Intraoperative ultrasound in spinal arachnoid cyst resection: illustrative cases.

BACKGROUND: Intraoperative ultrasound (iUS) has emerged as a valuable imaging resource in neurosurgical procedures. To improve familiarity with iUS technology and optimize its usage, additional exposure and technical demonstrations are needed. Spinal arachnoid cysts (SACs) are rare spinal cord lesions most often treated with resection, with procedural challenges stemming from poor preoperative lesion visualization and the infrequency of the procedure. The authors present a case series to detail the use of iUS in assisting with the resection of SAC. OBSERVATIONS: The cases of 2 patients with symptomatic thoracic SAC are presented. Case 1 involves a patient undergoing a T3-4 laminectomy with SAC resection, and case 2 involves a patient undergoing T7-9 laminectomy and SAC resection. Use of iUS assisted with tailored durotomies, allowed for improved perioperative visualization of the lesions, and provided immediate postresection CSF flow feedback. Both patients noted subjective improvement following resection, and no surgical complications were observed. LESSONS: In SAC resection, iUS proved to be an effective tool by enhancing visualization, providing immediate feedback on resection efficacy, and limiting surgical risk. Real-time imaging allowing for improved surgical direction may decrease potential harm and contribute to improved outcomes. Increasing iUS use in neurosurgical procedures should prove beneficial. https://thejns.org/doi/10.3171/CASE251034.