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|Year : 2012 | Volume
| Issue : 1 | Page : 134-135
Giant thoracolumbar intradural multilobulated arachnoid cyst
Sanjiv Kumar, Pramod Chauresia, Daljit Singh, Hukum Singh
Department of Neurosurgery, G B Pant Hospital, New Delhi, India
|Date of Web Publication||7-Mar-2012|
Room No. 529, Academic Block, G B Pant Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|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
Cystic lesions in the spine are mostly reported as small lesions located in the dorsal spine,  rarely can they be giant.  The largest reported cystic lesion in spine is extradural arachnoid cyst in cervicodorsal region in a child.  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|
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|Figure 2: Saggital T-1 image showing large cyst extending from D10-L4 with scalloping of the posterior border of the vertebral bodies|
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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".  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.  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.  Our patient can be categorized into Type III arachnoid cyst  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.
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[Figure 1], [Figure 2]