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Acta Clinica Croatica Jun 2021We present a case of a patient with treatment resistant hallucinatory experiences with incidental finding of an arachnoid cyst localized in the posterior infratentorial... (Review)
Review
We present a case of a patient with treatment resistant hallucinatory experiences with incidental finding of an arachnoid cyst localized in the posterior infratentorial cranial fossa dorsally to the cerebellum. Psychological testing revealed significant deficit of cognitive functions to the level of mild intellectual disability in a person that had previously finished high school with good grades. A combination of clozapine and lamotrigine led to significant improvement in mood and reduction of hallucinations, but without improvement in cognitive functions. We also performed a literature review of previously published case reports or case series of co-occurring posterior fossa arachnoid cyst and schizophrenia or psychosis or psychiatric symptoms using PubMed search and discuss some controversies considering their treatment outcome.
Topics: Arachnoid Cysts; Cerebellum; Cognition; Cranial Fossa, Posterior; Humans; Magnetic Resonance Imaging; Psychotic Disorders
PubMed: 34744282
DOI: 10.20471/acc.2021.60.02.18 -
Annals of Medicine and Surgery (2012) Dec 2023Arachnoid cysts are intra-arachnoid lesions filled with cerebrospinal fluid. They account for ~1% of all intracranial mass lesions and are non-neoplastic collections of...
INTRODUCTION
Arachnoid cysts are intra-arachnoid lesions filled with cerebrospinal fluid. They account for ~1% of all intracranial mass lesions and are non-neoplastic collections of cerebrospinal fluid within an anomalous arachnoid enclosure.
CASE PRESENTATION
The authors report a 35-year-old Arabian male who presented to the ER with a history of sudden loss of consciousness, anisocoria, and right hemiparesis. Contrast tomography showed a large frontoparietotemporal cyst (7.7×5.8×5.4) with uncal herniation and a midline shift of 12 mm. An emergency left FTP craniotomy with an excision of the cyst was performed.
DISCUSSION
Arachnoid cysts can be categorized as primary or secondary, arising congenitally or due to factors like trauma, infection, or neoplasia. It can rupture, leading to internal bleeding, causing symptoms such as headaches, seizures, and neurological decline. Rapid diagnosis is vital, with cranial computed tomography scans preferred for emergencies. Treatment options include surgical intervention like craniotomy, fenestration, or cyst peritoneal shunts. For uncal herniation, surgery can be successful and results depends on the amount of herniation.
CONCLUSION
Although benign, the arachnoid cysts led to uncal herniation when they become 'tension' cysts. A high level of suspicion is crucial for early recognition of the condition. Timely intervention has shown positive recovery outcomes.
PubMed: 38098583
DOI: 10.1097/MS9.0000000000001373 -
Romanian Journal of Morphology and... 2017Dandy-Walker complex (DWC) is a malformative association of the central nervous system. DWC includes four different types: Dandy-Walker malformation (vermis agenesis or...
Dandy-Walker complex (DWC) is a malformative association of the central nervous system. DWC includes four different types: Dandy-Walker malformation (vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa); Dandy-Walker variant (vermis hypoplasia, cystic dilatation of the fourth ventricle, normal posterior fossa); mega cysterna magna (large posterior fossa, normal vermis and fourth ventricle) and posterior fossa arachnoid cyst. We present and discuss four cases with different morphological and clinical forms of the Dandy-Walker complex. In all four cases, diagnosis was reached by incorporation of clinical (macrocephaly, seizures) and imaging [X-ray, computed tomography (CT), magnetic resonance imaging (MRI)] data. Two patients were diagnosed with Dandy-Walker complex, one patient was diagnosed with Dandy-Walker variant in a rare association with neurofibromatosis and one patient was diagnosed with a posterior fossa arachnoid cyst associated with left-sided Claude Bernard-Horner syndrome, congenital heart disease (coarctation of the aorta, mitral stenosis) and gastroesophageal reflux. In all forms of DWC, the clinical, radiological and functional manifestations are variable and require adequate diagnostic and therapeutic measures.
