Artikel
Arachnoid webs – report of 54 consecutive cases
Suche in Medline nach
Autoren
-
Viola Olesen
- Copenhagen University Hospital, Spine Unit, Orthopedic Department, Rigshospitalet, Denmark
-
Anders Kruse
- Copenhagen University Hospital, Spine Unit, Orthopedic Department, Rigshospitalet, Denmark
| Veröffentlicht: | 8. Mai 2019 |
|---|
Gliederung
Text
Objective: Arachnoid webs are focal intraspinal adhesions between the arachnoid membrane and pia mater, that cause obstruction of the normal flow of the cerebrospinal fluid and may compress the spinal cord. Arachnoid webs have a characteristic appearance in imaging studies coined as “the Scalpel Sign”. Some cases of arachnoid webs have an associated syringomyelia either above or below the web.
Methods: Retrospective data of 54 consecutive patients with arachnoid webs are presented. Due to clinical symptoms of spinal cord compression 15 of them were surgically treated.
The level and appearance of the webs were noted. In case of associated syringomyelia the location was described in relation to the web (cranial or caudal).
Patients were followed at least for one year with clinical assessment and MRI control.
Results: The arachnoid webs are typically located at the upper thoracic levels. The appearance of the webs and location of associated syringomyelia seems to differ according to the level of the web.
The usual web has a cranial convexity. A minority of webs have a caudal convexity and this subgroup of webs tend to be located at lower thoracic levels.
In cases of associated syringomyelia it is usually located cranial to the web. Few exceptions where the syringomyelia is located caudally to the web exist and are typically related to webs at lower thoracic levels.
Surgery was performed in 15 cases (6 females and 9 males). In 7 out of 15 cases an associated syringomyelia was present.
All surgically treated patients had satisfactory spinal cord decompression on MRI 3 months postoperatively.
We found substantial effect on syringomyelia by excision of the webs exclusively. In 5 cases the syringomyelia completely vanished 3 months postoperatively. The last 2 patients had significant decrease in the size of the syringomyelia 3 months postoperatively.
Conclusion: Arachnoid webs might underreported, as many of the patients with webs are asymptomatic and only a subgroup of patients needs surgery. Surgical treatment of arachnoid webs with excision of the web exclusively impose substantial effect on syringomyelia if present. Our findings suggest that the dynamics of the CSF flow in the upper thoracic spinal canal differs compared to the lower thoracic region. Future research should focus on identifying the etiology of arachnoid webs probably by applying supplementary imaging techniques.
