TITLE:
Spinal Arachnoid Web as a Rare, Well-Known but Underdiagnosed Entity: A Report of Three Cases
AUTHORS:
El Hadji Cheikh Ndiaye Sy, Mohamed Moyassar Onifade, Férol Gbenou, Hugues Ghislain Atakla, Irene Wrokie Kweidjartey, Kamga Nkouli Steve Jacquier, Jean Luc Blanc, Alioune Badara Thiam, Momar Code Ba
KEYWORDS:
Arachnoid Web, Spinal Cord, Scalpel Sign, Decompression
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.16 No.3,
July
22,
2026
ABSTRACT: Background: Spinal arachnoid web is an abnormality of the arachnoid membrane in the subarachnoid space which may cause progressive spinal cord compression and myelopathy. Its diagnosis is often delayed due to its nonspecific presentation and limited awareness. We report three managed cases of spinal arachnoid web, with highlights on the diagnostic and therapeutic challenges. Methods: We retrospectively reviewed three patients diagnosed with spinal arachnoid web between January 2020 and December 2022. Clinical presentation, imaging findings, management strategy, and outcomes were analysed. Results: All patients were male, with a mean age of 56.3 years. Two presented with progressive myelopathy and underwent surgical decompression with intradural excision of the arachnoid web. The final patient with mild symptoms was managed conservatively. MRI revealed the characteristic “scalpel sign” in all cases with associated syringomyelia in two patients. Their postoperative neurological statuses either plateaued or slightly improved with respect to gait. No recurrence was observed during follow-up. Conclusion: Spinal arachnoid web is a rare and potentially reversible cause of spinal cord compression. MRI plays a key role in diagnosis. From our experience, complete surgical resection of spinal arachnoid web was associated with clinical stabilisation and the absence of recurrence during the short follow-up period observed in this series. However, treatment should be individualized, taking into consideration the severity of symptoms, clinical and radiological findings.