Midline synovial and ganglion cysts causing neurogenic claudication

Figure 1 T2-weighted imaging of case 2. A, B: In the preoperative images, sagittal (A) and axial (B) T2 weighted magnetic resonance imaging displays a large intraspinal cystic lesion at the L4-5 level causing stenosis and thecal sac compression. The cystic lesion appears to have an eccentric component extending towards the left facet joint; C, D: Post-operative imaging following decompressive laminectomy and cyst excision. Bilateral laminectomies at L4-5 and cyst resection provide adequate decompression of the dorsal thecal sac and cauda equina, as shown in sagittal (C) and axial (D) images.

Figure 2 Case 2, pathological findings of midline ganglion cyst (hematoxylin eosin staining, × 400). Photomicrograph (original magnification × 400) reveals proteinaceous material (arrow) surrounded by dense fibro-connective tissue (asterisk), without the presence of synovial epithelium. These findings confirm the diagnosis of a ganglion cyst.