Yun ZH, Zhang J, Wu JP, Yu T, Liu QY. Transforaminal endoscopic excision of bi-segmental non-communicating spinal extradural arachnoid cysts: A case report and literature review. World J Clin Cases 2021; 9(31): 9598-9606 [PMID: 34877296 DOI: 10.12998/wjcc.v9.i31.9598]
Corresponding Author of This Article
Qin-Yi Liu, MD, Chief Doctor, Professor, Department of Orthopaedics, The Second Hospital of Jilin University, No. 218 Ziqiang Road, Nanguan Street, Changchun 130041, Jilin Province, China. qinyi@jlu.edu.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 6, 2021; 9(31): 9598-9606 Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9598
Transforaminal endoscopic excision of bi-segmental non-communicating spinal extradural arachnoid cysts: A case report and literature review
Zhi-He Yun, Jun Zhang, Jiu-Ping Wu, Tong Yu, Qin-Yi Liu
Zhi-He Yun, Jun Zhang, Jiu-Ping Wu, Tong Yu, Qin-Yi Liu, Department of Orthopaedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Yun ZH, Zhang J and Liu QY were the patient’s spine surgeons, reviewed the literature and contributed to manuscript drafting; Yun ZH, Wu JP and Yu T were responsible for revision of the manuscript for important intellectual content; Yun ZH analyzed and interpreted the imaging findings; all authors issued final approval for the version to be submitted.
Supported bythe Program of Scientific Development of Jilin Province, China, No. 20190201066JC; and the Health Appropriate Technology Poverty Alleviation Project of Jilin Province China, No. 2018FP043.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qin-Yi Liu, MD, Chief Doctor, Professor, Department of Orthopaedics, The Second Hospital of Jilin University, No. 218 Ziqiang Road, Nanguan Street, Changchun 130041, Jilin Province, China. qinyi@jlu.edu.cn
Received: April 18, 2021 Peer-review started: April 18, 2021 First decision: May 24, 2021 Revised: June 6, 2021 Accepted: August 17, 2021 Article in press: August 17, 2021 Published online: November 6, 2021 Processing time: 194 Days and 7.3 Hours
Abstract
BACKGROUND
Spinal extradural arachnoid cysts (SEACs) are a rare cause of spinal cord compression. Typically, these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac. For symptomatic SEACs, the standard treatment is to remove the cyst in total with a (hemi)laminectomy or laminoplasty. We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to remove bi-segmental non-communicating SEACs.
CASE SUMMARY
A 79-year-old female presented with pain related to bi-segmental SEACs at the T11-L1 segments. She underwent sequential transforaminal percutaneous endoscopic thoracic cystectomy of the SEACs. Following her first procedure, spinal magnetic resonance imaging demonstrated complete excision of the cyst at the T12-L1 segment. However, the cyst at the T11-T12 segment was still present. Thus, a second procedure was performed to remove this lesion. The patient’s right-sided lumbar and abdominal pain improved significantly postoperatively. Her Japanese Orthopaedic Association score increased from 11 to 25, her visual analogue scale score was reduced from 8 to 1. The physical and mental component summary of the 36-item short-form health survey (SF-36) were 15.5 and 34.375 preoperatively, and had increased to 79.75 and 77.275 at the last follow-up visit, respectively.
CONCLUSION
Bi-segmental non-communicating SEACs are extremely rare. Endoscopic surgery is a safe, effective, and reliable method for treating these cysts. In the event of bi-segmental SEACs, it is important to identify whether both cysts are communicating before surgery, and if not, to remove both cysts separately during the index surgery to avoid re-operation.
Core Tip: Spinal extradural arachnoid cysts (SEACs) are a rare cause of spinal cord compression. Typically, these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac. To date, few articles have reported SEACs that are not in direct communication with the subarachnoid space. For symptomatic SEACs, the standard treatment is to remove the cyst in total with a (hemi)laminectomy or laminoplasty. We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to treat them.
