A pure fluid-filled intradural cyst associated with intradural disc herniation and possible pathogenesis: a case report.
BACKGROUND
Lumbar intradural disc herniation (IDH) is rare, and intradural cyst associated with IDH is quite rare. Only seven cases of an intradural cyst associated with lumbar disc herniation have been reported, and all were gas-filled cysts. We report the first case, to our knowledge, of a fluid-filled intradural cyst associated with IDH.


OBJECTIVE
To report an extremely rare case of a fluid-filled intradural cyst associated with lumbar IDH and suggests the possible pathogenesis.


METHODS
Case report.


METHODS
An 82-year-old woman presented with right leg pain and motor weakness. Computed tomography and magnetic resonance imaging (MRI) scans showed calcified lumbar disc herniation and an intradural cystic mass at the L1-L2 level. An MRI, which was performed 2 years before admission, showed an IDH without a cyst at the same level.


RESULTS
Surgical resection of the intradural cyst was performed. Intraoperative finding showed a fluid-filled intradural cyst with 1-cm diameter of displacing nerve rootlets. The cyst was connected with extradural cystic components through a ventral dural hole, but the tract was blocked by fibrous septum. Histopathologic examination showed a pseudocyst that consisted of degenerative cartilaginous and fibrous tissues, including degenerative disc materials. We concluded that the cyst was an intradural cyst transformed from the intradural disc fragment.


CONCLUSIONS
The current case is the first report to our knowlege of a fluid-filled intradural cyst associated with IDH. The possible mechanism may be focal degeneration and spontaneous absorption of the intradural disc with fluid production. Unlike the gas-filled intradural cysts, the cause of the pure fluid-filled cyst may be disconnection from the intervertebral vacuum because of a calcified disc and septation of the cyst.
Department of Neurosurgery & Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 305 Gudeok-Ro Seo-Gu, Busan 602-739, Korea.
Kyoung Hyup
KH
Nam
In Ho
IH
Han
Won Ho
WH
Cho
Byung Kwan
BK
Choi
D000369:Aged, 80 and over; D003560:Cysts / Q000150:complications* / Q000473:pathology / Q000601:surgery; D004388:Dura Mater / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016896:Treatment Outcome
Fluid-filled cyst; Gas-filled cyst; Intradural disc herniation; Lumbar spine