gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Epidural arachnoid cysts of the spinal canal

Epidurale Arachnoidalzysten des Spinalkanals

Meeting Abstract

Suche in Medline nach

  • corresponding author J. Klekamp - Neurochirurgie, Christliches Krankenhaus Quakenbrück

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.05.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc243.shtml

Veröffentlicht: 11. April 2007

© 2007 Klekamp.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Arachnoid cysts of the spinal canal can be located in the subarachnoid space or extradurally in the epidural space. This paper will describe treatment and clinical course for epidural arachnoid cysts.

Methods: Hospital files, neuroradiological examinations, intraoperative documentations and follow-up examinations were analysed. The clinical course was documented with a neurological scoring system for each symptom and the Karnofsky score. Recurrence and survival rates were determined according to Kaplan-Meier statistics.

Results: Among a series of 1126 patients with spinal tumors treated between 1977 and 2006, 391 extradural tumors (34%) were encountered. Among these 391 patients with extradural tumors, there were 19 epidural arachnoid cysts. Six patients declined an operation, whereas 13 were operated. They presented at an average age of 37±15 years with an average history of 34±41 months. Mean follow-up was 16±29 months. Pain was the first indicator of this lesion in 53% of patients, whereas the remainder presented with increasing signs of a myelopathy. Small cysts extending over no more than two spinal segments were seen in 11 patients, while the remainder showed significant extensions over up to 13 segments. Epidural arachnoid cysts presented either as dura dissections between inner and outer dural layer or in a saccular form. Analogous to an arterial aneurysm, treatment of an epidural arachnoid cyst requires the identification and closure of the site of communication with the subarachnoid space, i.e. a dural defect. Most of them are located in a root sleeve. Depending on the size of the defect, nerve roots and even the cord itself may herniate into the cyst. Magnetic resonance imaging, myelography and postmyelographic computer tomography are the diagnostic modalities of choice. Treatment does not require resection of the cyst wall but demands closure of the dura defect. This can be achieved with a suture, a duraplasty or muscle and fibrin glue. Three patients demonstrated a recurrence within 8 months of surgery but declined reoperation because of minimal symptoms. The remainder showed postoperative improvement of pain and gait disorders in all but two patients who were left unchanged after surgery.

Conclusions: Extradural arachnoid cysts are rare space-occupying lesions of the spinal canal and may pose diagnostic problems in identifying the dural defect and the communication between cyst and subarachnoid space. If this defect can be obliterated adequately, the postoperative course is favorable.