Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well defined treatment strategy: a series of 5 patients diagnosed with SAC, submitted to neurosurgical treatment, was retrospectively analyzed. Objectives: SACs represent 1-2% of all spinal neoplasms: they can be extradural, intradural, or intrame-dullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neu-rosurgical management in patients with SACs treated at our Institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and De-cember 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (3 males, 2 females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging in-dicated that most cysts were at the thoracic level. Surgical interventions primarily in-volved cyst resection and adhesiolysis. Postoperative outcomes showed overall im-provement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (AIS) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences.

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences.