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
Citations to this article as recorded by
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
Long-term outcomes following surgical treatment of spinal arachnoid cysts: a population-based consecutive cohort study Victor Gabriel El-Hajj, Aman Singh, Kim Pham, Erik Edström, Adrian Elmi-Terander, Alexander Fletcher-Sandersjöö The Spine Journal.2023; 23(12): 1869. CrossRef
Large Lumbar Spinal Arachnoid Cyst Presenting with Calf Muscle Atrophy Byung Woo Choi, Ki-Wook Oh Korean Journal of Neuromuscular Disorders.2022; 14(2): 47. CrossRef
Objective To describe and analysed the functional outcome (FO) after spinal meningioma (SM) surgery.
Methods We processed the système national des données de santé (SNDS) i.e. , the French national administrative medical database to retrieve appropriate cases. We analysed the International Classification of Diseases 10 codes to assess the FO. Logistic models were implemented to search for variables associated with a favourable FO i.e. , a patient being independent at home without disabling symptom.
Results A total of 2,844 patients were identified of which 79.1% were female. Median age at surgery was 66 years, interquartile range (IQR) (56–75). Ninety-five point nine percent of the SMs were removed through a posterior ± lateral approach and 0.7% need an associated stabilisation. Benign meningioma represented 92.9% and malignant 2.1%. Median follow-up was 5.5 years, IQR (2.1–8), and at data collection 9% had died. The FO was good and increased along the follow-up: 84.3% of the patients were alive and had not associated symptoms at one year, 85.9% at 2 and 86.8% at 3 years. Nonetheless, 3 years after the surgery 9.8% of the alive patients still presented at least one disabling symptom of which 2.7% motor deficit, 3.3% bladder control problem, and 2.5% gait disturbance. One point seven percent were care-provider dependent and 2.1% chair or bedfast. In the multivariable logistic regression an older age at surgery (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29–0.47, p < 0.001), a high level of comorbidities (OR, 0.71; 95% CI, 0.66–0.75, p < 0.001), and an aggressive tumor (OR, 0.49; 95% CI, 0.33–0.73; p < 0.001) were associated with a worse FO.
Conclusion FO after meningioma surgery is favourable but, may be impaired for older patients with a high level of comorbidities and aggressive tumor.
Citations
Citations to this article as recorded by
Giant Thoracic Meningioma: Missed Diagnosis and Challenging Management in a Resource-Limited Setting Gerald Musa, Aaron Munkondya, Lukulula E Mwanza, Sandford Sumaili, Mwaba Nambela, Davies Chiwaya, Chifundo Daka, Kabongo Ngoy, Keith Simfukwe, Misa Funjika, Carlos Castillo-Rangel, Gervith Reyes Soto, Manuel De Jesus Encarnacion Ramirez, Nicola Montemurro Cureus.2026;[Epub] CrossRef
Clinical Characteristics and Surgical Outcomes of Intradural Spinal Tumor Resections: A Retrospective Single-Center Study Anastasija Krzemińska, Sara Chmielewska, Marta Koźba-Gosztyła, Bogdan Czapiga Journal of Clinical Medicine.2026; 15(10): 3669. CrossRef
Overall survival after carmustine wafers implantation for newly-diagnosed high grade glioma. A nationwide population-based controlled propensity score-matched analysis Charles Champeaux Depond, Vincent Jecko, Joconde Weller, Philippe Tuppin, Philippe Metellus Clinical Neurology and Neurosurgery.2025; 257: 109081. CrossRef
Accuracy of intraoperative neurophysiological monitoring in predicting postoperative neurological decline in intradural extramedullary spinal tumor surgery: a systematic review and meta-analysis Lukasz Antkowiak, Marta Antkowiak, Anna Kasperczuk, Wojciech Kaspera, Marek Mandera Neurosurgical Review.2025;[Epub] CrossRef
Predictors of functional outcomes following spinal meningioma surgery. A single-center retrospective experience of 59 cases Meissa Hamza, Angela Elia, Luca Paun, Benoit Hudelist, Xavier Schumacher, Marco Demasi, Catherine Oppenheim, Fabrice Chretien, Marc Zanello, Alexandre Roux, Johan Pallud Neurochirurgie.2024; 70(5): 101577. CrossRef
