Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Spine Case

Arachnoid cyst of thoracic spine

65 yo woman presents to office with complaint of mid-back pain, progressive over several weeks Numbness in her toes for about 2 weeks She also complains of difficulty walking; feels off balance, but not dizzy On exam she has mild increased deep tendon reflexes.

Description

65 yo woman presents to office with complaint of mid-back pain, progressive over several weeks
Numbness in her toes for about 2 weeks
She also complains of difficulty walking; feels off balance, but not dizzy
On exam she has mild increased deep tendon reflexes.

Gallery

Images

Figure 1T2-weighted MRI images. Sagital image (left) shows a subtle abnormality in the ventral spinal canal (at tip of blue arrow). Axial images (right) show the lesion which appears to be CSF in the right side of the ventral spinal canal. It is displacing and flattening the spinal cord.
Figure 2An intraoperative photo taken with the operating microscope. A laminectomy has been completed and the dorsal surface of the dura is exposed. The patient’s head is to the left with right being up and left being down in the image. The dura is flanked by two surgical cotton patties.
Figure 3An intraoperative photo taken with the operating microscope. The dura has been opened in the midline and tenting sutures (black string) is holding it open. The thickened arachnoid of the cyst can be seen as the pearly white membrane in the center of the frame (it is normally clear, as is seen on the far right of the frame).
Figure 4Intraoperative video showing the initial opening of the cyst.Microscissors are used to cut the arachnoid and CSF is released.
Figure 5Intraoperative video showing further resection of the cyst. Thick arachnoid bands are divided with microscissors exposing the spinal cord beneath.
Figure 6An intraoperative photo showing a single arachnoid band after resection of the arachnoid cyst. The spinal cord is clearly seen beneath.
Figure 7An intraoperative photo taken after the dura has been stitched closed with suture.
Figure 8T2 MRI obtained 3 months postop. It shows some postoperative changes and resolution of the arachnoid cyst with normal appearance of the spinal cord.

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