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  • Synovial Cysts of the Upper Cervical Spine

    Final Number:

    Christian Theodotou MD; Timur Urakov MD; Steven Vanni DO

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Degenerative cystic lesions of the upper cervical spine are rare and are generally believed to be due to instability. No consensus exists on the management of these lesions in symptomatic and asymptomatic patients. Conservative and surgical strategies have been described. Anterior or posterior surgical approaches with and without decompression and instrumentation have been described

    Methods: The PubMed database was searched for all relevant cases and case series describing non-rheumatoid atlantoaxial joint cysts. The following search phrases were used: “cervical AND synovial cyst”, “atlantoaxial AND synovial cyst”, “c1-2 AND synovial cyst”, “c1-c2 AND synovial cyst”, “cervical AND “juxtafacet cyst”, “atlantoaxial AND juxtafacet cyst”, “c1-2 AND juxtafacet cyst”, “c1-c2 AND juxtafacet cyst.” Results were then filtered for studies involving human subjects only and available in english. The results were not limited by publication date. Cases with cysts at other levels, including atlantooccipital cysts, were excluded. Cases with non-cystic lesions were excluded as well.

    Results: Total of 67 cases were included (Table 1, Table 2), a posterior approach was used in 28 patients, anterior approach in 32 patients, and a lateral approach in 3 patients. Non-operative management was reported in 4 cases. An unspecified surgical technique was used in 5 cases. Surgical fusion was reported in 38 cases. Resection of the cyst was attempted in 57 cases, of which 34 were interpreted as complete and 14 as subtotal. 25 of 32 anterior surgeries had complete cyst resection versus 7 of 20 posterior approaches. No resection of the cyst was performed in six surgical cases. Posterior instrumentation was performed in 8 cases out of 25 with posterior approach for decompression versus 30 out of 32 cases with anterior decompression.

    Conclusions: Atlantoaxial synovial cysts are rare and the optimal surgical approach has not been determined. We conducted a literature review and found a total of 67 other cases of atlantoaxial synovial cysts reported to date in the literature. We attempt to analyze available data and evaluate anterior versus posterior approaches and the need for decompression, amount of cyst resection, and instrumentation.

    Patient Care: The optimal treatment for atlantoaxial synovial cysts is a matter of debate. This article illustrates the different approaches for decompression, fusion, both, or neither for treating atlantoaxial synovial cysts.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1.Understand the different surgical approaches of atlantoaxial synovial cysts 2.Make informed decisions in choosing anterior versus posterior resection based on anticipated morbidity

