gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Intradural spinal arachnoid cysts in the absence of syringomyelia – a challenge

Meeting Abstract

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  • U.M. Mauer - Neurochirurgische Abteilung, Bundeswehrkrankenhaus Ulm
  • A. Gottschalk - Abteilung für Radiologie, Bundeswehrkrankenhaus Ulm
  • U. Kunz - Neurochirurgische Abteilung, Bundeswehrkrankenhaus Ulm

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.09

DOI: 10.3205/11dgnc184, URN: urn:nbn:de:0183-11dgnc1848

Published: April 28, 2011

© 2011 Mauer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Even if there is no evidence of syringomyelia, the presence of an intradural arachnoid cyst should be suspected as the underlying cause of cerebrospinal fluid (CSF) flow obstruction in patients, who present with inconclusive symptoms and have no obvious spinal canal narrowing or spinal cord changes.

Methods: We studied 31 consecutive patients (16 women, 15 men, mean age: 45 years) who had been diagnosed with intradural arachnoid cysts on the basis of cardiac-gated phase-contrast cine magnetic resonance imaging and partial with cardiac-gated cine balanced fast-field echo sequences.

Results: Although all patients had undergone many MRI investigations and had seen several physicians, the diagnosis of an intradural arachnoid cyst without syringomyelia had never been made.

A thorough analysis of sagittal T2-weighted images revealed irregular spinal cord calibres in half of the patients. When compared to patients with syringomyelia, these patients showed a significant decrease in CSF flow velocity in the central canal (p < 0.05).

8 patients required surgical management for urgent symptoms. In these cases, the arachnoid cysts were opened via hemilaminectomy or interlaminar fenestration and an expansive duraplasty was performed.

Five of the 8 patients reported improvement and 3 patients even had a complete resolution of their symptoms. Postoperative cardiac-gated phase-contrast cine MRI and cardiac-gated cine balanced fast-field echo sequences demonstrated free CSF flow.

Conclusions: Once cardiac-gated phase-contrast cine MRI has confirmed the diagnosis of an intradural arachnoid cyst, a minimal surgical procedure can also benefit some of the patients with atypical symptoms and lead to an improvement in specific cases. The diagnosis of this condition, however, is a challenge and remains the key to successful management.