Summary
18 cases of benign intradural spinal cyst (9 arachnoidal, 2 neuroepithelial, 7 endodermal) are reported and compared with 94 cases (67 arachnoidal, 7 neuroepithelial, 20 endodermal) obtained from the literature.
Arachnoidal intradural cysts (AIC) have no sex preference, occur at around the fourth-fifth decades of life and have characteristic intermittent root symptoms. They prefer the thoracic level and the posterior position. (Myelography images the cystic cavity (diverticular form). Surgical removal is usually easy.
Neuroepithelial intradural cysts (NIC) are rare, have a 2∶1 predilection for females and occur after the fourth decade. They have a serious clinical course similar to intramedullary or extramedullary tumours. They prefer the conuscauda and the anterolateral positions. They often give rise to manometric block and to albuminocytological dissociation. There may be substantial adhesions to the cord and roots and the intramedullary variety presents no clear plane of cleavage.
Endodermal intradural cysts (EIC) have a 2∶1 predilection for males and prefer the second and third decades. They may have an intermittent or serious course with signs of root and cord impairment. They prefer the cervical segment (in the anterior position) and the conus-cauda (in the posterior position). As a rule they present manometric block and albuminocytological dissociation. Their frequent tough adhesions to the roots and cord demand special care during their removal.
Similar content being viewed by others
References
Adams, R. D., Wegner, W.: Congenital cyst of the spinal meninges as cause of intermittent compression of the spinal cord. Arch. Neurol. Psychiat.58 (1947), 57–69.
Adams, R. D., Case records of the Massachusetts General Hospital, Case 46122. New Engl. J. Med.,262 (1960), 623–627.
Allegre, G., de Rougemont, J., Feroldi, J., Tommasi, M., Thierry, A.: Kystes méninges médullaires. A propos de deux observations. Rev. Neurol.108 (1963), 347–353.
Ambrosetto, C., Alvisi, C., Ferraro, M., Cisti leptomeningee spinali. Minerva Neurochir.12 (1968), 276–279.
Bentley, J. F. R., Smith, J. R., Developmental posterior enteric remnants and spinal malformations. The split notochord syndrome. Arch. Dis. Childh.35 (1960), 76–86.
Bliss, M. A., Cysts within the spinal canal. J. Amer. med. Ass.52 (1909), 885–886.
Bonhoeffer, K., Über meningeale Scheincysten am Rückenmark. Berliner Klin. Wschr.52 (1915), 1015–1018.
Bouché, G., Compression médullaire par arachnoidite cloisonnée. Laminectomie, guerison. Rev. Neurol.27 (1914), 69–77.
Bremer, J. L., Dorsal intestinal fistula; accessory neurenteric canal; diastematomyelia. Arch. Path.54 (1952), 132–138.
Brouwer, B., Über Arachnoiditis adhaesiva circumscripta. Dtsch. Z. Nervenheilk.117 (1931), 38–66.
Bruns, L., Ein Fall von arachnoidaler Zystenbildung (Bindegewebszysten) mit Kompression des Rückenmarks. Operation. Heilung. Neurol. Zbl.30 (1911), 1026–1032.
Bucy, P. C., Buchanan, D. N., Teratoma of the spinal cord. Surg. Gynec. Obstet.60 (1935), 1137–1144.
Cooper, I. S., Kernohan, J. W., Heterotopic glial nests in subarachnoid space: histopathologic characteristic, mode of origin and relation to meningeal gliomas. J. Neuropath. exp. Neurol.10 (1951), 16–29.
Crosato, F., Su di un caso di siringomielia associata ad impressione basilare, a deformità di Arnold-Chiari ed a cisti sierose aracnoidee. Riv. Neuropsychiat.3 (1957), 1–26.
Fortuna, A., la Torre, E., Ciappetta, P., Arachnoid diverticula: a unitary approach to spinal cysts communicating with the subarachnoid space. Acta neurochir. (Wien)39 (1977), 259–268.
Fortuna, A., Palma, L., Mercuri, S., Spinal Neuroepithelial cysts. Report of two cases and review of literature. Acta neurochir. (Wien)45 (1978), 177–185.
Gainer, J. V., Chou, S. M., Nugent, G. R., Weiss, V., Ependymal cyst of the thoracic spinal cord. J. Neurol. Neurosurg. Psychiat.37 (1974), 974–977.
Gerlach, J., Jensen, H. P., Mißbildungen des Rückenmarks. In: Handbuch der Neurochirurgie Vol. 7, Part 1 (Olivecrona, H., Tönnis, W., eds.), p. 348. Berlin-Heidelberg-New York: Springer. 1969.
