Pre-operative identification of a dural defect using T2*-reversed magnetic resonance imaging in a spinal extradural arachnoid cyst: A case report
TL;DR
A case of a SEAC in which the location of a dural defect was suggested preoperatively with the use of T2*-reversed magnetic resonance imaging (MRI) suggests the potential usefulness of T2*-reversed MRI for pre-operative localization of dural defects in SEACs.
Abstract
Spinal extradural arachnoid cysts (SEACs) are rare lesions that can cause progressive neurological symptoms due to spinal cord compression. Typically, these cysts are connected to the intradural subarachnoid space through a small defect in the dural sac. Surgical repair requires accurate identification of the dural defect; however, pre-operative localization remains challenging. We report a case of a SEAC in which the location of a dural defect was suggested preoperatively with the use of T2*-reversed magnetic resonance imaging (MRI). A 62-year-old woman presented to our hospital with a known thoracic cystic lesion and worsening urinary frequency and neurological symptoms. She presented with lower-extremity hyperreflexia, right iliopsoas weakness, deep sensory disturbance in the right lower limb, urinary frequency, and headache. Pre-operative MRI demonstrated a cystic lesion extending from Th (thoracic) 12 to L (lumber) 1. Notably, T2*-reversed imaging suggested a dural defect at the right lateral aspect of Th12. The patient was diagnosed with a SEAC, and surgical exploration confirmed a dural defect at the predicted site, which was directly sutured. Postoperatively, the cyst markedly decreased in size, and the patient’s symptoms gradually improved. We report a case of a SEAC, focusing on pre-operative localization of a dural defect. This case suggests the potential usefulness of T2*-reversed MRI for pre-operative localization of dural defects in SEACs.