Abolfazl Rahimizadeh1, Housain Soufiani. 1. Department of Neurosurgery, Pars Hospital, 83 Keshawarz Blvd, 14154 Tehran, Islamic Republic of Iran. Electronic address: A_rahimizadeh@hotmail.com.
Abstract
BACKGROUND CONTEXT: Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently. PURPOSE: Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis. STUDY DESIGN: To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis. METHODS: Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity. RESULT: Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status. CONCLUSION: Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.
BACKGROUND CONTEXT: Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently. PURPOSE: Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis. STUDY DESIGN: To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis. METHODS: Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity. RESULT: Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status. CONCLUSION: Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.