• Mauro Ruella, Marco Del PontFranciscoFDepartment of Neurosurgery, FLENI, Buenos Aires, Argentina., Aguilar Martin, Sebastián Juan María Giovannini, Tomás Ries Centeno, and Andres Cervio.
• Department of Neurosurgery, FLENI, Buenos Aires, Argentina. Electronic address: mauro.r_09@hotmail.com.
• World Neurosurg. 2022 Jan 1; 157: e77-e87.

BackgroundThe scalpel sign is a radiological finding observed on sagittal magnetic resonance imaging and computed tomography myelography corresponding to an indentation in the dorsal aspect of the spinal cord resembling a surgical scalpel blade. It is said to be a pathognomonic imaging discovery linked to dorsal arachnoid webs. However, other spine-related conditions may mimic dorsal arachnoid webs on magnetic resonance imaging, such as spinal arachnoid cysts or ventral spinal cord herniation, leading to misdiagnosis.MethodsA retrospective review was performed of cases involving 3 different diagnoses at our institution in the last 5 years that shared in common the characteristic focal dorsal indentation of the spinal cord.ResultsOf 7 cases identified, all but 1 were treated and confirmed intraoperatively. All lesions were located at the dorsal spinal cord. Magnetic resonance imaging was the study of choice for evaluation. Clinical manifestations included back pain and lower extremity numbness and weakness together with compressive myelopathy signs and urinary symptoms. Mean follow-up was 16.8 months with satisfactory postoperative results.ConclusionsIsolated radiological presentation of the scalpel sign is not sufficient to distinguish between dorsal arachnoid webs, arachnoid cysts, and ventral herniation of the spine. However, awareness of its importance is relevant for accurate curative surgical planning.Copyright © 2021 Elsevier Inc. All rights reserved.

25 keywords...

hide…