An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature - Report - MDSpire
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An unusual cause of chronic neuropathic pain: report of a case of multiple intradural spinal arachnoid cysts and review of the literature
This report presents a rare case of multiple intradural spinal arachnoid cysts (SACs) in an adult female, characterized by recurring and de novo cyst formation over a 10-year period. Surgical excision initially relieved spinal cord compression and symptoms, but cysts recurred and expanded extensively, leading to a shift toward conservative management.
Background
Spinal arachnoid cysts are uncommon meningeal lesions classified among spinal meningeal cysts, with intradural SACs being rarer than extradural ones. Typically, these cysts are solitary and infrequently recur after surgery, with recurrence rates estimated at 9.5–13% in pediatric and adult populations. Multiple intradural SACs are exceptionally rare, and long-term outcomes for such cases have not been well documented prior to this report.
Data Highlights
Parameter
Details
Patient Age
35 years (female)
Initial Symptoms
3-year history of progressive neck/back pain, hand weakness, radiating pain in C7-C8 dermatomes
Imaging Findings
Multiple intradural extramedullary cysts from cervical to thoracic spine and posterior fossa; severe spinal cord compression at Th4
First Surgery
Th3–Th6 laminectomy and cyst excision; complete removal confirmed by MRI
Second Surgery
Th8–Th10 laminectomy and cyst excision; resolution of cysts and compression on MRI
Follow-up
10 years with recurrent and de novo cyst formation; extensive cyst spread from C2 to Th11 and later entire cervical and thoracic spine
Management
Initial surgical excision followed by conservative management with analgesics after recurrence
Key Findings
Multiple intradural spinal arachnoid cysts can present simultaneously at various spinal levels and intracranially.
These cysts may cause significant spinal cord compression leading to neuropathic pain and neurological deficits.
Surgical excision can effectively relieve compression and improve symptoms initially.
Recurrence and de novo formation of intradural SACs can occur over years despite surgical treatment.
Extensive cyst progression may not correlate directly with symptom severity, allowing for conservative management in select cases.
Clinical Implications
Clinicians should consider multiple intradural SACs in patients with chronic neuropathic pain and progressive neurological symptoms. Surgical intervention remains the primary treatment for symptomatic spinal cord compression; however, long-term follow-up is essential due to potential cyst recurrence and new cyst formation. Conservative management with analgesics may be appropriate when cyst progression is extensive but symptoms remain mild.
Conclusion
This case highlights the rare occurrence of multiple, recurring, and de novo intradural spinal arachnoid cysts with long-term follow-up, demonstrating the challenges in management and the importance of individualized treatment strategies balancing surgical and conservative approaches.
References
Spinal meningeal cysts classification and recurrence rates [1,3,4,8]
2009 report on multiple extradural arachnoid cysts [2]
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