Spinal Arachnoid Web: A Didactic Report of Two Cases with Clinical, Radiological, Surgical and Pathological Correlations - 27/07/21
Bride arachnoïdienne: un rapport didactique de trois cas avec les correspondances cliniques, radiologiques, chirurgicales et anatomopathologiques.
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Highlights |
Arachnoid web 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 best-known diseases such as arachnoid cyst or transdural spinal cord herniation.
Fewer than 50 surgically proven cases have been reported in the scientific literature.
There is a need for a better recognition of Arachnoid Web among the medical community.
Careful analysis of the MRI semiology is crucial. Prompt and accurate diagnosis is mandatory to preserve functional prognosis, since appropriate surgical treatment with excision of the AW is curative, halting or even resolving the neurological symptoms.
Le texte complet de cet article est disponible en PDF.ABSTRACT |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : AW, AC, TSCH, CSF, MRI
KEYWORDS : Arachnoid Web, scalpel sign, syrinx
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