P. De Bonis, MD,
C. Lucantoni, MD,
L. D'Angelo, MD,
F. Doglietto, MD,
D. Romano, MD and
M. Visocchi, MD
From the Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
Address correspondence and reprint requests to Dr. Pasquale De Bonis, Institute of Neurosurgery, Catholic University School of Medicine, L.go A. Gemelli 8, 00168 Rome, Italy debonisvox{at}gmail.com
A 38-year-old woman presented with a 2-month history of lowback pain, radiating to the right leg, with no evident radiculardistribution. Neurologic examination did not show any pathologicsigns. Neuroimaging showed a spinal extradural arachnoid cyst(SEAC) at T11–L1 level, displacing the spinal cord anteriorly(figure).
Axial CT scan (A) and MR axial T2W image (B) at T12 level showing an arachnoid cyst located posteriorly in the spinal canal with lateral extension and scalloping of the right foramen and hemilamina (A). (C) MR coronal T2W image. (D, E) MR sagittal preoperative (D) and postoperative T2W images.
Cyst removal and ligation of the subarachnoid-cyst communicatingduct were performed. Pathologic examination documented an arachnoidwall. Patient is pain free at 1 year-follow-up. SEAC is a rarecause of spinal cord compression, radiculopathy, and back pain.It is more common in males and in the second decade of lifeand usually found in the thoracic spine.1 Though etiopathogenesisremains unclear, arachnoid pouching through a possibly congenitaldural defect and enlargement of the cyst due to a one-way valveis the most accredited theory.1 In the setting of intractableback and leg pain our patient underwent CT and MR scans (figure).MRI usually leads to a preoperative diagnosis and kinematicMRI might allow the preoperative identification of the communicationsite.2 Surgical treatment is indicated in symptomatic lesions:closure of the communicating duct and dural defect togetherwith removal of the cyst generally leads to symptoms improvement.1
Choi JY, Kim SH, Lee WS, Sung KH. Spinal extradural arachnoid cyst. Acta Neurochir 2006;148:579–585.[Medline]
Doita M, Nishida K, Miura J, Takada T, Kurosaka M, Fujii M. Kinematic magnetic resonance imaging of a thoracic spinal extradural arachnoid cyst: an alternative suggestion for exacerbation of symptoms during straining. Spine 2003;28:E229–E233.[Medline]
Top.
REFERENCES
