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Comorbidities and Risk Factors of Spinal Arachnoid Cysts Requiring Surgical Management: A Single-Center Series

Friday, May 3, 2024

Presenting Author(s)

Alexander A. Chernysh, BS

Clinical Research Assistant
Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island

Co-Author(s)

Hael Abdulrazeq, MD

Resident
Brown University/Rhode Island Hospital
Providence, RI, US
JC

Joaquin Q. Camara-Quintana, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island, United States
JF

Jared S. Fridley, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
Ziya L. Gokaslan, MD

Chair of Neurosurgery, Neurosurgeon-in-Chief
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System
Providence, Rhode Island, United States
PK

Petra M. Klinge, MD PhD

Professor of Neurosurgery
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
Owen P. Leary, BS (he/him/his)

Research Program Administrator
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
DL

David D. Liu, MD

Neurosurgery Resident
Brigham and Women's Hospital
Boston, Massachusetts, United States
TN

Tim Niu, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
AO

Adetokunbo A. Oyelese, MD PhD

Professor of Neurosurgery
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
Nathan J. Pertsch, MD

Neurosurgical Resident
Rush University Medical Center
Chicago, IL, US
PS

Prakash Sampath, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
Patricia Sullivan, MD

Attending Neurosurgeon
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States
AT

Albert E. Telfeian, MD PhD

Professor of Neurosurgery
Department of Neurosurgery, The Warren Alpert Medical School of Brown University and Lifespan Health System/Rhode Island Hospital, Providence, Rhode Island
Providence, Rhode Island, United States

Introduction: We aimed to characterize comorbid conditions and potential risk factors for spinal arachnoid cysts (SACs) treated surgically over a five-year period at a busy tertiary care center.

Methods: All cases with a diagnosis of SAC resulting in surgical treatment at our institution from 5/2015 to 4/2020 were reviewed for demographic details, preoperative presentation, surgical history, medical history including neurological comorbidities, and surgical details from the index SAC procedure. Results were summarized using descriptive statistics.

Results: Nineteen patients (mean age=41.8 years; SD=22.6) were treated surgically for SAC. 18/19 (95%) presented with entirely intradural lesions and 1/19 (5%) had both intradural and extradural components. Fifteen patients (79%) had ≥1 neurological or spinal comorbidity, including eleven patients (58%) that underwent ≥1 prior spine surgery with no evidence of SAC on preoperative imaging. In aggregate, these spinal procedures included six filum terminale (FT) resections for tethered cord syndrome, five extradural decompressions for degenerative spinal indications, two myelomeningocele repairs, one posterior fossa decompression for Chiari malformation, and one intramedullary spinal cord mass resection. Other neurological comorbidities included syringomyelia (n=4), non-surgically managed Chiari malformation (n=2), hydrocephalus (n=2), spina bifida occulta (n=1), history of ischemic stroke (n=1), and cerebral subarachnoid hemorrhage (n=1). Overall, 8/15 (53%) of patients with spinal surgical history and neurological comorbidities had their SAC occur adjacent to the site of prior neurological insult, with the rest occurring at more distant spinal levels. One patient with Loeys-Dietz syndrome was previously treated with a lumbar shunt without fenestration/resection. There were no SAC recurrences following operative management (mean follow-up=11.8 months; SD=9.2). Lastly, we calculated a postoperative symptomatic SAC development rate of 1.7% (6/352) following FT resection.

Conclusion : Our series of SACs reveal a prevalence of associated neurological comorbidities. We further report de-novo SAC formation after prior and often recent spinal intradural and extradural procedures, suggesting not just a pathological coincidence.