Outcome of utilizing real-time contrast medium to detect the fistulas in spinal epidural arachnoid cysts and treat with minimally invasive surgery.

Background: Spinal 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.

Methods: This 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.

Results: Among 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.

Conclusions: The "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.