Korean J Neurotrauma.  2018 Apr;14(1):35-38. 10.13004/kjnt.2018.14.1.35.

A Rare Cause of Thoracic Spinal Cord Compression by Multiple Large Tarlov Cysts

• Kleib AS
• Salihy SM
• Hamdi H
• Carron R
• Soumaré O

• KMID: 2410920
• DOI: http://doi.org/10.13004/kjnt.2018.14.1.35

Abstract

Spinal extradural arachnoid cyst (SEAC) is a rare cause of spinal cord compression. Bifocal location of thoracic and sacral SEACs is rarely reported in the literature. We report a case of thoracic spinal cord compression by SEAC associated with asymptomatic multiple sacral Tarlov cysts (TC). The surgical management and postoperative outcome of the patient are discussed. A 34-year-old woman was referred to the hospital for acute thoracic pain with a history of chronic long-standing back pain. She complained of walking difficulties. Neurological examination demonstrated incomplete spastic paraplegia with sensory level in T9. Magnetic resonance imaging revealed a large cystic formation from T7-11 and at the level of the sacrum. We performed laminectomies at the level of interest from T7-11. The cysts were dissected from the underlying dura after removal of the cerebrospinal fluid. We found nerve tissue in the cysts. We excised the cyst and preserved the nerve roots. Subsequently, a duraplasty was performed with autologous grafts from the lumbar fascia. The condition of the patient improved after surgery and he was recovering well at follow-up. Although the surgical treatment of TC is controversial, especially at the sacral lumbar level, decompression at the dorsal level in this case is indisputable.

Keyword

Extradural arachnoid cyst; Spinal cord compression; Tarlov cyst

MeSH Terms

Adult
Arachnoid
Back Muscles
Back Pain
Cerebrospinal Fluid
Decompression
Female
Follow-Up Studies
Humans
Laminectomy
Magnetic Resonance Imaging
Nerve Tissue
Neurologic Examination
Paraplegia
Sacrum
Spinal Cord Compression*
Spinal Cord*
Tarlov Cysts*
Transplants
Walking

Figure

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  FIGURE 1 (A) Sagittal turbo spin echo (TSE) T2-weighted image (WI) and T1-WI magnetic resonance images showing at the T9 to T11 vertebral levels. Note the compression of the spinal cord. (B) Sagittal postoperative TSE T2-WI and T1-WI show total the spinal extradural arachnoid cysts.

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  FIGURE 2 Sagittal turbo spin echo T2-weighted image (WI) and T1-WI magnetic resonance image showing at the sacral lumbar Taralov cysts.

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  FIGURE 3 Intraoperative image: total laminectomy T7 to T11 level exposing the spinal extradural arachnoid cysts.

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