Background. The wide variety of intraspinal cystic lesions necessitates dif
ferent elaborate diagnostic procedures to choose the right therapeutic mana
gement in symptomatic patients. Based on the case reports of seven patients
with symptomatic spinal arachnoid cysts we discuss the aetiology, diagnost
ic procedures and therapeutic management of extra-and intradural spinal cys
ts.
Method. All patients underwent MRI, Myelography and CT-Myelography during d
iagnostic evaluation. During surgery the cyst was resected and the communic
ation between the cyst and the subarachnoid space was closed.
Findings. Two patients were identified with intradural, five with extradura
l spinal arachnoid cysts. Postoperative outcome was favourable in those pat
ients without preoperative cord damage.
Interpretation. MRI is the diagnostic procedure of first choice because of
its potential to demonstrate the exact localisation, extent and relationshi
p of the arachnoid cyst to the spinal cord. Cord atrophy secondary to compr
ession can be visualised and used for prediction of neurological outcome. M
yelography and CT-Myelography (CTM) are still of diagnostic value since the
y might demonstrate the communication between the subarachnoid space and th
e cyst, which is important for surgical planning. The aim of surgical treat
ment is neural decompression and prevention of refilling of the cyst which
is best accomplished by complete resection of the cyst and closure of the c
ommunication between cyst and subarachnoid space.