Minimally Invasive Excision of Thoracic Arachnoid Web

OBJECTIVE: Arachnoid webs are rare intradural lesions that can cause direct spinal cord compression or alteration of the cerebrospinal fluid flow with syringomyelia. Surgery has been historically performed through wide-open laminectomies. The aim of this study is to prove the feasibility of minimally invasive techniques for the excision of arachnoid webs. METHODS: A retrospective review of two cases of minimally invasive excision of thoracic arachnoid webs was performed. Surgery was undertaken through expandable tubular retractors. RESULTS: Complete excision was achieved through the described approach, with minimal bony removal and soft tissue disruption. There were no intraoperative or perioperative complications. Both patients were mobilized early and discharged home within 24 hours after surgery. Postoperative imaging showed good re-expansion of the spinal cord, with no evidence of residual compression or tethering. CONCLUSIONS: For symptomatic arachnoid webs, surgery remains the only definitive treatment. In expert hands, the excision of arachnoid webs can be achieved with tubular retractors and minimally invasive techniques.