Bowman John J, Edwards Charles C
The Maryland Spine Center, Baltimore, MD, USA.
J Spine Surg. 2020 Dec;6(4):736-742. doi: 10.21037/jss-20-590.
The authors present the case of an otherwise healthy 38-year-old female with an atypical extradural arachnoid cyst with multi-level involvement in the lumbar spine leading to left quadriceps weakness and dysesthesia. Upon presentation, a lumbar spine MRI with contrast and plain radiographs revealed extensive L4 bony erosion. An MR angiogram and cervical spine MRI with contrast were then obtained in order to rule out any aortic root or cervical spine pathology. With no other apparent clinically relevant pathology revealed by these additional tests, an L3-5 posterior decompression and fusion procedure was performed. Her preoperative symptoms were successfully resolved following the procedure, with no resultant surgical complications. The cyst is atypical not only due to its size and location, but also due of the significant bony erosion of the left L4 pedicle and vertebral body. To the authors' knowledge, this is the first reported case of an extradural arachnoid cyst in the lumbar spine with bony erosion of the pedicle and vertebral body. In cases such as this, a CT myelogram may be useful in planning the operative approach through visualization of the exact communication between cyst and dura. This approach may also aid in diagnosing and identifying atypical cyst presentations such as the one presented here.
作者报告了一例38岁健康女性病例，其患有非典型硬膜外蛛网膜囊肿，累及腰椎多个节段，导致左股四头肌无力和感觉异常。就诊时，腰椎增强MRI和平片显示L4广泛骨质侵蚀。随后进行了磁共振血管造影和颈椎增强MRI，以排除任何主动脉根部或颈椎病变。这些额外检查未发现其他明显的临床相关病变，遂行L3 - 5后路减压融合术。术后患者术前症状成功缓解，无手术并发症。该囊肿不典型，不仅因其大小和位置，还因其导致左侧L4椎弓根和椎体明显骨质侵蚀。据作者所知，这是首例报道的腰椎硬膜外蛛网膜囊肿伴椎弓根和椎体骨质侵蚀的病例。在此类病例中，CT脊髓造影可能有助于通过可视化囊肿与硬脑膜之间的确切连通情况来规划手术入路。这种方法也可能有助于诊断和识别非典型囊肿表现，如此处呈现的病例。
