• Tomoko Tanaka, Raja S Boddepalli, Douglas C Miller, Zongxian Cao, Vivek Sindhwani, Joan R Coates, Raghav Govindarajan, and N Scott Litofsky.
• Division of Neurological Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA. Electronic address: TanakaT@health.missouri.edu.
• World Neurosurg. 2018 Jan 1; 109: 298-303.

BackgroundSpinal extradural arachnoid cysts are relatively uncommon. Rarely, large cysts presented with spinal cord compression requiring surgical intervention.Case DescriptionWe report a patient with a progressively enlarging spinal extradural arachnoid cyst causing worsening right S1 radiculopathy and gastrocnemius muscle atrophy. Electromyography and nerve conduction studies revealed an S1 motor radiculopathy. Serial magnetic resonance imaging findings confirmed enlargement of the small cyst originating from the sacral thecal sac on the right while 2 smaller cysts on the left remained stable. Dynamic computed tomography myelogram revealed connection to the thecal sac behind the right S1 nerve root. We performed a right hemilaminectomy from L5 to S2, exposed the cyst pedicle ligated it, and marsupialized the cyst. After surgery, the patient showed clinical and electrodiagnostic improvement.ConclusionThis case illustrates the principles of timely surgical intervention after advanced diagnostic imaging and electrodiagnostic testing to improve neurologic function and minimize complications.Copyright © 2017 Elsevier Inc. All rights reserved.

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