    References: 1.Sonntag VK. No movement, no cyst. World neurosurgery. 2013;79(5-6):660-1. Epub 2012/11/20. 2.Crockard HA, Sett P, Geddes JF, Stevens JM, Kendall BE, Pringle JAS. Damaged ligaments at the craniocervical junction presenting as an extradural tumour: a differential diagnosis in the elderly. J Neurol Neurosurg Psychiatry. 1991;54(9):817-21. 3.Ferraccioli GF, Della Casa-Alberighi O, Marubini E, Priolo F, Mathieu A, Fantini F, et al. Is the control of disease progression within our grasp? Review of the GRISAR study. (Gruppo Reumatologi Italiani Studio Artrite Reumatoide). Br J Rheumatol. 1996;35(Suppl 2):8-13. 4.Christophis P, Asamoto S, Kuchelmeister K, Schachenmayr W. "Juxtafacet cysts", a misleading name for cystic formations of mobile spine (CYFMOS). European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2007;16(9):1499-505. Epub 2007/01/05. 5.Boviatsis EJ, Stavrinou LC, Kouyialis AT, Gavra MM, Stavrinou PC, Themistokleous M, et al. Spinal synovial cysts: pathogenesis, diagnosis and surgical treatment in a series of seven cases and literature review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2008;17(6):831-7. Epub 2008/04/05. 6.Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. J Neurosurg. 1974;41:372-6. 7.Bydon M, Lin JA, de la Garza-Ramos R, Sciubba DM, Wolinsky JP, Witham TF, et al. The role of spinal fusion in the treatment of cervical synovial cysts: a series of 17 cases and meta-analysis. Journal of neurosurgery Spine. 2014;21(6):919-28. Epub 2014/09/27. 8.Miller JD, Al-Mefty O, Middleton TH. Synovial cyst at the craniovertebral junction. Surg Neurol. 1989;31:239-42. 9.Alguacil-Garcia A. Spinal synovial cyst (ganglion). Am J Surg Pathol. 1987;11(9):732-5. 10.Cecchi PC, Peltz MT, Rizzo P, Musumeci A, Pinna G, Schwarz A. Conservative treatment of an atlantoaxial degenerative articular cyst: case report. The spine journal : official journal of the North American Spine Society. 2008;8(4):687-90. Epub 2007/04/17. 11.Sameshima T, Shibahashi K, Nozaki T, Akabane A, Kihara A, Horiuchi H, et al. Atlantoaxial Intraspinal Juxtafacet Cyst. Neurol Med Chir (Tokyo). 2013;53:125-8. 12.Parks RM, Konig MA, Boszczyk B, Shafafy M. Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2013;22(1):21-5. Epub 2012/03/03. 13.Aizawa T, Ozawa H, Kusakabe T, Nakamura T, Chanplakorn P, Itoi E. C1/2 facet cyst revealed by facet joint arthrography. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. 2010;15(4):603-7. Epub 2010/08/20. 14.Aksoy FG, Gomori JM. Symptomatic cervical synovial cyst associated with an os odontoideum diagnosed by magnetic resonance imaging. Spine (Phila Pa 1976). 2000;25(10):1300-2. 15.Akiyama H, Tamaki N, Kondoh T, Nagashima T. Craniocervical junction synovial cyst associated with atlanto-axial dislocation. Neurol Med Chir (Tokyo). 1999;39:539-43. 16.Fransen P, Pizzolato GP, Otten P, Reverdin A, Lagier R, de Tribolet N. Synovial cyst and degeration of the transverse ligament: an unusual cause of high cervical myelopathy. J Neurosurg. 1997;86:1027-30. 17.Kaufmann AM, Halliday WC, West M, Fewer D, Ross I. Periodontoid synovical cyst causing cervico-medullary compression. Can J Neurol Sci. 1996;23(3):227-30. 18.Onofrio BM, Mih AD. Synovial cysts of the spine. Neurosurgery. 1988;22(4):642-7. 19.Lyons MK, Birch B. Transoral surgical approach for treatment of symptomatic atlantoaxial cervical synovial cysts. Turkish neurosurgery. 2011;21(4):483-8. Epub 2011/12/24. 20.Weymann CA, Capone P, Kinkel PR, Kinkel WR. Synovial cyst of the upper cervical spine: MRI with gadolinium. Neurology. 1993;43:2151-2. 21.Morio Y, Yoshioka T, Nagashima H, Hagino H, Teshima R. Intraspinal synovical cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rehumatoid atlantoaxial instability. Spine (Phila Pa 1976). 2003;28(23):492-5. 22.Fuentes S, Metellus P, Dufour H, Do L, Grisoli F. Retro-odontoid synovial cyst with Forestier's disease. Neurochirurgie. 2004;50(5):521-5. 23.Okamoto K, Doita M, Yoshikawa M, Manabe M, Sha N, Yoshiya S. Synovial cyst at the C1-C2 junction in a patient with atlantoaxial subluxation. J Spinal Disord Tech. 2004;17:535-8. 24.Ohnishi Y, Iwatsuki K, Taketsuna S, Ninomiya K, Yoshimine T. Retro-odontoid synovial cyst resected via an anterolateral approach without fusion. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2015;24 Suppl 4:S508-13. Epub 2014/09/13. 25.Henaux PL, Hamlat A, Riffaud L, Guegan Y, Morandi X. Spontaneous regression of a symptomatic atlanto-occipital joint cyst. Case report. Neurochirurgie. 