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Abstract

We report the case of a 33-year-old male patient with no past medical history presenting to our tertiary referral center with progressive (two years) deficit of lower limb motor impairment (2/5 Medical Research Council [MRC] scale) and sensory impairment. T2- and T1-weighted MRI images clarified the nature of the cyst from T3 to T8. In our case, surgical management was warranted to relieve tension over the spinal cord, thus improving symptoms. Two multilevel laminectomies were performed, one centered on the proximal pole and the other on the distal pole; subsequently, the epidural cyst was gradually folded until it was totally extracted without complications. In the present study, we discuss a technique of extended spinal compressive arachnoid cyst. To the best of our knowledge, this technique has not been previously described in the existing body of literature. Here, we present a case of a successful procedure that seems both efficient and safe. Further study will be required to confirm its safety and efficacy.

Introduction

Spinal arachnoid cyst is a rare entity, accounting for about 1% of all spinal tumors, predominantly in the thoracic spine (65%) [1]. Spontaneous arachnoid cysts are more common in males with a peak incidence in the second decade of life [2].

Theories about its pathogenesis are diverse, one of which suggests that it is due to a defect in the dura mater that gradually grows until it causes a leak with a unidirectional flow of cerebrospinal fluid (CSF). Therefore, it is proposed that the existence of a defect as a solution of continuity between the subarachnoid space and the cystic lesion allows the pressure difference to stimulate the flow of CSF in the direction of the subarachnoid space toward the cyst [3].

It has also been reported that a history of trauma, inflammation, or infections causes arachnoid adhesions; these adhesions may be related to the formation of cysts with a valve effect that facilitates herniation of the arachnoid membrane and the resulting accumulation of CSF. Theories about its origin converge on the existence of communication between the subarachnoid space, whether idiopathic (congenital) or acquired [4].

These lesions are generally asymptomatic; however, when there are clinical manifestations, it is due to a mass-occupying effect and its location. Clinical manifestations can vary from radicular pain, sensory symptoms, motor deficit, autonomic deficit, and even manifestations of myelopathic compression [5].

In this article, we describe the successful management of a compressive spinal epidural arachnoid cyst that was operated on using two multilevel laminectomies centered on both poles of the extensive lesion.

Technical Report

We report the case of a 33-year-old male patient with no past medical history presenting to our tertiary referral center. He presented to the outpatient clinic complaining of progressive gait disorder for two years, impacting his daily life to the point of inability to ambulate.

On physical examination, we found that the patient had paraparesis in the lower limbs, with 2/5 and 3/5 (Medical Research Council [MRC] scale) proximally and distally for the left and right limbs, respectively. Sensory deficit was observed from levels T8 with alteration in proprioception and hyposensitivity. Increased patellar and Achilles reflexes were...(More)

For more info please read, A Technical Note on Alternating Laminectomies Plus Folding Cystectomy, by Cureus