Spinal Extradural Arachnoid Cysts: Clinical, Radiological, and Surgical Feature

James K. Liu, M.D.; Chad D. Cole, M.D.; Peter Kan, M.D.; Meic H. Schmidt, M.D.


Neurosurg Focus. 2007;22(2) 

In This Article

Clinical Features

Spinal arachnoid cysts generally develop in adolescents, and twice as many cases occur in male as in female patients.[4] Thoracic cysts usually occur in young adolescents, whereas thoracolumbar and lumbar cysts usually appear in adults in the fourth decade of life.[4,5] These lesions often arise dorsally and can partially protrude into the adjacent neural foramen. A single cyst can ex tend over several spinal segments, or multiple cysts with separate dural defects and communicating pedicles can compose one lesion.[15]

The location of the cyst within the spine and the severity of spinal cord and root compression affect the clinical presentation.[16] Spastic tetraparesis and impaired sensory levels are indicative of cervical cysts, whereas Horner syndrome is a common presentation in patients with cysts that occur lower in the cervical spine.[4] Patients with thoracic cysts tend to present with progressive spastic paraparesis, but back pain is generally uncommon; conversely, patients with lumbar and lumbosacral cysts classically present with low-back pain, radiculopathy, and bowel and bladder dysfunction. Overall, motor weakness is usually more predominant than sensory loss.[11,21,25] Symptoms can be intermittent and exacerbated by Valsalva maneuvers or gravitational positional forces.[24] Remissions and fluctuation in symptoms have been reported in approximately 30% of cases.[4]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: