- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- Division of Neurosurgery, Department of Surgery, King Abdulaziz Medical City, Ministry of the National Guard– Health Affairs, Riyadh, Saudi Arabia.
- Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Rahaf Farhan Alanazi, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
DOI:10.25259/SNI_928_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Rahaf F. Alanazi1,2, Thana S. Namer2,3, Abdulrahman Almalki2,3, Fahd AlSufiani2,4, David Pinilla Arias2,3. Idiopathic thoracolumbar spinal epidural arachnoid cysts: A case report and systematic review. 30-Dec-2022;13:599
How to cite this URL: Rahaf F. Alanazi1,2, Thana S. Namer2,3, Abdulrahman Almalki2,3, Fahd AlSufiani2,4, David Pinilla Arias2,3. Idiopathic thoracolumbar spinal epidural arachnoid cysts: A case report and systematic review. 30-Dec-2022;13:599. Available from: https://surgicalneurologyint.com/surgicalint-articles/12084/
Background: Idiopathic spinal epidural arachnoid cysts (SEACs) are rare and may cause myelopathy and cord compression. They typically arise from a congenital defect in the dura that communicates with the intrathecal subarachnoid space. Although the ideal treatment of SEACs is direct dural repair and cyst excision, there is as yet no clear standard of care for the management of these lesions.
Methods: A 47-year-old female presented with myelopathy attributed to an magnetic resonance imaging-documented posterior epidural T12-L2 cyst (i.e., 1.1 × 6 × 3.3 cm) lesion. The patient underwent a direct dural repair of the fistulous communication between the subarachnoid space and the cyst, along with cyst drainage/ excision through a right-sided laminotomy. Postoperatively, the patient was asymptomatic. We additionally reviewed the literature regarding the management of SEACs.
Results: Our review yielded 14 articles involving 18 patients with predominantly thoracolumbar (57%) SEACs that were either communicating (61%) or not communicating (39%) with the subarachnoid space. They averaged 35.5 years of age and exhibited a male preponderance (66%). Symptoms typically included pain (78%), followed by weakness/myelopathy (42%). Surgery frequently included bilateral laminectomies (57%) followed by unilateral laminectomies (50%) that typically resulted in symptom resolution.
Conclusion: SEACs are rare typically thoracolumbar lesions that may cause myelopathy which resolves following direct dural closure/subarachnoid fistulous occlusion
Keywords: Arachnoid cysts, Epidural, Idiopathic, Spine
Spinal epidural arachnoid cysts (SEACs), characterized by a dural defect, typically arise without a previous history of trauma, surgery, infection, or inflammation.[
Literature search strategy
We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and performed a literature review of PubMed (1976–2021) using “spinal,” “epidural,” and “arachnoid cyst.” Multiple variables were studied, along with a review of one or our own cases.
A 47-year-old female presented with a progressive lower extremity paraparesis of 4-month duration (i.e., pain, numbness, urge incontinence, weakness left 3/5- right 4/5 proximal/left 1/5 and right 2/5 distal), and a L1 pin level. The thoracolumbar magnetic resonance imaging (MRI) revealed a posterior epidural T12-L2 cystic lesion measuring 1.1 × 6 × 3.3 cm [
(a) T2-W magnetic resonance imaging (MRI) sagittal (a) and axial (b) images disclose a well-defined uniformly hyperintense (identical to CSF) cystic lesion extending from the lower end of the T12 vertebral body to the lower end of L2 vertebral body causing a mass effect and compression over the cord. The cystic structure is exiting through the bilateral L1-L2 exiting neural foramina and causing mass effect on the exiting nerve roots.
(a) Intraoperative images of surgical exposure and cyst resection. (a) Unilateral right approach and preliminary exposure of the cranial portion of the cyst (Arrowhead). (b) Progressive resection of the cyst capsule. (c) Dissection and resection of the lateral recess portion of the cyst. (d) Complete bilateral resection of the cyst through a unilateral approach.
Our search yielded 107 results from PubMed. There were no duplicate records found. All studies were screened based on their titles and abstracts, and nonrelevant studies (n = 86) were removed. The remaining articles (n = 21) were then fully read for eligibility. Overall, 14 studies met the eligibility criteria for the final review [
Fourteen articles involving 18 cases with idiopathic SEACs met our inclusion criteria [
Idiopathic SEACs are rare cystic lesions that originate as protrusions of the arachnoid membrane through a dura defect. They may increase in size due to CSF pulsations and consequently enlarge to the point that they compress the spinal cord and/or nerve roots resulting in neurological deficits.[
Etiology of SEACs
The pathogenesis of idiopathic SEACs most often results from defects in the dura due to a congenital dural membrane defect.[
The pathophysiology of idiopathic SEAC has been variably described.[
Imaging of SEACs
MRI is typically used to determine the communication site between the spinal subarachnoid space and the cyst cavity.[
Treatment of SEAC
Treatment for asymptomatic patients consists of conservative management but symptomatic lesions require direct surgical occlusion of the fistulous defect (i.e., laminotomy, hemilaminectomy, laminectomy with complete cyst wall excision, and dural repair).[
Idiopathic spinal epidural arachnoid cysts (SEAC) are rare. When diagnosed with MR, they should be treated with direct surgical occlusion of fistulous communication to achieve optimal postoperative resolution of myelopathy.
Patient’s consent not required as there are no patients in this study.
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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