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Possible Arachnoid Cyst T11-T12
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Possible Arachnoid Cyst T11-T12

I've searched for info on Arachnoid cysts, but don't find anyone who has had them or had surgery to remove.

My symptoms right now are mild low back pain.  Had this very intermittently last 20 years. April of this year, it became more frequent and now is  present almost all the time.   (main pain is  2-3 inches left of spine near tailbone).  This week, I  had several extreme shooting, electric pains that last for a couple of seconds and then disappears.  This comes with bending or twisting.  I do have mild osteoporosis and osteopenia in lumbar and hip.  Have a family history of bad back.  Mother had osteo and broken back several times.  Sister has had 2 back surgeries, one spinal fusion.  

Here are the results of MRI's I had:  (sorry it's so long--but I wanted to give as much info as possible).  

#1 w/o contrast

Lumbar Spine:  Straightening of the normal lumbar lordosis is present.  2 mm of retrolisthesis at L4-L5 level with alignment otherwise normal.  Vertebral body hemangiona is noted at the L1 level.  Marrow signal is heterogeneous but no additional focal lesions are apparent.  Discogenic marrow changes are noted at the L4-L5 level.  Disc desiccation is present at all levels in the lumbar region.  Conus medullaris and cada equine are normally positioned.  There does appear to be some anterior displacement by a cystic extradural lesion in the lower thoracic spine.  This measures approx. 5.5 cm in length x 1.2 cm AP x 3.3 cm in width.  On the sagittal T2 weighted sequence the dura appears to be reflected anterior to the lesion with appears likely extradural in location.  There is slight loculation or lobulation of this fluid collection which extends from approximately T11-T12 levels.  This extends through the left neural foramina at the T11-T12 level with the remaining portion of the cystic collection within the spinal canal posterior to thecal sac.  This is slightly more prominent on the left.  I would favor this representing an arachnoid cyst, however, the differential diagnosis would potentially include cystic neoplasm. Additionally, hematoma, seroma, or abscess would be potential considerations particularly if there is history of recent procedure or instrumentation at this level.  This large cystic lesion does compress the thecal sac and produce mild to moderate stenosis at the T11-T12 level.

T12-L1:  There is no evidence for disc bulge, disc herniation or spinal stenosis.  The cystic Lesion discussed above extends down just to the T12-L1 level located to the left of the midline at this level with possible narrowing of the left lateral recess.  

L1-L2: Disc desiccation is present.  Small anterior extradural defect is present compatible with either spurring or minor disc bulging.  No spinal stenosis is evident.  

L2-L3:  No evidence for disc herniation or spinal stenosis is evident.  

L3-L4:  Small amount of bright T2 signal is present in the posterior annulus compatible with a small annular tear.  Mild broad-based disc bulging is present as well.  Mild degenerative facet spurring is present.  No definite central canal stenosis is apparent.  

L4-L5:  Grade 1 retrolisthesis is present.  Mild degenerative facet spurring is present with small amount of fluid in each of the facet complexes.  Borderline mild spinal stenosis at this level.  No disc herniation is noted.  

L5-S1:  The thecal sac tapers abruptly at the mid L5 vertebral body level. This is likely a normal variant.  No disc herniation or spinal stenosis is noted.  


#2 with and without contrast
Thoracic Spine:  There is a lobular cystic lesion centered in the posterior epidural space of the spinal canal at the T11-T12 level.  This measures 5.4 cm in length and 2.6 x 1.1 cm in greatest transverse dimensions.  This consists of homogeneous high T2, low T1 signal surrounded by an extremely thin enhancing rim and 2 or 3 very them septations.  No solid nodular component is apparent.  This extends into and through the left neural foramen at T11-T12 and mild at T12-L1.  This also exerts mass effect on the posterior aspect of the thecal sac, resulting in mild-moderate narrowing of the thecal sac at T11-T12.  This lesion appears to have caused mild pressure erosion of the posterior elements at T11-T12 expanding the spinal canal, so that thecal sac narrowing is less pronounced than it would otherwise be.  There is no flattening of the spinal cord.  

The rest of the thoracic spine is unremarkable.  Vertebrae are otherwise normal in height and shape, with no evidence of fracture or destructive process.  There are no significant bone marrow signal abnormalities.  Intervertebral discs are well preserved, with no herniations or significant bulges.  No neural forminal narrowing is apparent at any other level. The entire thoracic spinal cord is of normal caliber, contour and signal.  No intrathecal abnormalities are apparent.  Paraspinal soft tissues are unremarkable.  

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I am scheduled to see two different neurosurgeons in the about two weeks (I want second opinion).  I thought it would be good to have information before I go so I know what to ask.  

1.  Would they remove this type of cyst and would this be the cause of the pain or is it from another issue?

2.  After reading about arachnoiditis, it seems very risky to work in this area because of infection and problems after the procedure.  Is this accurate?

3. If they do remove cyst, is this a procedure that is very rare and specialized?  

4.  I know there are other issues, how serious are they and would any of them suggest a surgery?

At this point, my pain is not bad enough for me to decide to go through any surgery unless it is absolutely necessary.  I want to have as much info as necessary so I can understand what the dr. is saying and to help me make decisions.  

Thanks for any ideas, suggestions or just to hear about your experience.  

Debbie
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