Microsurgical Management of Spinal Extradural Arachnoid Cyst: Case Report and Review of Literature.

Spinal extradural arachnoid cysts (SEACs) are rare benign lesions that may cause progressive neurological deterioration due to cord compression. Surgical intervention is required for symptomatic cases, although the optimal surgical strategy remains unclear. We report the case of a 35-year-old female patient who presented with back pain, bilateral lower limb numbness, and progressive weakness leading to paraplegia. MRI revealed two thoracic extradural cystic lesions extending from the fifth to the ninth thoracic vertebrae (T5-T9) with cord compression. The patient underwent thoracic (T5-T9) laminectomy and complete excision of the cysts, along with closure of the intradural subarachnoid communication. Histopathology of the cyst walls confirmed arachnoid cysts. Postoperatively, the patient showed significant neurological recovery, achieving independent ambulation with only mild residual spasticity. A short video demonstrating complete excision of the arachnoid cysts and closure of the communication is shown in the article, providing a clear understanding of the surgical strategy for managing this rare disease. This case highlights the importance of early diagnosis and complete surgical excision with dural defect closure for optimal clinical outcomes in SEACs.