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European Spine Journal : Official... May 2016Mostly seen at the thoracic level, arachnoid cysts are a very rare cause of cervical spinal cord compression. Generally treated by laminectomy and cyst fenestration,... (Review)
Review
PURPOSE
Mostly seen at the thoracic level, arachnoid cysts are a very rare cause of cervical spinal cord compression. Generally treated by laminectomy and cyst fenestration, this approach does not allow removing the cyst in its entirety without manipulating the weakened spinal cord. The aim of this report is to present the case of a cervical intradural arachnoid cyst surgically removed by an anterior approach with corporectomy.
METHODS
Here is the case of an 18-year-old amateur boxer presenting with a voluminous cervical intradural anterior arachnoid cyst, extending from C2 to C5. Symptoms were cervical pain, quadriparesis, and clumsiness of both arms which had appeared just after a traffic accident. An anterior approach was chosen, through a C5 corporectomy.
RESULTS
The patient totally recovered from his sensitive symptoms at discharge and from his motor symptoms 6 weeks later. Early as well as 3-years post-operatively, MRI confirmed expansion of the spinal cord without any centro-medullar signal. The patient remained asymptomatic 3 years after surgery. Since the first report in 1974, 16 cases of symptomatic cervical intradural arachnoid cysts were treated via a posterior approach, one by MRI-guided biopsy, and one was re-operated on through an anterior approach. For 14 patients, their conditions had improved, while one died of pneumonia, one presented a condition worsened, and one had a stable neurological status.
CONCLUSION
Using an anterior approach is a safe procedure that allows resection of a cervical arachnoid cyst without any manipulation of the weakened spinal cord, while giving the best possible view.
Topics: Adolescent; Arachnoid Cysts; Cervical Vertebrae; Humans; Male; Neck Pain; Quadriplegia; Spinal Cord Compression
PubMed: 25995113
DOI: 10.1007/s00586-015-4026-7 -
Clinical Neurology and Neurosurgery May 2021Large interhemispheric cysts (IHC) with partial or complete agenesis of corpus callosum (ACC) constitute a heterogeneous group of rare disorders. Neurosurgical...
OBJECTIVE
Large interhemispheric cysts (IHC) with partial or complete agenesis of corpus callosum (ACC) constitute a heterogeneous group of rare disorders. Neurosurgical treatment, in the terms of if, when and how to operate, remains unclear METHODS: We performed a surgical literature review of series or reports of IHCs with callosal anomalies; we evaluated whether revision surgeries were necessary and considered the dimensional change in the cyst postoperatively and the developmental outcome. We also reported our experience with sfour patients treated by programmable cysto-peritoneal (CP) shunting. Patients' clinical history, neuroradiological and neuropsychological performances were evaluated pre and post operatively.
RESULTS
The review included 133 patients with surgically-treated IHCs. Although most authors are in agreement to perform surgery if the patients present signs of raised ICP and to not intervene in those completely asymptomatic, for other signs and symptoms the debate is still open; only few authors performed cognitive tests pre and post-operatively. Shunting procedures were successful in 60% of our reviewed cases and often lead to a major cyst collapse. Craniotomy achieves good results but is extremely invasive. Endoscopy is minimally invasive and our review demonstrated a success rate of 66%. However, endoscopy does not ensue a complete cyst collapse. Our series and review seem to suggest a possible link between parenchymal re-expansion and cognitive outcome.
CONCLUSIONS
Early and effective surgery seems to obtain a greater cerebral parenchyma re-expansion and long-term cognitive evolution. Endoscopy is safe and reliable, but more data is needed on the impact of uncomplete cyst collapse on neurocognitive outcome.
Topics: Agenesis of Corpus Callosum; Central Nervous System Cysts; Cerebrospinal Fluid Shunts; Craniotomy; Humans; Treatment Outcome
PubMed: 33799088
DOI: 10.1016/j.clineuro.2021.106600 -
Operative Neurosurgery (Hagerstown, Md.) Jan 2023Middle meningeal artery (MMA) embolization is becoming increasingly studied as a safe, effective treatment for chronic subdural hematoma (cSDH) in adults. Among...
BACKGROUND
Middle meningeal artery (MMA) embolization is becoming increasingly studied as a safe, effective treatment for chronic subdural hematoma (cSDH) in adults. Among pediatric patients, however, MMA embolization for cSDH has been rarely described, and the potential benefit of this approach for pediatric patients remains unknown.
OBJECTIVE
To systematically review the literature and identify cases of pediatric MMA embolization for cSDH. We also report our experience with pediatric MMA embolization.
METHODS
A systematic review of the literature was performed to identify cases of pediatric MMA embolization for cSDH. Inclusion criteria included English language availability and pediatric age defined as less than 18 years. A pediatric patient treated with MMA embolization was also identified at our institution.
RESULTS
Five cases of pediatric MMA embolization for cSDH were identified in the literature. Two were associated with arachnoid cysts, 2 with antiplatelet/anticoagulation therapy, and 1 with abusive head trauma. There were no adverse events, and all patients demonstrated clinical and radiological improvement on follow-up. At our institution, a previously healthy 8-year-old male was found to have a right-sided acute-on-chronic SDH during a headache evaluation. A diagnostic angiogram was performed to rule out a dural arteriovenous fistula, and right-sided MMA embolization was performed concurrently. Rapid clinical and radiological improvement was observed, with complete resolution by 6 months.
CONCLUSION
MMA embolization may represent a treatment option for pediatric patients with cSDH.
Topics: Male; Adult; Humans; Child; Adolescent; Meningeal Arteries; Hematoma, Subdural, Chronic; Embolization, Therapeutic; Treatment Outcome; Central Nervous System Vascular Malformations
PubMed: 36519875
DOI: 10.1227/ons.0000000000000446 -
Neuro-Chirurgie Jan 2022Cerebral venous sinus thrombosis (CVST) following brain surgery is a feared complication, commonly described after direct injury to the sinus. However, distant CVST...
Cerebral venous sinus thrombosis (CVST) following brain surgery is a feared complication, commonly described after direct injury to the sinus. However, distant CVST occurring away from the operative area are unexpected. Yet, there is a strong physio-pathological rational supporting the role of intracranial hypotension as a risk factor of CVST. Here, we report the case of a frontal arachnoid cyst depletion followed by an extensive contralateral CVST. Given the major prognostic consequences observed in this clinical illustration, we further investigated the hypothesis of intracranial hypotension as an etiology of CVST by carrying out a systematic review of the literature.
Topics: Humans; Intracranial Hypotension; Sinus Thrombosis, Intracranial
PubMed: 33667532
DOI: 10.1016/j.neuchi.2021.02.010