Pre-Residency Fellow RNZ Neuroscience, Lagos, Nigeria Atlanta, Georgia, United States
Introduction: Spinal arachnoid cysts are rarely occurring benign CSF containing lesions which can occur anywhere along the spinal axis, however mostly in the thoracic spine. They occur either ventrally or dorsally and could be extradural, intradural-extramedullary, or intramedullary. They may be asymptomatic or present with symptoms related to spinal cord and/or nerve roots compression. We report the case of a patient with idiopathic ventrolateral thoracic intradural extramedullary arachnoid cyst with a fulminant course and a literature review.
Case A 49-year-old who developed sudden onset midback pain radiating to the anterior chest wall with rapid progression to gait instability, urinary retention, and paraplegia within 10 hours. His presentation for expert neurosurgical care was delayed due to lack of funds and unfavorable insurance policies. At presentation 3 months after onset of symptoms, his spine MRI showed a ventral cystic lesion with severe cord compression, and he had T5-7 laminectomies with a limited left 6th rib costotransversectomy for excision of the cyst. Post-operatively, he reported slight improvement in bladder sensation, however paraplegia persisted.
Methods: We conducted PubMed and Google Scholar searches of the keywords “arachnoid cyst,” “idiopathic,” “thoracic,” and “intradural”. Identified articles and cases were screened for relevance against a defined inclusion and exclusion criteria.
Results: 110 cases of clearly defined idiopathic thoracic intradural arachnoid cysts described in various literature with the average duration of presentation reported ranging between 1 week to 20 years. 99% of the cases required surgical intervention to prevent symptom progression.
Conclusion : Arachnoid cysts are mostly benign lesions; however, they may have disastrous outcomes if not promptly addressed with the urgency when symptoms are progressive as seen in our patient.
