J Korean Neurosurg Soc.  2012 Nov;52(5):491-494. 10.3340/jkns.2012.52.5.491.

Iatrogenic Intradural Lumbosacral Cyst Following Epiduroscopy

• Ryu KS
• Rathi NK
• Kim G
• Park CK

• KMID: 2018259
• DOI: http://doi.org/10.3340/jkns.2012.52.5.491

Abstract

We report a rare complication of iatrogenic spinal intradural following minimally invasive extradural endoscopic procedues in the lumbo-sacral spines. To our knowledge, intradural cyst following epiduroscopy has not been reported in the literature. A 65-year-old woman with back pain related with previous lumbar disc surgery underwent endoscopic epidural neuroplasty and nerve block, but her back pain much aggravated after this procedure. Postoperative magnetic resonance imaging revealed a large intradural cyst from S1-2 to L2-3 displacing the nerve roots anteriorly. On T1 and T2-weighted image, the signal within the cyst had the same intensity as cerebrospinal fluid. The patient underwent partial laminectomy of L5 and intradural exploration, and fenestration of the cystic wall was accomplished. During operation, the communication between the cyst and subarachnoid space was not identified, and the content of the cyst was the same as that of cerebrospinal fluid. Postoperatively, the pain attenuated immediately. Incidental durotomy which occurred during advancing the endoscope through epidural space may be the cause of formation of the intradural cyst. Intrdural cyst should be considered, if a patient complains of new symptoms such as aggravation of back pain after epiduroscopy. Surgical treatment, simple fenestration of the cyst may lead to improved outcome. All the procedures using epiduroscopy should be performed with caution.

Keyword

Intradural lesion; Intradural cyst; Epiduroscopy

MeSH Terms

Back Pain
Endoscopes
Epidural Space
Female
Humans
Laminectomy
Magnetic Resonance Imaging
Nerve Block
Spine
Subarachnoid Space

Figure

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  Fig. 1 Lumbar sagittal T2 weighted (A), Gd-enhanced T1 weighted (B), axial T2 weighted (C), and Gd-enhanced T1 weighted (D) magnetic resonance imaging scans showing the postoperative changes of L4-5 level, which presenting no recurrence of disc herniation except for the findings of mild adhesion and left partial hemilaminectomy of L4 (white and black arrows).

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  Fig. 2 A fluoroscopic view showing the endoscopic epidural neuroplasty. An epidural catheter is inserted into the epidural space of L5-S1 levels through the sacral hiatus. The tip of epidural catheter is located just around right L5 root.

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  Fig. 3 Sagittal T2 (A), T1 (B), Gd-enhanced T1 (C) and axial T2 (D) weighted magnetic resonance imaging scans showing an intradural cystic lesion (black arrows), spanning from L2-3 to S2-3 level and displacing cauda equina anteriorly. The cyst fluid having the same signal intensity as cerebrospinal fluid.

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  Fig. 4 Myelography-computed tomography images showing an intradural cyst spanning from L4-5 to S2-3 level (black arrow) (A). The contrast media is partially filled up in the cystic cavity of the lower spines (black arrows) (B).

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  Fig. 5 Intraoperative photographs. A : After hemilaminectomy, the dura mater is opened. B : A large arachnoid cyst, which presents well demarcated by thin and transparent wall and contains cerebrospinal fluid, is observed in the dorsal part of the intradural space, compressing and displacing the cauda equina anteriorly. C : Cystic wall and enlargement of the window were performed. No connection of the cyst with subarachnoid space is noticed. D : After partial removal of cyst wall, nerve roots are exposed and decompressed.

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  Fig. 6 Sagittal (A) and axial (B) postoperative magnetic resonance imaging scans showing complete disappearance of the intradural cyst.

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