Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery
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Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected.
This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique.
The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.
KeywordsDigital subtraction angiography Cerebrospinal fluid fistula Giant spinal arachnoid cyst Minimally invasive surgery
Digital subtraction angiography
High resolution computed tomography
Spinal extradural arachnoid cyst
Spinal arachnoid cysts are uncommon. They have different clinical manifestations depending on the affected spinal region and nerve roots. They are categorized as intradural or extradural lesions. Surgical intervention aims at complete cyst excision with fistula closure. However, localizing the fistula is the key to decreasing the recurrence. We present a case where the position of the fistula was detected by simultaneously performing a myelography and a digital subtraction cystography.
Discussion and conclusions
When managing a giant spinal extradural arachnoid cyst, accurate localization of the fistula gives assurance that minimally invasive surgery can be performed. We propose a brand new technique to localize the fistula of a spinal arachnoid cyst. The intraoperative use of a microscope and an endoscope also contributes to surgical safety. However, we need more cases with varying conditions to further evaluate this technique.
No funding was received.
Availability of data and materials
All the data supporting the findings are contained within the manuscript.
KSC, GYY, YJZ, CYC and CMC contributed to the study conception. KSC, GYY and CMC drafted the manuscript. YJT contributed to the study design, analysis and interpretation of data. YJZ, CYC and CMC revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Ethics approval and consent to participate
Consent for publication
A written informed consent was obtained from the patient for publication of this case report and any accompanying images.
The authors declare that they have no competing interests.
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