Spinal arachnoid cysts: A case series & systematic review of the literature

Pratipal Kalsi; Nader Hejrati; Anastasios Charalampidis; Pang Hung Wu; Michel Schneider; Jamie Rf Wilson; Andrew F Gao; Eric M Massicotte; Michael G Fehlings

doi:10.1016/j.bas.2022.100904

Spinal arachnoid cysts: A case series & systematic review of the literature

Brain Spine. 2022 Jun 15:2:100904. doi: 10.1016/j.bas.2022.100904. eCollection 2022.

Authors

Pratipal Kalsi^{1

2}, Nader Hejrati^{1

2

3}, Anastasios Charalampidis^{1

2}, Pang Hung Wu^{1

2}, Michel Schneider^{1

2}, Jamie Rf Wilson^{1

2}, Andrew F Gao^{4

5}, Eric M Massicotte^{1

2

6}, Michael G Fehlings^{1

2

3

6}

Affiliations

¹ Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada.
² Spine Program, University of Toronto, Toronto, Ontario, Canada.
³ Division of Genetics and Development, Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.
⁴ Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada.
⁵ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Ontario, Canada.
⁶ Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Abstract

Introduction: Spinal arachnoid cysts (SACs) are rare lesions with challenging and controversial management.

Research question: We analyzed our experiences from a case series and provide a systematic review to determine 1) Demographic and clinical features of SACs, 2) Optimal imaging for diagnosis and operative planning, 3) Optimal management of SACs, and 4) Clinical outcomes following surgery.

Materials and methods: A single-institution, ambispective analysis of patients with symptomatic SACs surgically managed between May 2005 and May 2019 was performed. Data were collected as per local ethics committee stipulations. A systematic review of SACs in adults was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and a preapproved protocol.

Results: Our series consisted of 11 patients, M:F 8:3, mean age 47.8 years (range 18-73 years). Mean follow-up was 19 months (range 5-36 months). SACs were excised or marsupialised (7), fenestrated (3) or partially excised (1). Eight patients had expansile duroplasty, 3 primary dural closure. One patient had a cystoperitoneal shunt. All patients were AIS D preoperatively; 4 remained unchanged and 7 improved to AIS E at follow-up. Our systematic search retrieved 725 citations. Fourteen case series met the inclusion criteria. There was no evidence to support superiority of one surgical strategy over another. Surgery for symptomatic patients resulted in positive clinical outcomes.

Discussion and conclusions: Symptomatic SACs require surgical intervention. Limited evidence suggests that decompressing the cord, breakdown of arachnoid adhesions, and establishing CSF flow by consideration of expansile duroplasty are important for positive outcomes.

Keywords: Case series; Spinal arachnoid cysts; Spine; Surgical decompression; Systematic review.

Publication types

Review