• Wei Gao, Qixuan Jiang, Tianjian Liu, Aiqin Chen, Xiaohang Jiang, Xinben Hu, Chi Gu, Yajuan Tang, Fang Shen, Jingyin Chen, Guangyu Ying, and Yongjian Zhu.
• Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
• Eur Spine J. 2025 Jan 7.

BackgroundSpinal epidural arachnoid cysts (SEACs) are rare, non-neoplastic pathologies that can cause compressive myelopathy. Preoperative identification of the exact fistula location is crucial for minimally invasive management.MethodsThis single-center retrospective study included 27 patients with SEACs who underwent "double-needle puncture myelography" to precisely localize the fistula before minimally invasive surgery. Clinical presentations, radiological findings, and surgical outcomes were analyzed.ResultsAmong the 27 patients, the most common clinical complaint was sensory dysfunction (14 patients, 51.9%). Motor dysfunction, manifested as lower limb weakness, was observed in 11 patients (40.7%), while 2 patients were asymptomatic at admission. Consistency analysis between radiographic localization and intraoperative findings demonstrated that the "double-needle puncture myelography" technique accurately identified the surgical segments and laterality of all fistulas except for one patient, who required repeat radiographic localization. Minimally invasive approaches, including hemilaminectomy or mini-hemilaminectomy, were successfully performed in 26 patients (96.3%) for fistula exposure.ConclusionsThe "double-needle puncture myelography" technique allows for the swift acquisition of precise anteroposterior and lateral projection dynamic X-ray images during the procedure. As a valuable preoperative diagnostic tool, it accurately pinpoints the location of the fistula, thereby minimizing surgical trauma and preserving spinal stability.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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