostly reported as small lesions located in the dorsal spine, [1] rarely can they be giant. [2] The largest reported cystic lesion in spine is extradural arachnoid cyst in cervicodorsal region in a child. [3] We report an interesting image of an adult with a giant multilobular cyst located in the dorsolumbar region.

A 50-year-old female presented with progressive paraparesis of three years' duration. On examination she had Grade 3/5 power with no sensory deficit. Magnetic resonance imaging (MRI) of the thoraco-lumbo-sacral region revealed an intradural cystic lesion extending from T10 to L4 vertebral bodies located posterior to the cord with bilateral extension at T12-L1, L2-L3 and L3-L4 levels, and compressing the spinal cord [Figure 1]. It had the same cerebrospinal fluid (CSF) intensity on T1 and T2 weighted images and showed no contrast enhancement. The lesion had caused scalloping of the posterior surface of the vertebral bodies [Figure 2] and widening of neural foramena bilaterally. T11, L1 and L3 laminectomies were performed. Dura was stretched and thinned out with thickening at places. Arachnoid membrane was pearly white, thickened. Fenestration at multiple levels with drainage of the cyst and biopsy of the cyst wall was done. Histopathological examination of the biopsy specimen revealed thickened arachnoid. The postoperative course was uneventful. The patient showed improvement over a period of three months.
Figure 1: Coronal T-2 image showing multilobular branching arachnoid cyst at D10-L4 with extension through the neural foramen at multiple levels giving a tree-like appearance

Click here to view
Figure 2: Saggital T-1 image showing large cyst extending from D10-L4 with scalloping of the posterior border of the vertebral bodies

Click here to view


Among the various types of cystic lesions of the spinal canal, CSF-filled meningeal cysts constitute the majority and are variously named as "arachnoid cysts", diverticula or "pouches". [4] The location may be intradural, extradural, or perineural. Arachnoid cysts are assumed to be the result of pathologic proliferation and distribution of the arachnoid trabeculae during the embryonic period. While most of the arachnoid cysts are intradural, non-traumatic spinal extradural arachnoid cysts are considered to arise from a congenital dural defect, which allows the arachnoid membrane to herniate through the adjacent duramater. [4] Most of the congenital Type III cysts can be found posterior to the spinal cord, as opposed to those caused by trauma which can be found anterior to the spinal cord. [5] Our patient can be categorized into Type III arachnoid cyst [6] located at the thoracolumbar region, postero-lateral to the cord, and involved seven vertebral bodies extending from T10-L4. There is controversy regarding the best treatment for such cases. Fenestration of the cyst and/or partial excision of the wall are the recommended treatment options. A lumboperitoneal shunt is supposed to result in long-term relief of symptoms.

 
  References Top

1.Stern Y, Spiegelmann R, Sadeh M. Spinal intradural arachnoid cysts. Neurochir 1991;34:127-30.  Back to cited text no. 1
    
2.Safriel YI, Sanchez G, Jhaveri HS. Giant anterior cervicothoracic arachnoid cyst. Spine 2002;27:366-8.  Back to cited text no. 2
    
3.Kahraman S, Anik I, Gocmen S, Sirin S. Extradural giant multiloculated arachnoid cyst causing spinal cord compression in a child: Case report. J Spinal Cord Med 2008;31:306-8.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Osenbach RK, Godersky JC, Traynelis VC, Schelper RD. Intradural extramedullary cysts of the spinal canal: Clinical presentation, radiographic diagnosis, and surgical management. Neurosurgery 1992;30:35-42.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Lee HJ, Cho DY. Symptomatic spinal intradural arachnoid cysts in the paediatric age group: Description of three new cases and review of the literature. Pediatr Neurosurg 2001;35:181-7.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Nabors MW, Pait TG, Byrd EB, Karim NO, Davis DO, Kobrine AI, et al. Updated assessment and current classification of spinal meningeal cysts. J Neurosurg 1988;68:366-77.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow