Ahead of Print: Ventral “Spinal Epidural Meningeal Cysts” – Not Epidural and Not Cys ts? Case Series

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BACKGROUND: Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood.

OBJECTIVE: We present the clinical, radiographic, surgical, and pathologic findings of four patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis.

METHODS: Four patients with anterior spinal epidural meningeal cysts are retrospectively reviewed.

RESULTS: Ventral spinal epidural meningeal cysts are often large, extending on average from C2 to L1 in our series. Patients typically present with a prolonged course of symptoms and signs including segmental muscle weakness and atrophy, subtle myelopathy, mild to moderate spinal pain, and headache. Histopathologic analysis of the cyst wall demonstrates collagenous tissue consistent with dura but without arachnoid features. Dynamic CT-myelography is the study of choice for localization of the primary dural defect. Patient symptoms and neurologic deficits routinely improve after appropriate surgical intervention.

CONCLUSION: Diverse signs and symptoms herald the presentation of ventral spinal meningoceles. Intraoperative, radiographic, and pathologic findings are all suggestive of an intradural dissection as the etiology. Hence, they may be more appropriately named “ventral spinal intradural dissecting meningoceles.” Definitive treatment involves identification and obliteration of the dural defect.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.



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