Infantile arachnoid cyst compressing the sacral nerve root associated with spina bifida and lipoma--case report.
A 2-year-old boy presented with a rare sacral arachnoid cyst manifesting as gait disturbance. Neuroimaging revealed an intradural cyst in the sacral nerve root sheath associated with spina bifida occulta and a lipoma at the same level. At surgery, the conus medullaris was situated at the L-1 level and not tethered. The highly pressurized arachnoid cyst had exposed the dural sheath of the left S-2 nerve root and compressed the adjacent nerves. An S-2 nerve root pierced through the cyst. There was no communication between the cyst and spinal arachnoid space. We thought the one-way valve mechanism had contributed to the cyst enlargement and the nerve compression. Radical resection of the cyst was not attempted. A cyst-subarachnoid shunt was placed to release the intracystic pressure. Postoperatively, his gait disturbance improved and no deterioration occurred during the 4-year follow up. Both tethered cord syndrome and sacral arachnoid cyst in the nerve root sheath should be considered in pediatric progressive gait disturbance. Cyst-subarachnoid shunt is an alternative method to cyst resection or fenestration to achieve neurological improvement.
Tsutsumi
S
S
Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Tamananbu Regional Hospital, Japan.
Wachi
A
A
Uto
A
A
Koike
J
J
Arai
H
H
Sato
K
K
D016080:Arachnoid Cysts / Q000150:complications* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D002675:Child, Preschool; D006801:Humans; D008067:Lipoma / Q000150:complications*; D008297:Male; D009408:Nerve Compression Syndromes / Q000209:etiology*; D012445:Sacrococcygeal Region; D013120:Spinal Cord Neoplasms / Q000150:complications*; D016135:Spinal Dysraphism / Q000150:complications*; D013126:Spinal Nerve Roots