Objective Spinal arachnoid cysts (SACs) are rare lesions that often present with back pain and myelopathy. There is a paucity of literature evaluating the impact of surgical timing on neurological outcomes for primary SAC management. To compare long-term neurological outcomes in patients who were managed differently and to understand natural progression of SAC.
Methods We conducted a retrospective analysis of adult patients treated for SAC at our institution from 2010 to 2021, stratified into 3 groups (conservative management only, surgical management, or conservative followed by surgical management). Study outcome measures were neurological outcomes as measured by modified McCormick Neurologic Scale (MNS), postoperative complications, and cyst recurrence. Nonparametric analysis was performed to evaluate differences between groups for selected endpoints.
Results Thirty-six patients with SAC were identified. Eighteen patients were managed surgically. The remaining 18 patients were managed conservatively with outpatient serial imaging, 7 of whom (38.9%) ultimately underwent surgical treatment due to neurological decline. Most common presenting symptoms included back pain (50.0%), extremity weakness (36.1%), and numbness/paresthesia (36.1%). Initial/preoperative (p = 0.017) and 1-year postoperative (p = 0.006) MNS were significantly different between the 3 groups, but not at 6 weeks or 6 months postoperatively (p > 0.05). Additionally, at 1 year, there was no difference in MNS between patients managed surgically and those managed conservatively but ultimately underwent surgery (p > 0.99).
Conclusion Delayed surgical intervention in minimally symptomatic patients does not seem to result in worse long-term neurofunctional outcomes. At 1 year, postoperative MNS were significantly higher in both surgical groups, when compared to the conservative group highlighting worsening clinical picture regardless of preoperative observational status.
Citations
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Twice the Leak: Managing CSF Fistulas in a Recurrent Thoracic Arachnoid Cyst—A Case Report Federica Bellino, Leonardo Bradaschia, Marco Ajello, Diego Garbossa Reports.2025; 8(3): 152. CrossRef
The utility of intraoperative ultrasonography for spinal cord surgery Hangeul Park, Jun-Hoe Kim, Chang-Hyun Lee, Sum Kim, Young-Rak Kim, Kyung-Tae Kim, Ji-hoon Kim, John M. Rhee, Woo-Young Jo, Hyongmin Oh, Hee-Pyoung Park, Chi Heon Kim, Barry Kweh PLOS ONE.2024; 19(7): e0305694. CrossRef
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Objective To evaluate how multimodal intraoperative neuromonitoring (IONM) changes during spinal ependymoma (SE) resection correlate with long-term neuro-functional outcomes.
Methods A retrospective analysis of patients aged 18 years or older who underwent surgical resection for SE over a 10-year period was conducted. IONM changes were defined as sustained transcranial motor evoked potential (TcMEP) and/or somatosensory evoked potential (SSEP) signal decrease of 50% or greater from baseline. Primary endpoints were postoperative modified McCormick Neurologic Scale (MNS) scores at postoperative day (POD) < 2, 6 weeks, 1 year, and 2 years. Univariate and multivariate analyses were performed.
Results Twenty-nine patients were identified. Average age was 44.2 ± 15.4 years. Sixteen (55.2%) were male and 13 (44.8%) were female. Tumor location was 10 cervical-predominant (34.5%), 13 thoracic-predominant (44.8%), and 6 lumbar/conus-predominant (20.7%). A majority (69.0%) were World Health Organization grade 2 tumors. Twentyfour patients (82.8%) achieved gross total resection. Thirteen patients (44.8%) had a sustained documented IONM signal change and 10 (34.5%) had a TcMEP change with or without derangement in SSEP. At POD < 2, 6 weeks, 1 year, and 2 years, MNS was significantly higher for those when analyzing subgroups with either any sustained IONM or TcMEP ± SSEP signal attenuation > 50% below baseline (all p < 0.05).
Conclusion Sustained IONM derangements > 50% below baseline, particularly for TcMEP, are significantly associated with higher MNS postoperatively out to 2 years. Intraoperative and postoperative management of these patients warrant special consideration to limit neurologic morbidity.
Citations
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Outcomes of initially chosen non-operative management for spinal ependymoma Guang-Hao Zheng, Yao-Wu Zhang, Kai Ji, Hui Qiao, Xiao Wu, Yi-Xiang Liu, Wei-Hao Liu, Bo Wang, Chong Wang, Xing-Yu Liu, Yong-Zhi Wang, Wen-Qing Jia Journal of Clinical Neuroscience.2026; 144: 111780. CrossRef
Survival of pediatric patients with ependymoma in a tertiary cancer center in Rio de Janeiro, Brazil Gabriela Oigman, Yung Gonzaga, Marcio Christiani, Denise Magalhaes, Veronica Moreira, Diana S. Osorio, Sima Ferman Frontiers in Oncology.2024;[Epub] CrossRef
Results of surgical treatment of spinal cord ependymomas A. V. Gorodnina, A. V. Kudziev, A. S. Nazarov, E. A. Akhmedov, Yu. V. Beliakov, A. V. Ivanenko, G. A. Asaturyan, A. Yu. Orlov Russian Neurosurgical Journal named after Professor A. L. Polenov.2024; 16(3): 26. CrossRef
Predictors of Progression-Free Survival in Patients With Spinal Intramedullary Ependymoma: A Multicenter Retrospective Study by the Neurospinal Society of Japan Kentaro Naito, Daisuke Umebayashi, Ryu Kurokawa, Toshiki Endo, Masaki Mizuno, Minoru Hoshimaru, Phyo Kim, Kazutoshi Hida, Toshihiro Takami Neurosurgery.2023; 93(5): 1046. CrossRef
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