Diagnostic and therapeutic management of spinal arachnoid cysts

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.