PMC8571186_01
(a) Pre-operative imaging sagittal T2-weighted magnetic resonance image (MRI) of the thoracolumbar spine revealed a large ventral extra-axial cystic lesion causing spinal canal stenosis worst at T1-3. (b) Preoperative imaging sagittal T2-weighted MRI of the cervicothoracic spine revealed the cystic lesion extends to C2 level.
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F1
T4 that resulted in spinal cord compression, maximal between the T1-3 level [Figure 1]. There was an accompanying hyperintense T2 intramedullary signal within the thoracic spinal cord at these levels consistent with spinal cord edema.
PMC8571186_02
(a) Intraoperative photograph showed a large extradural meningeal cyst arising from the ventral aspect of the spinal canal. (b) The dural layer immediately ventral to the spinal cord was opened and revealed the "normal" layer of dura immediately dorsal to the vertebral body.
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F2
Once the dura was opened and the spinal cord was mobilized laterally, a few arachnoid bands were encountered and lysed, but no clear arachnoid cyst was visualized [Figure 2a]. Notably, a separate layer of dura was also found immediately dorsal to the vertebrae indicating we indeed entered the cyst space [Figure 2b].
PMC8571186_03
PMC8571186_04
(a) Postoperative sagittal T2-weighted MRI cervical spine revealed improved central stenosis, decreased size of meningeal cyst with shunt catheter in place. (b) Postoperative sagittal T2-weighted MRI thoracic spine showed similar findings.
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F3
As the prior laminectomy with cyst fenestration had failed, the repeat surgery included a cystoperitoneal shunt placement [Figure 3].