Spinal intradural extramedullary arachnoid cysts in adults—operative therapy and clinical outcome

• Published in: Acta neurochirurgica 2020-03, Vol.162 (3), p.691-702
• Main Authors: Schmutzer, Michael, Tonn, Joerg-Christian, Zausinger, Stefan
• Format: Article
• Language: English
• Subjects: Brain diseases; Central nervous system diseases; Clinical outcomes; Compression; Cysts; Epidural hematoma; Gait; Hematoma; Hemorrhage; Interventional Radiology; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Movement disorders; Neurology; Neuroradiology; Neurosurgery; Original Article - Spine - Other; Paresis; Patients; Spinal cord; Spine (thoracic); Spine - Other; Surgery; Surgical Orthopedics
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-019-04156-0

Background Spinal arachnoid cysts (SAC) are rare mostly idiopathic intradural lesions with compression of the spinal cord and clinical signs of radiculo- and/or myelopathy. We retrospectively analyzed radiological and clinical characteristics of patients with surgical treatment of SAC including a subgroup evaluation of long-term outcome and QoL. Method Patients with SAC treated between 1993 and 2017 were evaluated. Craniocaudal (c.c.) and anteroposterior (a.p) cyst diameters were measured pre- and post-OP. McCormick and Odom score for myelopathy, general outcome and QoL (SF-36, EORTC-QLQ30) were recorded. Results A total of 72 patients (female:male = 1.9:1) were analyzed with mean FU of 44.8 ± 60 months (long-term data from 25 patients with FU 78.2 ± 63.9 months). All had surgery due to solitary cysts: 10 cervical (13.9%), 45 thoracic (62.5%), and 17 lumbosacral (23.6%), the majority (79.2%) located dorsally. Main symptoms were gait disturbance (80%), dysesthesia (64%) and paresis (80%). Patients had (hemi-)laminectomy with cyst fenestration in 48 (66.7%) and complete resection in 18 cases (25.0%). Four cases (5.5%) were treated by cystoperitoneal shunt, 2 by marsupialization (2.8%). In total, 11 revisions were necessary in 9/72 (12.5%) patients (one patient underwent 3 revisions). Two patients were reoperated for wound revision/epidural hematoma (each n  = 1). Seven patients needed additional cyst wall resection after 1.5–31.0 months due to insufficient cyst shrinking and persistent clinical symptoms after first surgery; most of the cysts were multiple septated and of post-hemorrhagic origin. The mean c.c. size decreased from 5.2 ± 3.7 cm pre-OP to 2.7 ± 3.9 cm ( p