Section of Neurosurgery, Carilion Clinic, Roanoke, Virginia, USA.
Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Neurosurgery. 2023 Mar 1;92(3):450-463. doi: 10.1227/neu.0000000000002231. Epub 2022 Nov 28.
Adult spinal intradural arachnoid cysts are rare pathologic entities with an unclear etiopathogenesis. These lesions can be dichotomized into primary (idiopathic) or secondary (related to inflammation, intradural surgery, or trauma) etiologies. Limited series have depicted optimal management strategies and clinical outcomes.
To illustrate our experience with spinal intradural arachnoid cysts and to present a literature review of surgically treated cysts to elucidate the clinical and anatomic differences between etiologies.
Institutional review revealed 29 patients. Various data were extracted from the medical record. Initial and follow-up symptomatologies of the surgical cohort were compared. The literature review included case series describing cysts managed surgically.
From patients treated surgically at our institution (22), there was a significant reduction in thoracic back pain postoperatively ( P = .034). A literature review yielded 271 additional cases. Overall, primary and secondary lesions accounted for 254 and 39 cases, respectively. Cysts of secondary origin were more likely localized ventral to the spinal cord ( P = .013). The rate of symptomatic improvement after surgical intervention for primary cysts was more than double than that of secondary cysts ( P < .001). Compared with primary etiologies, the rates of radiographic progression ( P = .032) and repeat surgery ( P = .041) were each more than double for secondary cysts.
Surgical intervention for spinal intradural arachnoid cysts improves thoracic back pain. The literature supports surgical intervention for symptomatic primary spinal intradural arachnoid cysts with improved clinical outcomes. Surgery should be cautiously considered for secondary cysts given worse outcomes.
成人椎管内蛛网膜囊肿是一种罕见的病理实体，其发病机制尚不清楚。这些病变可分为原发性（特发性）或继发性（与炎症、椎管内手术或创伤有关）病因。有限的系列研究描述了最佳的治疗策略和临床结果。
展示我们在椎管内蛛网膜囊肿方面的经验，并对接受手术治疗的囊肿进行文献复习，以阐明不同病因的临床和解剖差异。
机构审查显示共有 29 名患者。从病历中提取了各种数据。比较了手术组患者的初始和随访症状。文献复习包括描述接受手术治疗的囊肿的病例系列。
在我院接受手术治疗的 22 名患者中，术后胸背部疼痛明显减轻（P=0.034）。文献复习还包括 271 例额外的病例。总的来说，原发性和继发性病变分别占 254 例和 39 例。起源于继发性的囊肿更可能位于脊髓腹侧（P=0.013）。原发性囊肿手术干预后症状改善的比例是继发性囊肿的两倍多（P<0.001）。与原发性病因相比，继发性囊肿的影像学进展（P=0.032）和再次手术（P=0.041）的比例均高出两倍以上。
手术干预椎管内蛛网膜囊肿可改善胸背部疼痛。文献支持对有症状的原发性椎管内蛛网膜囊肿进行手术干预，以获得更好的临床结果。鉴于继发性囊肿的预后较差，应慎重考虑手术治疗。
