Management of a recurrent spinal arachnoid cyst presenting as arachnoiditis in the setting of spontaneous spinal subarachnoid hemorrhage: illustrative case. J Neurosurg Case Lessons 2024 Feb 05;7(6)
Date
02/05/2024Pubmed ID
38315980Pubmed Central ID
PMC10849147DOI
10.3171/CASE23660Scopus ID
2-s2.0-85184713284 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: Spontaneous spinal subarachnoid hemorrhage is a rare pathological entity with a variety of presentations depending on the underlying etiology, which often remains cryptogenic. The literature is sparse regarding the most efficacious treatment or management option, and there is no consensus on follow-up time or modalities. Additionally, there are very few reports that include operative videos, which is provided herein.
OBSERVATIONS: The authors present a case of spontaneous spinal subarachnoid hemorrhage without an underlying etiology in a patient with progressive myelopathy, back pain, and lower-extremity paresthesias. She presented to our institution, and because of progressive worsening of her symptoms and the development of compressive arachnoid cysts, she underwent thoracic laminectomies for evacuation of subdural fluid, fenestration of the arachnoid cysts, and lysis of significant arachnoid adhesions. Her clinical course was further complicated by the recurrence of worsening myelopathy and the development of a large compressive arachnoid cyst with further arachnoiditis. The patient underwent repeat surgical intervention for cyst decompression with an improvement in symptoms.
LESSONS: This case highlights the importance of long-term follow-up for these complicated cases with an emphasis on repeat magnetic resonance imaging. Unfortunately, surgical intervention is associated with short-term relief of the symptoms and no significant nonoperative management is available for these patients.
Author List
Hussain O, Treffy R, Reecher HM, DeGroot AL, Palmer P, Bakhaidar M, Shabani SAuthors
Hope M. Reecher BS, MD Postdoctoral Researcher in the Radiology department at Medical College of WisconsinSaman Shabani MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
