Symptomatic secondary spinal arachnoid cysts: a systematic review.
Spine J
; 23(8): 1199-1211, 2023 08.
Article
em En
| MEDLINE
| ID: mdl-36924909
ABSTRACT
BACKGROUND CONTEXT Secondary spinal arachnoid cysts have rarely been reported but present significant challenges for management. These cysts could be anteriorly located with long rostral-caudal extensions and many are related to arachnoiditis, leading to difficult-to-treat disorders. Thus far, due to the scarcity of reports, the features of the disease and the optimal therapeutic strategies remain unclear. PURPOSE:
To investigate clinical features and the optimal treatment modalities of secondary spinal arachnoid cysts compared with primary spinal arachnoid cysts. STUDYDESIGN:
Systematic review. PATIENT SAMPLE Systematic review identified 103 secondary cases from 80 studies and reports. OUTCOMEMEASURES:
Condition of symptom relief and duration of treatment response were analyzed.METHODS:
An electronic literature search of the PubMed database was conducted for studies on secondary spinal arachnoid cysts between 1990 and 2022. Non-English publications, nonhuman studies, reports of a primary cyst, studies not including case details, and studies of nonsymptomatic cases were excluded.RESULTS:
This systematic review included 103 secondary cases. The most commonly reported etiologies were iatrogenic factors, trauma, and subarachnoid hemorrhage, accounting for 88 intradural extramedullary, 11 extradural, one intradural/extradural, one interdural, and one intramedullary spinal arachnoid cyst after a median duration of 30, 12, and 9 months, respectively. Extradural cysts were more prone to occur at dorsal locations and affect thoracic segments (mean cyst length 3.4 segments). Intradural cysts showed a relatively higher ventral/dorsal ratio (11.09, 1.751, and 3.501 for cysts occurring from iatrogenic factors, trauma, and subarachnoid hemorrhage, respectively) and thoracic distribution, with a mean cyst length of 4.3 segments (5.1 for ventral and 3.5 for dorsal cysts). For intradural cysts, recurrence risk was lower after surgical resection than after fenestration/marsupialization (12-month recurrence risk 21.43% vs 50.72%, log-rank test p=.0248, Gehan-Breslow-Wilcoxon test p=.0126). In cases treated with shunting, one recurrence (1/8 cases) was noted after external shunting and two recurrences (2/5 cases) after internal shunting at a median follow up of 12 months.CONCLUSIONS:
Secondary spinal arachnoid cysts, particularly intradural cysts, are rarer and more challenging to treat than primary spinal cysts. Although fenestration/marsupialization is the commonly adopted treatment, the recurrence rate is high. For unresectable cysts, shunting procedures, particularly shunting into a body cavity (eg, pleural or peritoneal cavity) away from the subarachnoid space, could be a therapeutic alternative besides fenestration/marupialization, yet its efficacy requires confirmation by more data.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Doenças da Medula Espinal
/
Hemorragia Subaracnóidea
/
Cistos Aracnóideos
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article