Anterior Thoracic Intradural Spinal Arachnoid Cyst- A Rare Cause of Spinal Cord Compression in a Two-Year Old Child

Abstract

Spinal arachnoid cysts (SAC) are rare cause of spinal cord compression in children. This paper reports thoracic anterior intradural spinal arachnoid cyst as a rare cause of myelopathy in toddlers. A two-year-old Nigerian male who presented with weakness of both lower limbs which progressed to paraplegia nine days prior to presentation, bi-sphincteric dysfunction and sensory in the trunk and both lower limbs. Examination revealed spastic paraplegia, grade 4 deep tendon reflexes in both lower limbs, with T6 sensory level. MRI showed Th4-Th7 anterior intradural cyst with significant thoracic cord compression. He had microscope-assisted Th4–Th6 laminoplasty and cyst wall excision through left posterolateral approach. Histology confirmed spinal arachnoid cyst. He made good clinical improvement at one year follow up. Anterior thoracic intradural arachnoid cyst may be a rare cause of paraplegia in toddlers. High index of suspicion and early neuroimaging are needed to avoid missed diagnosis. Careful microscope-assisted surgery ensures good outcome.