Presentation
History of resection of spinal cord tumor since 3 years, now complaining of partial weakness of both lower limbs and hypoesthesia up to knee level. Good sphinctric control. MRI dorsal spine was requested to exclude tumor recurrence.
Patient Data
There are post-operative changes related to T10 & T11 spinolaminectomies with no masses, collection or cord signal alteration.
There is a well-defined intradural extramedullary cyst-like lesion of CSF signal seen opposite T5-6 level compressing the posterior aspect of the cord being displaced anteriorly with focal complete effacement of anterior CSF column, yet no current cord signal alteration.
Vertebral hemangioma is noted at T2 vertebral body.
Case Discussion
The spinal cord compression is likely responsible for the patient's complaint, not the previous surgical level. The CSF-intensity cyst-like lesion has features of a posterior intradural spinal arachnoid cyst.
The thoracic spine is the most common location of spinal arachnoid cysts with predilection to occur dorsal to the cord. They can be intradural-extramedullary or extradural in location, with the intradural location being less common. They can be primary or secondary to trauma or previous surgery. Secondary arachnoid cysts can be intradural or extradural.
Differential diagnosis is dorsal thoracic arachnoid web, in which there is focal indentation of the spinal cord with scalpel sign.
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