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Sacral Intradural Arachnoid Cyst of Cauda Equina: A Case Report and Review of the Literature

Year: 2025

Type: article

Abstract: This report presents the case of a 36-year-old man complaining of chronic low back pain and numbness along the posterolateral surface of the right leg. Magnetic resonance imaging (MRI) revealed a disc degeneration and protrusion at the L5-S1 level and an extensive fluid-equivalent formation with a craniocaudal dimension of 8 cm at the S1-S5 level. Initially, due to the minimal clinical complaints, the cyst was considered asymptomatic. Two months later, the patient presented to the clinic with polyradiculopathy across S1-S5 dermatomes bilaterally, paresis of the tibial nerves, and retention of the pelvic-reservoir functions. Follow-up MRI confirmed the previous study, but visualized S1-S5 root compression. Given the presence of cauda equina syndrome, the patient was considered a surgical candidate. A cyst measuring 8 cm in craniocaudal length and 3 cm in width was found intradurally. Microsurgical resection of the cyst was performed. Histological examination confirmed the diagnosis of an arachnoid cyst. Postoperatively, due to recurrence, a lumbo-peritoneal shunt was implanted, after which the patient's neurological status significantly improved. Follow-up examination after 72 months revealed mild motor and sensory deficits. Maximal safe resection of the cyst is the most effective therapeutic approach that leads to the elimination of complaints and absence of recurrences. In cases with recurrence, a lumbo-peritoneal shunt may be considered.

Source: Cureus

DOI: 10.7759/cureus.89673

Authors: Mihail Kalnev, Atanas Davarski, Ivo Kehayov, Borislav Kitov

Institution: Medical University Plovdiv

Language: English

Topic: Spine and Intervertebral Disc Pathology

Subfield: Pathology and Forensic Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4413239328