Cervical cord presyrinx

A 25-year-old woman presented with two months history of high-pressure headaches and unsteady gait. On examination, she had truncal ataxia, but no long tract signs. Craniospinal MRI showed hydrocephalus, an arachnoid cyst in the posterior fossa and cervical cord oedema without cavitation (Fig. 1). Several treatment options were considered including surgical excision of the cyst, shunting and endoscopic fenestration. We elected to excise the cyst because it was easily accessible and we felt that excision would definitively tackle the problem with low morbidity, without relying on the patency of shunts or endoscopic fenestrations. She therefore underwent posterior fossa craniectomy and excision of the cyst. An MRI done a week after surgery, showed complete resolution of the cord oedema (Fig. 1).