title: Ventral "spinal epidural meningeal cysts"--not epidural and not cysts? Case series and review of the literature.
abstract: BACKGROUND
  Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood.
  
  
  OBJECTIVE
  We present the clinical, radiographic, surgical, and pathologic findings of 4 patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis.
  
  
  METHODS
  Four patients with anterior spinal epidural meningeal cysts are retrospectively reviewed.
  
  
  RESULTS
  Ventral spinal epidural meningeal cysts are often large, extending on average from C2 to L1 in our series. Patients typically present with a prolonged course of symptoms and signs, including segmental muscle weakness and atrophy, subtle myelopathy, mild to moderate spinal pain, and headache. Histopathologic analysis of the cyst wall demonstrates collagenous tissue consistent with dura but without arachnoid features. Dynamic computed tomographic myelography is the study of choice for localization of the primary dural defect. Patient symptoms and neurological deficits routinely improve after appropriate surgical intervention.
  
  
  CONCLUSIONS
  Diverse signs and symptoms herald the presentation of ventral spinal meningoceles. Intraoperative, radiographic, and pathological findings are all suggestive of an intradural dissection as the etiology. Hence, they may be more appropriately named "ventral spinal intradural dissecting meningoceles." Definitive treatment involves identification and obliteration of the dural defect.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Bret Gene
authors.initials: BG
authors.lastname: Ball
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Luetmer
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
authors.forename: Bahram
authors.initials: B
authors.lastname: Mokri
authors.forename: Neeraj
authors.initials: N
authors.lastname: Kumar
authors.forename: David G
authors.initials: DG
authors.lastname: Piepgras
mesh_terms: D000328:Adult; D003560:Cysts / Q000473:pathology* / Q000601:surgery; D004824:Epidural Space / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008578:Meninges / Q000473:pathology* / Q000601:surgery; D008588:Meningocele / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D013118:Spinal Cord Diseases / Q000473:pathology* / Q000601:surgery