title: Nuances in Localization and Surgical Treatment of Syringomyelia Associated with Fenestrated and Webbed Intradural Spinal Arachnoid Cyst: A Retrospective Analysis.
abstract: BACKGROUND
  Intradural spinal arachnoid cysts (SACs) are among many etiologies for syringomyelia. Consequentially, neurologic symptoms arise such as pain, gait disturbance, and bladder dysfunction. Identification of SAC on magnetic resonance imaging (MRI) can be challenging, as SACs can be fenestrated or in the form of fine webs.
  
  
  METHODS
  Imaging and clinical data for 7 patients who underwent surgical treatment for SAC associated with syringomyelia were reviewed. All previous publications of this pathology were reviewed via MEDLINE search.
  
  
  RESULTS
  Seven patients with a mean age 59 years were found to have a SAC causing syringomyelia. Intraoperative exploration confirmed SAC appearances of fine webs or a fluid-filled loculation impinging on the spinal cord. Common presentations were back pain, gait disturbance, and bladder incontinence. Diagnosis was made by MRI, although in 3 cases, the SAC was not identified on the initial review. Computed tomography myelogram was performed in one case due to the enlarged syringomyelia and lack of obvious spinal cord compression. Thoracic laminectomy/laminoplasty was performed for all patients, centered at the level of a subtle indentation of the cord; the syringomyelia proper was not directly addressed. Postoperatively, all patients had complete resolution of their symptoms with MRI demonstrating resolution of the syringomyelia.
  
  
  CONCLUSIONS
  Careful evaluation of the MRI can demonstrate subtle indentation of the cord at the caudal or cephalad end of the syringomyelia and may obviate the need for additional imaging. Meticulous arachnoid dissection and establishment of good CSF flow is sufficient for resolution of the syringomyelia, averting the need for more aggressive procedures.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Visish M
authors.initials: VM
authors.lastname: Srinivasan
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jared S
authors.initials: JS
authors.lastname: Fridley
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Thomas
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA. Electronic address: omeis@bcm.edu.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Omeis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016080:Arachnoid Cysts / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D004388:Dura Mater / Q000473:pathology; D005260:Female; D006801:Humans; D007796:Laminectomy; D017116:Low Back Pain / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology; D013118:Spinal Cord Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D013595:Syringomyelia / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Arachnoid cyst; Arachnoid web; Intradural cyst; Spinal cyst; Syringohydromyelia; Syringomyelia; Syrinx