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Removal of spinal cyst and paralysis

Wednesday, 24 July 2002
Answered by: S.K. Pandya
Neurosurgeon
Jaslok Hospital & Research Centre
Mumbai
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Q. I am a 43 years old lady with severe pain in the left leg and lower back. Hospital: Udai Clinic, Nampally, Hyderabad. Investigations- X-Ray: showed slip-disc; MRI: showed spinal cord cyst. Intradural extramedullary lesion of size 2 cm by 1.1 cm. Few other cysts in cervical area have been found. An ovarian cyst has also been found but has been attributed to menopause. Chances of paralysis explained prior to surgery. The duration of surgery was four hours. According to the Neurosurgeon, the cyst removal was incomplete because of the positioning of the cyst in the spinal cord. Some fluid was syringed out and sent for pathological examination. A further four days were needed to ascertain if the cyst would refill. We have been given 60-40% chance against cyst re-growth. Incase the cyst relapses, another surgery would be required which is of a high-risk nature according to the doctor with a 80% chance of paralysis. Histopathology report: Arachnoidal cyst 4 cm. Kindly advise me on the following: a)Chances of relapse of the cyst; b) Surgical complications c) Conservative treatment for the cyst

A.  Chances that the cyst may reform: Unpredictable. If most of the cyst wall has been removed and the cyst has been saucerised, the chances are small. Complications of surgery: This depends on the location of the cyst in relation to the spinal cord. If it lies in front of the spinal cord and the surgeon is operating from behind the cord (as is usually the case), the surgeon will need to move the spinal cord to one side to reach the cyst. This is not always tolerated by the spinal cord, howsoever delicately it can be done. This may result in worsening of weakness in muscles below the level of the spinal cord. Most times, however, such weakness is temporary. Conservative treatment of the cyst: I am not aware of any proven effective non-operative therapy for such cysts.

A.  Chances that the cyst may reform: Unpredictable. If most of the cyst wall has been removed and the cyst has been saucerised, the chances are small. Complications of surgery: This depends on the location of the cyst in relation to the spinal cord. If it lies in front of the spinal cord and the surgeon is operating from behind the cord (as is usually the case), the surgeon will need to move the spinal cord to one side to reach the cyst. This is not always tolerated by the spinal cord, howsoever delicately it can be done. This may result in worsening of weakness in muscles below the level of the spinal cord. Most times, however, such weakness is temporary. Conservative treatment of the cyst: I am not aware of any proven effective non-operative therapy for such cysts.

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