Topics: Child, Preschool; Dandy-Walker Syndrome; Female; Humans; Infant; Male
PubMed: 29250689
DOI: No ID Found -
Journal of Neurosurgery. Case Lessons Nov 2022Spinal cysts in the interdural space are extremely rare and are not included in the standard classification of spinal meningeal cysts.
BACKGROUND
Spinal cysts in the interdural space are extremely rare and are not included in the standard classification of spinal meningeal cysts.
OBSERVATIONS
A 60-year-old female presented to our hospital with a spastic gait and numbness in both palms. Magnetic resonance imaging (MRI) revealed a spinal cyst from C4 to T4 compressing the spinal cord. Computed tomography myelography revealed a fistula at C4-5 and C5-6 that connected the cyst along the right C5 and C6 root sleeves. The cyst was located within the dura mater, and communication with the arachnoid space was achieved using a shunt tube. There was partial spastic gait amelioration after the procedure, but the patient experienced a relapse 2 months postoperation. A repeat procedure was performed without a shunt tube to allow greater communication between the cyst and the subarachnoid space. After this, marked improvement in gait function was observed, and MRI showed a significant reduction in cyst volume.
LESSONS
Interdural spinal meningeal cysts are rare. When the interdural cyst cannot be removed entirely, surgery may be appropriate for providing a shunt tube or establishing communication between the cyst and arachnoid space to maintain the circulation of cerebrospinal fluid collected in the cyst cavity.
PubMed: 36345207
DOI: 10.3171/CASE22198 -
Child's Nervous System : ChNS :... Apr 2015Schizencephaly is an uncommon congenital disorder of cerebral cortical development. The defect is characterized by the presence of a cleft in the brain extending from...
BACKGROUND
Schizencephaly is an uncommon congenital disorder of cerebral cortical development. The defect is characterized by the presence of a cleft in the brain extending from the surface of the pia mater to the cerebral ventricles. The margins of the cleft are lined with heterotropic, dysplastic gray matter. The causes of schizencephaly are heterogeneous and can include teratogens, prenatal infection, maternal trauma, or EMX2 mutations.
METHOD
In the present paper, the authors described difficulties in employing diagnostic imaging in differentiating between type II (open-lip) schizencephaly and much more common intracranial fluid spaces of a different origin (arachnoid cysts and hydrocephalus).
RESULT
In all the three cases, the treatment consisted in implantation of a shunt system; nevertheless, it should be emphasized that a surgical intervention in the third presented case (type II schizencephaly) aimed at relieving the symptoms of intracranial hypertension-a directly life-threatening condition-since shunting is not a method of treating schizencephaly itself.
CONCLUSIONS
Although proper interpretation of the character of intracranial fluid spaces is of significance for further therapeutic management, yet, the key decision as to the surgical intervention is made based on clinical presentation, predominantly on symptoms of intracranial hypertension.
Topics: Cerebrospinal Fluid Shunts; Child, Preschool; Female; Humans; Infant, Newborn; Male; Schizencephaly; Tomography, X-Ray Computed
PubMed: 25690450
DOI: 10.1007/s00381-015-2638-1 -
Journal of General and Family Medicine May 2022A 43-year-old woman presented to our hospital with headache accompanied with nausea and intermittent vomiting without abdominal pain. The patient had undergone...
A 43-year-old woman presented to our hospital with headache accompanied with nausea and intermittent vomiting without abdominal pain. The patient had undergone ventriculoperitoneal shunt placement for hydrocephalus owing to quadrigeminal cistern arachnoid cyst. Cranial computed tomography demonstrated enlarged bilateral ventricles, and the abdominal radiograph demonstrated a reverse U-shaped catheter that seemed to have been fractured in the left peritoneal cavity.
PubMed: 35509328
DOI: 10.1002/jgf2.525 -
BioMed Research International 2015Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression,...
Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.
Topics: Adult; Arachnoid Cysts; Female; Humans; Male; Neuroendoscopy
PubMed: 25685785
DOI: 10.1155/2015/389474 -
Neurospine Mar 2022This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).
