• Toshiya Ichinose, Katsuyoshi Miyashita, Shingo Tanaka, Nozomu Oikawa, Masahiro Oishi, Iku Nambu, Masashi Kinoshita, and Mitsutoshi Nakada.
• Department of Neurosurgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
• World Neurosurg. 2020 Jun 1; 138: 68-72.

BackgroundSymptomatic intramedullary arachnoid cysts are rarely observed lesions, particularly in the pediatric age group. Treatment includes cyst fenestration or resection of the cyst wall, and recurrence after surgery has never been reported. We report a rare case of a spinal intramedullary arachnoid cyst, which recurred after cyst fenestration and required reoperation after a certain period.Case DescriptionA 4-year-old boy presented to our hospital with tetraparesis and bladder and rectum disorder. A cystic intramedullary lesion in the cervical spinal cord was detected in preoperative imaging. An emergency fenestration of cyst was performed, and his symptoms were resolved immediately. One month after the operation, the symptoms and cyst recurred. The symptoms improved in the natural course without reoperation. However, the cyst increased in size and the symptoms recurred after 27 months from the first relapse and the cyst was removed urgently. The diagnosis was an arachnoid cyst. After the reoperation, the cyst has disappeared and not recurred.ConclusionsTo the best of our knowledge, this is the first report of recurrence of an intramedullary arachnoid cyst. This case indicates the importance of considering the resection of cyst wall as possible because of the probability of cyst recurrence after fenestration, while careful observation is the option in the short term, especially for children or high-risk cases.Copyright © 2020 Elsevier Inc. All rights reserved.

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