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.
STUDY DESIGN
Systematic review.
PATIENT SAMPLE
Systematic review identified 103 secondary cases from 80 studies and reports.
OUTCOME MEASURES
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 (1:1.09, 1.75:1, and 3.50:1 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.
Keywords
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Article info
Publication history
Published online: March 14, 2023
Accepted:
March 6,
2023
Received in revised form:
March 3,
2023
Received:
July 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: Y-BW: Nothing to disclose. D-HW: Nothing to disclose. S-LD: Nothing to disclose.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
