Strategies to Improve Surgical Outcome of Spinal Arachnoid Cyst – A Single Center, Single Surgeon Experience from a Tertiary Care Center

Background and Objective: Spinal arachnoid cysts (SACs) is an uncommon entity with ambiguous explanations for origin, diagnostic dilemma and surgical management of choice till date. Surgery is recommended in patients with evident neurological symptomatology or gradual progression of symptoms. In the current case series, we analyze the strategies to improve the surgical outcome of SACs. Materials and Methods: Twenty three consecutive patients who underwent surgery of all SACs patients between 2005 and 2020 a tertiary referral center, formed the study population. In this ambispective observational study, we report the strategies to improve surgical outcome of patients with SACs Results: The average age of the study population was 37.1 ± 6.81 years with 14 (60.86%) women. The most common symptom at presentation was localized pain in back reported by 12 (52.2%) patients, followed by paraesthesia and pain in 7 (30.4%) and limb weakness and incontinence in two (8.7%) patients each. The mean duration of symptoms was 33.7 months (0.25 to 144). The etiology was history of trauma in three patients; history of spinal injection, congenital SAC or meningocele operation in childhood were reported in one patient each. The most common location of cyst was in the dorsal region (65%), followed by the dorso-lumbar region (17 %), lumbar (13%) and one patient had SAC in lumbosacral region. Three patients underwent laminectomy with marsupialization of cyst and in rest laminoplasty was performed. Cyst was found to be intradural in five patients and extradural in 18 patients. Complete excision of cyst was achieved in 13 patients. Ligation of dural connection was performed if found. Post operatively patient were followed up for an average of 18 months (3 - 135). One patient developed weakness postoperatively. One patient suffered a delayed wound infection and one patient had recurrence and was again operated after 6 months. Conclusion: Surgical exploration with identificaiton of cyst connection in extradural and excision with closure of dural defect in intradural SACs is well tolerated and provides optimal surgical outcome.