Arachnoid ossificans containing metaplastic hematopoietic marrow resulting in diffuse thoracic intrathecal cysts and severe myelopathy

Eur Spine J. 2012 Jun;21 Suppl 4(Suppl 4):S436-40. doi: 10.1007/s00586-011-2005-1. Epub 2011 Sep 4.

Abstract

Objective: To present a rare case of multiple compressive thoracic intradural cysts with pathologic arachnoid ossification, review the literature and present the surgical options. Few reports have identified the existence of arachnoid calcifications and intrathecal cysts causing progressive myelopathy. The literature regarding each of these pathologies is limited to case reports. Their clinical significance is not well studied, although known to cause neurologic sequelae.

Methods: An 81-year-old female clinically presents with rapidly progressive myelopathy. Pre-operative magnetic resonance imaging identified multiple compressive thoracic intrathecal cysts. Surgical exploration and decompression of these cysts identified calcified plaques within the arachnoid. Histopathologic examination revealed fibrocalcific tissue undergoing ossification with bone marrow elements.

Results: Due to progressive myelopathy, the thoracic cysts were decompressed and calcified plaques were excised, once identified intra-operatively.

Conclusions: On last examination, the patient's neurologic status had not improved, but had stabilized. The rate of neurologic improvement from excision and decompression is variable, but it may still be warranted in the face of progressive neurologic deficits.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Arachnoid Cysts / pathology*
  • Arachnoid Cysts / surgery
  • Bone Marrow / pathology*
  • Calcinosis / pathology*
  • Calcinosis / surgery
  • Decompression, Surgical
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Metaplasia / pathology
  • Metaplasia / surgery
  • Ossification, Heterotopic / pathology*
  • Ossification, Heterotopic / surgery
  • Spinal Cord Diseases / pathology*
  • Spinal Cord Diseases / surgery
  • Thoracic Vertebrae / pathology*
  • Thoracic Vertebrae / surgery
  • Treatment Outcome

Supplementary concepts

  • Spinal intradural arachnoid cysts