Spinal Arachnoid Web: A didactic report of two cases with clinical, radiological, surgical and pathological correlations.

Autor: Bertholon S; Department of Radiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France., Grange S; Department of Radiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France. Electronic address: grangesylvain@hotmail.fr., Grange R; Department of Radiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France., Forest F; Department of Pathology, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France., Tetard MC; Department of Neurosurgery, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France., Boutet C; Department of Radiology, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France., Vassal F; Department of Neurosurgery, University Hospital of Saint-Etienne, 42055 Saint-Etienne cedex 2, France.
Jazyk: angličtina
Zdroj: Neuro-Chirurgie [Neurochirurgie] 2022 Jan; Vol. 68 (1), pp. 11-15. Date of Electronic Publication: 2021 Jul 27.
DOI: 10.1016/j.neuchi.2021.07.002
Abstrakt: Background: Arachnoid web (AW) is a rare but probably underestimated cause of spinal cord injury that is complex to diagnose due to subtle MRI findings and similarities to other better-known diseases such as arachnoid cyst (AC) or transdural spinal cord herniation (TSCH). Increased recognition of AW is mandatory since delay in diagnosis can lead to potentially serious neurological sequelae.
Case Presentations: We report two additional cases of AW for didactic purposes, with special emphasis on the distinctive MRI and intraoperative findings. Both patients presented with progressively worsening neurological symptoms, including proprioceptive ataxia, motor weakness, numbness and neuropathic pain. The diagnosis of AW was suspected on the basis of specific MRI criteria, especially the so-called "scalpel sign". Formal confirmation of the diagnosis was obtained in two patients that were managed surgically. Postoperative follow-up demonstrated significant functional recovery.
Discussion: There is a need for better recognition of AW by the medical community. Careful analysis of MRI semiology is crucial for the distinction between AW, AC and TSCH. Prompt and accurate diagnosis is mandatory to conserve functional prognosis, since appropriate surgical treatment with AW resection is curative, halting or even resolving the neurological symptoms.
(Copyright © 2021. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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