CT-Guided Percutaneous Injection of Fibrin Glue for the Therapy of Symptomatic Arachnoid Cysts

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Fig 1.
A, Depth and angle of the puncture needle entry. Neuroimages demonstrate CT-guided percutaneous injection of fibrin glue. B, Preoperative CT scans demonstrate a collection of CSF (CT value=12.3) within the cyst. C, Intraoperative CT scans demonstrate the needle placement into the center of the cyst. D, Postoperative CT scans demonstrate hyperattenuated material (CT value=48.5) within the cyst, consistent with aggregated fibrin glue. The CT values before and after fibrin glue placement are shown in B and D. E−F, Pictures of puncture needle (E) and syringe pump system (F) consisting of 2 syringes connected via a connecting stent.
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Fig 2.
A 46-year-old woman who underwent percutaneous injection of fibrin glue with the aid of CT guidance for a symptomatic sacral arachnoid cyst. A and C, Sagittal and coronal T2-weighted MR images before fibrin glue injection demonstrate that an expansile arachnoid cyst (arrow) is filling with CSF. B and D, Sagittal and coronal T2-weighted MR images obtained 7 months postoperatively demonstrate that the disappeared cyst (arrow) has not re-inflated with CSF.

Table 1:

Summary of cyst characteristics and clinical symptoms in 38 patients

Cyst Location	No. of Cysts	Clinical Symptoms
L5-S1	11 (28.9%)^a	Leg pain, numbness in perineal region and legs, muscle atrophy
S1-S2	14 (36.8%)^a	Lumbosacral pain, constipation, urinary frequency, and perineal discomfort (numbness)
S2-S3	15 (39.5%)	Lumbosacral pain, constipation, urinary frequency and burning sensation around the anus

Table 3:

Preoperative and postoperative size of cysts for all 38 consecutive patients after 3 months

a No significant changes in cyst size on MR imaging/CT studies obtained 3 months postoperatively
b Follow-up results performed at 3 months after a second fibrin glue therapy (P<.001, preoperative vs postoperative), suggesting that fibrin glue could effectively fill and close the cyst cavity.