2011;57(3):129-32. 26.Grob D, Wursch R, Grauer W, Sturzenegger J, Dvorak J. Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976). 1997;22(14):1580-3. 27.Vergne P, Bonnet C, Zabranieki L, Bertin P, Moreau JJ, Treves R. Synovial cyst at the C1-C2 Junction and Spondyloarthropathy. J Rheumatol. 1996;23(8):1438-40. 28.Pizzolato GP, Lagier R. Synovial cyst of the transverse ligament of the atlas causing tetraparesia in a context of generalized osteoarthritis. Clin Exp Rhematol. 1997;15(1):121-2. 29.Bydon M, Papadimitriou K, Witham T, Wolinsky JP, Sciubba D, Gokaslan Z, et al. Treatment of spinal synovial cysts. World neurosurgery. 2013;79(2):375-80. Epub 2012/10/02. 30.Van Gompel JJ, Morris JM, Kasperbauer JL, Graner DE, Krauss WE. Cystic deterioration of the C1-2 articulation: clinical implications and treatment outcomes. Journal of neurosurgery Spine. 2011;14(4):437-43. Epub 2011/02/15. 31.Birch BD, Khandji AG, McCormick PC. Atlantoaxial degenerative articular cysts. J Neurosurg. 1996;85:810-6. 32.Cai CY, Palmer CA, Paramore CG. Exuberant transverse ligament degeneration causing high cervical myelopathy. J Spinal Disord. 2001;14(1):84-8. 33.Boockvar JA, Tsiouris AJ, Hofstetter CP, Kovanlikaya I, Fralin S, Kesavabhotla K, et al. Safety and maximum tolerated dose of superselective intraarterial cerebral infusion of bevacizumab after osmotic blood-brain barrier disruption for recurrent malignant glioma. Clinical article. Journal of neurosurgery. 2011;114(3):624-32. Epub 2010/10/23. 34.Eustacchio S, Trummer M, Unger F, Flaschka G. Intraspinal synovial cyst at the craniocervical junction. Zentralbl Neurochir. 2003;64:86-9. 35.Burkhardt JK RH, Shin BJ, Moliterno JA, Hofstetter CP, Boockvar JA. Intra-arterial chemotherapy for malignant gliomas: a critical analysis. Interventional Neuroradiol. 2011;17:286-95. 36.Cohen MH, Shen YL, Keegan P, Pazdur R. FDA drug approval summary: bevacizumab (Avastin) as treatment of recurrent glioblastoma multiforme. Oncologist. 2009;14(11):1131-8. Epub 2009/11/10. 37.Norden AD, Young GS, Setayesh K, Muzikansky A, Klufas R, Ross GL, et al. Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology. 2008;70(10):779-87. Epub 2008/03/05. 38.Parney IF CS. Current chemotherapy for glioblastoma. Cancer J. 2003;9(3):149-56. 39.Kirk HJ, Pik JH. A novel operative technique to manage a symptomatic synovial cyst associated with an os odontoideum. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2009;16(6):822-4. Epub 2009/03/24. 40.Chang H, Park J, Kim K. Synovial cyst of the transverse ligament of the atlas in a patient with os odontoideum and atlantoaxial instability. Spine (Phila Pa 1976). 2000;25(6):741-4. 41.Puffer RC, Van Gompel JJ, Morris JM, Krauss WE. Resolution of cystic deterioration of the C1-2 articulation with posterior fusion: treatment implications for asymptomatic patients. World neurosurgery. 2013;79(5-6):773-8. Epub 2012/10/10. 42.Goel A. Resolution of cystic deterioration of the C1-2 articulation with posterior fusion: treatment implications for asymptomatic patients. World neurosurgery. 2014;81(1):e1-2. Epub 2013/10/15. 43.Harries A, Wasserberg J. Synovial cyst presenting as a C1/2 tumour. British journal of neurosurgery. 2010;24(5):595-6. Epub 2010/09/28. 44.Louis DN OH, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97-109. 45.Goffin J, Wilms G, Plets C, Bruneel B, Casselman J. Synovial Cyst at the C1-C2 Junction. Neurosurgery. 1992;30(6):914-5. 46.Choe W, Walot I, Schlesinger C, Chambi I, Lin F. Synovial cyst of dens causing spinal cord compression. Case report. Paraplegia. 1993;31(12):803-7. Epub 1993/12/01. 47.Jeon JY, Kovanlikaya I, Boockvar JA, Mao X, Shin B, Burkhardt JK, et al. Metabolic Response of Glioblastoma to Superselective Intra-Arterial Cerebral Infusion of Bevacizumab: A Proton Magnetic Resonance Spectroscopic Imaging Study. AJNR Am J Neuroradiol. 2012. Epub 2012/05/12. 48.Elhammady MS, Farhat H, Aziz-Sultan MA, Morcos JJ. Isolated unilateral hypoglossal nerve palsy secondary to an atlantooccipital joint juxtafacet synovial cyst. Journal of neurosurgery Spine. 2009;10(3):234-9. Epub 2009/03/27. 49.Bydon A, Xu R, Parker SL, McGirt MJ, Bydon M, Gokaslan ZL, et al. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes. The spine journal : official journal of the North American Spine Society. 2010;10(9):820-6. Epub 2010/05/22.

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