Gerstmann, J., Beiträge zur Pathologie des Rückenmarks. Zur Frage der Meningitis serosa und serofibrosa circumscripta spinalis. Z. ges. Neurol. Psychiat.29 (1915), 96–167.
Giuffrè, R., la Torre, S., Unusual spinal subdural epithelial cysts: report of two cases. Minerva Neurochir.10 (1966), 255–259.
Glettenberg, O., Zur Differentialdiagnose zwischen extramedullarem Tumor und Arachnoiditis spinalis adhaesiva. Nervenarzt8 (1935), 232–241.
Guidetti, B., Fortuna, A., Moscatelli, C., Riccio, A., I tumori intramidollari. Relazione al XVI Congr. Soc. Ital. Neurochir., Genova, Nov. 1964. Lav. Neuropsich.35 (1964), 1–409.
Guidetti, B.: Removal of extramedullary benign spinal cord tumors. In: Advances and technical standards in neurosurgery, Vol. 1 (Krayenbühl, H.,et al., eds.), pp. 173–197. Wien-New York: Springer. 1974.
Guidetti, B., Fortuna, A.: Differential diagnosis of intramedullary and extra-medullary tumours. In: Handbook of clinical neurology, Vol. 19, Tumors of the spine and spinal cord, part 1 (Vinken, P., Bruyn, G., eds.), pp. 51–75. Amsterdam: North Holland. 1975.
Guidetti, B., Mercuri, S., Vagnozzi, R., Long-term results of the surgical treatment of 129 intramedullary spinal gliomas. J. Neurosurg.54 (1981), 323–330.
Harriman, D. G. F., An intraspinal enterogeneous cyst. J. Path. Bact.75 (1958), 413–419.
Hirano, A., Ghatak, N. R., Wisoff, H. W., Zimmerman, H. M., An epithelial cyst of the spinal cord. An electromicroscopic study. Acta Neuropath.18 (1971), 214–223.
Hoefnagel, D., Benirschke, K., Duarte, J., Teratomatous cysts within the vertebral canal. Observations on the occurrence of sex chromatin. J. Neurol. Neurosurg. Psychiat.25 (1962), 169–174.
Hoffman, G. T., Cervical arachnoidal cysts: report of 6 year old negro male with recovery from quadriplegia. J. Neurosurg.17 (1960), 327–330.
Hoffman, E. P., Garner, J. T., Johnson, D., Shelden, C. H., Traumatic arachnoidal diverticulum associated with paraplegia. Case report. J. Neurosurg.38 (1973), 81–85.
Hyman, I., Hamby, W. B., Sanes, S., Ependymal cyst of the cervicodorsal region of the spinal cord. Arch. Neurol. Psychiat.40 (1938), 1005–1012.
Kahn, A. P., Hirsch, J. F., de Lace, C., Lyon, C., Saporta, L., Evrard, P., Les kistes enteriques intrarachidiens. A propos de trois observations. Neurochirurgie17 (1971), 33–44.
Kennedy, F., Compression of the spinal cord producing the Brown-Sequard syndrome: cured by operation. J. Nerv. Ment. Dis.38 (1911), 689–690.
Klump, T. E., Neuroenteric cyst in the cervical spinal canal of a 10-week-old boy. Case report. J. Neurosurg.35 (1971), 472–476.
Kubie, L. S., Fulton, J. F., A clinical and pathological study of two teratomatous cysts of the spinal cord containing mucus and ciliated cells. Surg. Gynec. Obstet.47 (1928), 297–311.
Kuhlendahl, H., Spinale Arachnoidalezysten. Zbl. Neurochir.19 (1959), 198–204.
Kwok, D. M., Jeffreys, R. V., Intramedullary enterogenous cysts of the spinal cord. J. Neurosurg.56 (1982), 270–274.
Lombardi, G., Morello, G., Congenital cysts of the spinal membranes and roots. Brit. J. Radiol.36 (1963), 197–205.
Maxirnow, A. A., A textbook of histology. 8th ed. (Bloom, W., Fawcett, D. W., eds.), 720 pp. Philadelphia: W. B. Saunders and Co. 1962.
McLetchie, N. G. B., Purves, J. K., de C. H. Saunders, R. L., The genesis of gastric and certain intestinal diverticula and enterogenous cysts. Surg. Gynec. Obstet.99 (1954), 135–141.
Meier, H., Chai, C. K., Spasticity and hereditary neurological mutation in the mouse characterized by vertebral arthropaty and leptomeningeal cyst formation. Exp. Med. Surg.28 (1970), 24–38.
Mendel, K., Adler, S., Zur Kenntnis der Meningitis serosa spinalis. Berl. Klin. Wschr.45 (1908), 1596–1602.
Moore, M. T., Book, M. H., Congenital cervical ependymal cyst. Report of a case with symptoms precipitated by injury. J. Neurosurg.24 (1966), 558–561.
