A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias.
BACKGROUND
The clinical significance of pathologies of the spinal dura is often unclear and their management controversial.


OBJECTIVE
To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results.


METHODS
Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed.


RESULTS
Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery.


CONCLUSIONS
The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively.
Department of Neurosurgery, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany.
Jörg
J
Klekamp
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003560:Cysts / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D004108:Dilatation, Pathologic; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000145:classification* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
Arachnoid cyst; Brachial plexus injury; Low-pressure syndrome; Spinal cord herniation; Tarlov cyst