Dorsal Torasik Araknoidal Web: Nadir Bir Olgu Sunumu

Abstract

Araknoidal web’ler, subaraknoid boşlukta bulunan ve pial yüzeylerden kaynaklanan intradural ekstramedüller yerleşimli fibröz konnektif doku bantlarıdır. Hastalar asemptomatik olabilir, kord basısı ve beyin omurilik sıvısının akım dinamiğinin bozulması ile ilişkili semptomatik durumlar ile başvurabilirler. Araknoidal web’lerin kendisi, görüntüleme yöntemleri ile genellikle ayırt edilemese de oldukça spesifik ancak patognomonik olmayan ‘’Neşter işareti (Scalpel sign) ‘’nin varlığı bu antitenin tanılandırılmasında önemlidir. Manyetik rezonans görüntüleme tanı için en yararlı modalitedir. Bu olgu sunumunda, nadir görülen bir antite olan torasik araknoidal web tanısı alan 39 yaşındaki bir hastanın klinik ve radyolojik bulgularını sunduk.

Keywords

• Neşter İşareti
• Manyetik Resonans Görüntüleme
• Araknoidal Web

Dorsal Thoracic Arachnoidal Web: A Rare Case Report

Abstract

Arachnoid webs are intradural, extramedullary, fibrous connective tissue bands located, originating from the pial surfaces within the subarachnoid space. Patients may present asymptomatically or with symptomatic conditions associated with cord compression and disturbances in cerebrospinal fluid flow dynamics. Although arachnoid webs themselves are often indistinguishable via imaging modalities, the presence of the highly specific yet non-pathognomonic “scalpel sign” is crucial for diagnosing this entity. Magnetic resonance imaging is the most useful modality for diagnosis. This case report presents the clinical and radiological findings of a 39-year-old patient diagnosed with the rare entity of thoracic arachnoid web.

Keywords

• Scalpel Sign
• magnetic Resonance Imaging
• Arachnoid Web

References

1. REFERENCES Reardon MA, Raghavan P, Carpenter-Bailey K, Mukherjee S, Smith JS, Matsumoto JA, et al. Dorsal thoracic arachnoid web and the “scalpel sign”: a distinct clinical-radiologic entity. AJNR Am J Neuroradiol. 2013;34(5):1104-1110. doi: 10.3174/ajnr. A3432.
2. Saiz A, Sanz Díaz J, Peña Suarez J, Santamarta E, Martínez L, Suárez Arcay C, et al. Advanced MRI techniques in arachnoid web diagnosis. ECR 2019/ C-1853. DOI: 10.26044/ecr2019/C-1853.
3. Yamamoto A, Fujimoto M, Aoki K, Suzuki Y, Mizuno M, Suzuki H. A Dorsal Arachnoid Web of the Cervical Spine: A Case Report. NMC Case Rep J. 2021;8(1):281-286. doi: 10.2176/nmccrj.cr.2020-0300.
4. Arora V, Verma H, Kamal R, Nasir Ahmed L. Dorsal arachnoid web: the ‘scalpel’ sign -a case report and differential diagnosis. Egypt J Radiol Nucl Med 53, 163 (2022). https://doi.org/10.1186/s43055-022-00847-4
5. Ben Ali H, Hamilton P, Zygmunt S, Yakoub KM. Spinal arachnoid web-a review article. J Spine Surg. 2018;4(2):446-450. doi: 10.21037/jss.2018.05.08.
6. Buttiens A, Feyen B, Dekeyzer S. Dorsal Arachnoid Web: A Rare Cause of Myelopathy. J Belg Soc Radiol. 2021;105(1):88. doi: 10.5334/jbsr.2592.
7. Derouen K, Shelvin KB, Payton T, Crabill GA, Wilson JM, Tender G. Arachnoid webs with spinal cord compression: insights from three cases. J Surg Case Rep. 2023;16(12): rjad662. doi: 10.1093/jscr/rjad662.
8. Choi JW, DeSimone KE, Dacumos VM, Hoshide RR, Qiao Y, Hui FK. Scalpellum occulta: A rare case of dorsal spinal arachnoid web without the scalpel sign. Radiol Case Rep. 2024;19(4):1552-1555. doi:10.1016/j.radcr.2024.01.036

9. Halloran PJ, Leclair NK, Bulsara KR, Chozick BS, Moss IL, Becker KP, et al. Dorsal arachnoid web of the thoracic spine associated with an arachnoid cyst and a presyrinx state as an unexplained cause of thoracic myelopathy: illustrative case. J Neurosurg Case Lessons. 2024;8(8). doi:10.3171/CASE24313
10. Tran TDD, Vo PD, Truong TV, Ho TD. A case of neurosurgical treatment of thoracic dorsal arachnoid web. Surg Neurol Int. 2023; 14:210. doi:10.25259/SNI_398_2023
11. Naggar A, El Ouali I, Aidi S, Melhaoui A, Kettani NEC, Fikri M, et al. Spinal arachnoid web: a systematic review of a rare entity, with two illustrative case reports. Egypt J Radiol Nucl Med 2024; 55, 178. https://doi.org/10.1186/s43055-024-01348-2
12. Inoue J, Miyakoshi N, Hongo M, Kobayashi T, Abe T, Kikuchi K, et al. Diagnosis and Surgical Treatment of Thoracic Dorsal Arachnoid Web: A Report of Two Cases. Case Rep Orthop. 2020;14(9). https://doi.org/10.1155/2020/8816598
13. Meena VK, Patel TG. Case Series of Arachnoid Webs: Scalpel Sign - A Clue for the Diagnosis. Neurol India. 2023;71(1):153-155. doi:10.4103/0028-3886.370446