23rd Annual Pain Medicine Meeting 2024

Double Trouble - Unveiling the Dual Space Occupation of an Epidural and Intradural Meningeal Cyst: A Case Report.

Christian Wirawan, DO; Magdalena Anitescu, MD, PhD

INTRODUCTION

Chronic low back pain affects 16 million people in the U.S.

- Common causes: facet arthropathy, spinal stenosis, herniated disks, muscle strains.

- Rare cause: spinal meningeal cysts, which are uncommon sources of low back pain.

- Three types of spinal meningeal cysts**:

- Type I: Extradural cysts without neural tissue.

- 1a: Spinal arachnoid cysts.

- 1b: Sacral meningocele.

- Type II (Tarlov cysts): Extradural cysts with neural tissue, often found near sacral roots, more common in women.

- Type III: Intradural spinal arachnoid cysts.

- Spinal arachnoid cysts: Fluid-filled collections between the brain/spinal cord and arachnoid membrane.

- 80% found in the thoracic region, 15% in cervical, and 5% in lumbar areas.

- Tarlov cysts: CSF-filled dilations of the nerve root sheath, commonly found in women near the sacral roots.

METHODS

1.IRB exempt for medically challenging case.

2.Written consent obtained

CASE REPORT/ DISCUSSION

•51-year-old male presenting with fall and intracranial hemorrhage

•Symptoms: chronic back pain, neurogenic claudication, headaches

•Septated cystic lesion spanned from L2 to S1

•Constricted thecal sac and insinuated into multiple neural foramina

•110.6 mm long, 64.8 mm wide, 18.1 mm thick

•Treated with naproxen, gabapentin, physical therapy, trigger point injections, nerve blocks, caudal epidural

•Interdisciplinary discussion with neurosurgery, neurology, therapist, interventional pain specialist

•Options included: conservative measures, ventriculoperitoneal drain, surgical resection

DOUBLE TROUBLE - UNVEILING THE DUAL SPACE OCCUPATION OF AN EPIDURAL AND INTRADURAL MENINGEAL CYST: A CASE REPORT