title: Infantile arachnoid cyst compressing the sacral nerve root associated with spina bifida and lipoma--case report.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Health and Medical Treatment Corporation, Tamananbu Regional Hospital, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: A
authors.initials: A
authors.lastname: Wachi
authors.forename: A
authors.initials: A
authors.lastname: Uto
authors.forename: J
authors.initials: J
authors.lastname: Koike
authors.forename: H
authors.initials: H
authors.lastname: Arai
authors.forename: K
authors.initials: K
authors.lastname: Sato
mesh_terms: 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