Morello, G., Lombardi, G., Choroido-ependymal cysts of the spinal roots: case report. J. Neurosurg.21 (1964), 1103–1107.
Mosso, J. A., Verity, M. A., Ependymal cyst of the spinal cord. J. Neurosurg.43 (1975), 757–760.
Murray, R. O., Intradural arachnoid cyst of the lumbar spinal canal. Brit. J. Radiol.32 (1959), 689–692.
Nair, V. K., Gardner, W. J., Isolated interruption of spinothalamic tract by arachnoid cyst. J. Neurosurg.32 (1970), 686–688.
O'Connel, J. E. A., The cerebrospinal fluid pressure as an aetiological factor in the development of lesion affecting the central nervous system. Brain76 (1953), 279–298.
Palma, L., di Lorenzo, N., Spinal endodermal cysts without associated vertebral or other congenital abnormalities. Report of four cases and review of the literature. Acta neurochir. (Wien)33 (1976), 283–300.
Palmer, J. J., Spinal arachnoid cysts. Report of six cases. J. Neurosurg.41 (1974), 728–735.
Perret, G., Green, D., Keller, J., Diagnosis and treatment of intradural arachnoid cysts of the thoracic spine. Radiology79 (1962), 424–429.
Popoff, N., Feigin, I., Heterotopic central nervous tissue in subarachnoid space. Arch. Pathol.78 (1964), 533–537.
Puussepp, L., Variété rare de tératome sous-dural de la région cervicale (intestinome). Quadriplegia. Extirpation. Guérison complète. Rev. Neurol.41 (1934), 879–886.
Raja, I. A., Hankinson, J., Congenital spinal arachnoid cysts. Report of two cases and review of the literature. J. Neurol. Neurosurg. Psychiat.33 (1970), 105–110.
Rewcastle, N. B., Francoeur, J., Teratomatous cysts of the spinal canal. With “sex chromatine studies”. Arch. Neurol.11 (1964), 91–99.
Schisano, G., Cisti aracnoidee spinali. Acta Neurol.16 (1961), 773–781.
Schlesinger, H., Beiträge zur Klinik der Rückenmarks- und Wirbelsäulentumoren, pp. 46, 162–163. Jena: Gustav Fischer. 1898.
Scoville, W. B., Manlapaz, J. S., Otis, R. D., Cabieses, F., Intraspinal enterogenous cyst. J. Neurosurg.20 (1963), 704–706.
Shapiro, R., Myelography. Chicago. Year book, Medical Publisher, 2nd ed. 1968.
Skoog, A. L., Spinal cord compression from leptomeningeal cysts with a report of two cases. J. Amer. Med. Ass.65 (1915), 394–398.
Silvernail, W. I., Jr., Brown, R. B., Intramedullary enterogeneous cyst. Case report. J. Neurosurg.36 (1972), 235–238.
Spiller, W. G., Circumscribed aerous spinal meningitis. A little-recognized condition amenable to surgical treatment. Amer. J. Med. Sci.137 (1909), 95–97.
Stewart, J. R., Stewart D. H., Red, D. E., Spinal arachnoid diverticula. J. Neurosurg.35 (1971), 65–70.
Strully, K. J., Meningeal diverticula of sacral nerve roots (perineural cysts). J.A.M.A.161 (1956), 1147–1152.
Teng, P., Rudner, R., Multiple arachnoid diverticula. Arch. Neurol.2 (1960), 348–356.
Teng, P., Papatheodorou, C., Spinal arachnoid diverticula. Brit. J. Radiol.39 (1966), 249–254.
Tournox, P., Hermo, J. F., Pseudo-acrophatie ulcéro-mutilante et malformation kystique arachnoidienne lombaire. Neurochirurgie16 (1970), 436–438.
Veraguth, O., Die Arachnoidose. Schweiz. Med. Wschr.74 (1944), 1043–1051.
Vincent, C., Puech, P., David, M.: Sur le diagnostique, le traitement chirurgical, et le pronostique des arachnoidites spinales. Rev. Neurol.37 (1930), 577–592.
Wilkins, R. H., Odom, G. L., Intradural spinal cysts. In: Handbook of clinical neurology, Vol. 20 (Vinken, P., Brujn, G., eds.), pp. 52–102. Amsterdam: North Holland. 1976.
Wisoff, H. S., Ghatak, N. R., Ependymal cysts of spinal cord: case report. J. Neurol. Neurosurg. Psychiat.34 (1971), 546–550.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fortuna, A., Mercuri, S. Intradural spinal cysts. Acta neurochir 68, 289–314 (1983). https://doi.org/10.1007/BF01401186
Issue Date:
DOI: https://doi.org/10.1007/BF01401186