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.

Disclosures

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]

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