{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T09:51:55Z","timestamp":1781862715881,"version":"3.54.5"},"reference-count":23,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Predominantly Dorsal Thoracic Spinal Arachnoid Webs (DAW\/SAW: 90%-100%), attributed to arachnoidal scarring obstructing cerebrospinal fluid (CSF) dynamics, typically cause dorsal cord compression. Their multiple etiologies include; trauma, idiopathic\/post-surgical, inflammatory\/infection, subarachnoid hemorrhage, and\/or congenital defects.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Patients with DAW\/SAW are typically in their early\/mid-fifties, and present with; back pain (i.e., 41.2%-88.9%), motor deficits (i.e. 59%-77.8%), sensory loss (i.e., numbness 65%-66.7%), and\/or sphincter dysfunction (i.e., 33.3%).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n MR and Myelo-CT studies for DAW\/SAW classically demonstrate the positive scalpel sign (i.e., single or multilevel dorsally compressive \u201cfluid\u201d collections often containing multiple loculations\/fenestrations usually accompanied by Syrinxes (i.e., 44 - 83%), and\/or Spinal Arachnoid Cyst (SAC) formation. Conservative treatment is rarely effective. Alternatively, surgery consisting of laminectomy\/decompression, resection\/ lysis, marsupialization and\/or fenestration of loculated collections including attendant SAC resections, and decompression\/shunting of Syrinxes, results in postoperative improvement in up to 91% of patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Patients with DAW\/SAW typically present with MR\/Myelo-CT studies that demonstrate the dorsal thoracic positive scalpel sign in conjunction with Syrinxes, and\/or SAC. Surgery typically includes laminectomy\/ decompression, lysis\/resection of arachnoidal adhesions with marsupialization\/fenestration, and\/or shunting, to achieve up to a 91% incidence of postoperative neurological improvement.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_654_2026","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T08:58:16Z","timestamp":1781859496000},"page":"364","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perspective\/short review: Diagnosis and surgery for mostly dorsal thoracic spinal arachnoid webs with\/ without Syrinxes and\/or Spinal Arachnoid Cysts"],"prefix":"10.25259","volume":"17","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[{"name":"Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY, c\/o Dr. Marc Agulnick 1122 Franklin Avenue Suite 106, Garden City, NY 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