Descriptive epidemiology of 399 histologically confirmed newly diagnosed meningeal solitary fibrous tumours and haemangiopericytomas in France: 2006–2015 Charles Champeaux Depond, Sonia Zouaoui, Amélie Darlix, Valérie Rigau, Hélène Mathieu-Daudé, Fabienne Bauchet, Mohamed Khettab, Brigitte Trétarre, Dominique Figarella-Branger, Luc Taillandier, Julien Boetto, Johan Pallud, Mathieu Peyre, Marine Lottin, Luc Acta Neurochirurgica.2024;[Epub] CrossRef
Survival After Newly-Diagnosed High-Grade Glioma Surgery: What Can We Learn From the French National Healthcare Database? Charles Champeaux Depond, Luc Bauchet, Dahmane Elhairech, Philippe Tuppin, Vincent Jecko, Joconde Weller, Philippe Metellus Brain Tumor Research and Treatment.2024; 12(3): 162. CrossRef
Surgical Treatment of Spinal Meningiomas in the Elderly (≥75 Years): Which Factors Affect the Neurological Outcome? An International Multicentric Study of 72 Cases Gabriele Capo, Alessandro Moiraghi, Valentina Baro, Nadim Tahhan, Alberto Delaidelli, Andrea Saladino, Luca Paun, Francesco DiMeco, Luca Denaro, Torstein Ragnar Meling, Enrico Tessitore, Cédric Yves Barrey Cancers.2022; 14(19): 4790. CrossRef
Spinal Meningioma Surgery in Octogenarians: Functional Outcomes and Complications over a 2-Year Follow-Up Period Pavlina Lenga, Gelo Gülec, Awais Akbar Bajwa, Mohammed Issa, Karl Kiening, Basem Ishak, Andreas W. Unterberg Medicina.2022; 58(10): 1481. CrossRef
Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1) Victor Gabriel El-Hajj, Jenny Pettersson-Segerlind, Alexander Fletcher-Sandersjöö, Erik Edström, Adrian Elmi-Terander Cancers.2022; 14(24): 6251. CrossRef
Objective Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking.
Methods Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n = 21; posterior fossa bony and dural decompression [PFBDD], n = 40; and posterior fixation [PF], n = 12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome.
Results Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p = 0.049). The mean CCOS score at discharge was highest in the PF (12.0 ± 1.41) and lowest in PFBDD group (10.98 ± 1.73, p = 0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29–16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70–33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p = 0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71 ± 0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n = 3, 4.1%) occurred in the PFBDD group.
Conclusion Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.
Citations
Citations to this article as recorded by
C1-C2 Fixation for Chiari with Syringomyelia Associated with Atlantoaxial Instability, Atlantooccipital Assimilation and an Anomalous Vertebral Artery Course Chirag Jain, Nupur Pruthi World Neurosurgery.2024; 191: 37. CrossRef
Low versus High Intracranial Compliance in Adult Patients with Chiari Malformation Type 1–Comparison of Long-Term Outcome After Tailored Treatment Radek Frič, Geir Ringstad, Per Kristian Eide World Neurosurgery.2023; 173: e699. CrossRef
Chiari Syndrome: Advances in Epidemiology and Pathogenesis: A Systematic Review Raquel Rodríguez-Blanque, Cristina Almazán-Soto, Beatriz Piqueras-Sola, Juan Carlos Sánchez-García, Andrés Reinoso-Cobo, María José Menor-Rodríguez, Jonathan Cortés-Martín Journal of Clinical Medicine.2023; 12(20): 6694. CrossRef
Individualized Functional Decompression Options for Adult Chiari Malformation With Syringomyelia and A Novel Scale for Syringomyelia Resolution: A Single-Center Experience Shiyuan Han, Bo Hou, Zhimin Li, Feng Feng, Yongning Li, Jun Gao Neurospine.2023; 20(4): 1501. CrossRef
Letter to the Editor. Outcome prediction and assessment after surgery in CM-I: there is more to it than meets the eye Kuntal Kanti Das, Jaskaran Singh Gosal, Deepak Khatri, Arun K. Srivastava Journal of Neurosurgery.2022; 136(3): 934. CrossRef
Commentary on “Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients” Moon-Jun Sohn Neurospine.2022; 19(1): 63. CrossRef
Relationship Between Syrinx Resolution and Cervical Sagittal Realignment Following Decompression Surgery for Chiari I Malformation Related Syringomyelia Based on Configuration Phenotypes Chunli Lu, Longbing Ma, Jian Guan, Zhenlei Liu, Kai Wang, Wanru Duan, Zan Chen, Hao Wu, Fengzeng Jian Neurospine.2022; 19(4): 1057. CrossRef
Role of Atlas Assimilation in the Context of Craniocervical Junction Anomalies Andrei Fernandes Joaquim, Alécio Cristino Evangelista Santos Barcelos, Jefferson Walter Daniel World Neurosurgery.2021; 151: 201. CrossRef
First
Prev
