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Peer-reviewedCC BY 4.0Journal of Surgical Case Reports

Intraoperative demonstration of a check-valve mechanism in a spinal extradural arachnoid cyst with nerve root incarceration

  • Takashi Dezawa
  • Katsunori Fukutake
  • Keiji Hasegawa
  • Daisuke Kamakura
  • Naobumi Tochigi
  • Hiroshi Takahashi
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Abstract

Spinal extradural arachnoid cysts (SEDACs) are rare lesions thought to arise from a dural defect associated with a check-valve mechanism, although direct intraoperative evidence is limited. We report a 17-year-old female presenting with persistent low back pain and bilateral lower extremity numbness. Magnetic resonance imaging demonstrated a cystic lesion at the Th12–L1 level displacing the dural sac, while computed tomography myelography failed to identify a communicating tract. Surgical exploration was performed due to persistent symptoms and a suspected dynamic mechanism. Intraoperatively, a dural defect at the nerve root sleeve with nerve root incarceration was identified. Cerebrospinal fluid leakage ceased after closure of the defect, confirming a check-valve mechanism. The cyst was resected and the defect repaired. The patient’s symptoms resolved completely, with no recurrence at 2-year follow-up. This case provides direct intraoperative evidence of the proposed pathophysiology of SEDAC.

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Cite

BibTeXRIS
BibTeX
@article{dezawa2026intraoperative,
  title = {{Intraoperative demonstration of a check-valve mechanism in a spinal extradural arachnoid cyst with nerve root incarceration}},
  author = {Takashi Dezawa and Katsunori Fukutake and Keiji Hasegawa and Daisuke Kamakura and Naobumi Tochigi and Hiroshi Takahashi},
  journal = {Journal of Surgical Case Reports},
  year = {2026},
  month = nov,
  doi = {10.1093/jscr/rjag1020},
  url = {https://doi.org/10.1093/jscr/rjag1020},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Intraoperative demonstration of a check-valve mechanism in a spinal extradural arachnoid cyst with nerve root incarceration
AU  - Takashi Dezawa
AU  - Katsunori Fukutake
AU  - Keiji Hasegawa
AU  - Daisuke Kamakura
AU  - Naobumi Tochigi
AU  - Hiroshi Takahashi
PY  - 2026
DA  - 2026/11/04
JO  - Journal of Surgical Case Reports
DO  - 10.1093/jscr/rjag1020
UR  - https://doi.org/10.1093/jscr/rjag1020
AB  - Spinal extradural arachnoid cysts (SEDACs) are rare lesions thought to arise from a dural defect associated with a check-valve mechanism, although direct intraoperative evidence is limited. We report a 17-year-old female presenting with persistent low back pain and bilateral lower extremity numbness. Magnetic resonance imaging demonstrated a cystic lesion at the Th12–L1 level displacing the dural sac, while computed tomography myelography failed to identify a communicating tract. Surgical exploration was performed due to persistent symptoms and a suspected dynamic mechanism. Intraoperatively, a dural defect at the nerve root sleeve with nerve root incarceration was identified. Cerebrospinal fluid leakage ceased after closure of the defect, confirming a check-valve mechanism. The cyst was resected and the defect repaired. The patient’s symptoms resolved completely, with no recurrence at 2-year follow-up. This case provides direct intraoperative evidence of the proposed pathophysiology of SEDAC.
SN  - 2042-8812
ER  -