OBJECTIVE
This study aimed to illustrate the features of fistula location distribution, surgical strategies, and outcomes in spinal epidural meningeal cysts (SEMCs).
METHODS
The authors searched and reviewed the medical records for cases of SEMCs. Imaging features, operative reports, and media were reviewed to accurately describe the surgical techniques employed. We recorded the level and laterality of the fistula according to the operative report and the media. Consistency analysis was performed on the dominant laterality of the cyst on preoperative axial magnetic resonance imaging and laterality of the fistula in the operative media or report. When cyst and fistula lateralities were the same, they were considered consistent. Finally, the Japanese Orthopedic Association (JOA) score was used to obtain patient-reported results at each follow-up.
RESULTS
Thirty patients with SEMCs were identified. Fistula repair was performed in all patients. Two patients experienced cyst recurrence after surgery and were repaired during the second surgery. Based on imaging findings, SEMCs mostly occurred in the thoracolumbar junction. Most of the fistulas (87.88%) were at the T12 or L1 levels. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst rather than in the middle level of the cyst. A fistula laterality of 72.72% was consistent with cyst laterality. The JOA improvement rate was 61.84% ± 26.63%.
CONCLUSION
Most fistulas were always located at the T12-L1 level as well as the middle level of the cyst, which is always consistent with cyst laterality. In patients with multiple adjacent SEMCs, the fistula may be at one end of the cyst. Cleft closure is key to healing SEMCs.
PubMed: 34990537
DOI: 10.14245/ns.2142526.263 -
Clinical Case Reports Mar 2022Endoscopic fenestration is best as it is minimally invasive and does not require hardware in the surgical site (Figure 1). This case shows the safety of endoscopic...
Endoscopic fenestration is best as it is minimally invasive and does not require hardware in the surgical site (Figure 1). This case shows the safety of endoscopic fenestration and the utility of operative adjuncts (. 1999;14:443; . 2005;19:E7).
PubMed: 35340642
DOI: 10.1002/ccr3.5386 -
Surgical Neurology International 2019Neuroepithelial cysts are benign, well-circumscribed, nonenhancing CSF-like masses that might virtually present in any intracranial location. Common locations are the...
BACKGROUND
Neuroepithelial cysts are benign, well-circumscribed, nonenhancing CSF-like masses that might virtually present in any intracranial location. Common locations are the frontal lobe, thalamus, midbrain and pons, vermis, the lateral and fourth ventricles, and the choroid fissure (Choroid fissure cysts). Usually asymptomatic, cysts in the posterior fossa have been reported to cause cranial nerve palsies, focal brainstem dysfunction, and hydrocephalus. Supratentorial cysts might cause seizures or focal motor and/or sensory deficits. Histopathological examination reveals that neuroepithelial cysts are lined by ependymal (columnar epithelium) or choroid plexus cells (low cuboidal epithelium). The differential diagnosis includes enlarged perivascular spaces, infectious cyst-neurocysticercosis, porencephalic cyst, and arachnoid cyst.
CASE DESCRIPTION
A patient with a symptomatic histologically confirmed pineal region neuroepithelial cyst underwent park bench position and a right supracerebellar infratentorial approach. The pineal region was accessed over the right cerebellar hemisphere and the lesion was identified after a lateral opening of the quadrigeminal cistern. After a careful dissection of the lesion, the cyst was pulled out with long ring microforceps and long sharp bipolar forceps; both assisted by a thumb-regulated suction tube. A complete lesion was removed in a piece and meticulous attention was paid to any bleeding securing complete hemostasis of the surgical site. The postoperative course was uneventful. The patient underwent rehabilitation without recurrence of the lesion.
CONCLUSION
This unedited video offers all detailed aspects that a neurosurgeon as the senior author JH considers essential when performing an efficient and safe surgery into the pineal region for this very rarely documented pineal region neuroepithelial cyst.
VIDEOLINK
http://surgicalneurologyint.com/videogallery/pineal-cyst-4.
PubMed: 31123634
DOI: 10.4103/sni.sni_351_18