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The New England Journal of Medicine Jan 2019
Topics: Arachnoid Cysts; Brain; Child, Preschool; Female; Head; Humans; Magnetic Resonance Imaging; Movement Disorders; Syndrome
PubMed: 30699323
DOI: 10.1056/NEJMicm1808747 -
Journal of Spine Surgery (Hong Kong) Jun 2018The spinal arachnoid web is an abnormal formation of an arachnoid membrane in the subarachnoid space. It is a rare entity with some degree of uncertainty surrounding its... (Review)
Review
The spinal arachnoid web is an abnormal formation of an arachnoid membrane in the subarachnoid space. It is a rare entity with some degree of uncertainty surrounding its etiology. It can result in a displacement of the spinal cord causing pain and neurological symptoms as well as blockage of cerebrospinal fluid (CSF) flow and subsequent syringomyelia. The syrinx resulting from the altered CSF flow dynamics has been described to assume variable positions relative to the web itself. The "scalpel sign" is regarded as a pathognomonic feature of a spinal arachnoid web. The arachnoid web, however, is relatively thin and may be elusive of routine radiological investigations. As such, a myriad of preoperative and intraoperative investigations have been postulated to improve the sensitivity of detecting this abnormality. Management of spinal arachnoid webs ranges from conservative management to surgical excision where in the latter, the extent of excision remains the subject of debate. The authors herein present a review of the available information on this rare topic.
PubMed: 30069540
DOI: 10.21037/jss.2018.05.08 -
Middle East African Journal of... 2015Oculocerebrocutaneous or Delleman syndrome is a rare congenital syndrome characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects,...
Oculocerebrocutaneous or Delleman syndrome is a rare congenital syndrome characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects, intracranial cysts and skin appendages. We here report a case of 1-year-old male child with periocular skin tags, lid colobomas, and dermal hypoplasia. The patient had delayed developmental milestones and history of tonic-clonic seizures. Magnetic resonance imaging of the head revealed a large arachnoid cyst, aplastic cerebellar vermis and polymicrographic pattern of the cerebral cortex. A complex cyst of spleen was also noted on abdominal ultrasonography. Orbital cysts depending on the size can be excised or left alone. Neuroimaging evaluation of patients with congenital orbital cysts and skin appendages is emphasized for early and appropriate management.
Topics: Arachnoid Cysts; Central Nervous System Cysts; Coloboma; Cysts; Eye Abnormalities; Eyelids; Fingers; Humans; Infant; Magnetic Resonance Imaging; Male; Orbital Diseases; Skin Abnormalities
PubMed: 25624688
DOI: 10.4103/0974-9233.148363 -
Journal of Neurosciences in Rural... 2024
PubMed: 38746515
DOI: 10.25259/JNRP_554_2023 -
Cureus Nov 2022A 66-year-old man presented to the emergency department with sudden onset of dysarthria, left central facial palsy, and left hemihypesthesia involving the...
A 66-year-old man presented to the emergency department with sudden onset of dysarthria, left central facial palsy, and left hemihypesthesia involving the tongue. The patient was hemodynamically stable (blood pressure of 153/84 mmHg and heart rate of 80 bpm) and normoglycemic, without a history of trauma or toxic exposure. Assuming an acute stroke, the patient immediately underwent a brain CT scan that revealed a large left-sided fronto-parieto-temporal arachnoid cyst, with approximately 9.5 x 5.1 cm of maximum diameters (anteroposterior and transversal), compressing the brain parenchyma and the ventricular system, with a right deviation of the median structures by about 5 mm. The patient had a complete spontaneous resolution of the initial symptoms while in the emergency department. He declined admission to the ward for observation and further investigation, choosing to be discharged against medical advice. Lately, the patient represented to the ED with a new episode, this time with worsening symptoms, and consented to a cystoperitoneal shunt insertion. The procedure was well tolerated, and the patient has been asymptomatic since surgery.
PubMed: 36569705
DOI: 10.7759/cureus.31782 -
Journal of Neurosurgery. Case Lessons Apr 2022Hemifacial spasm (HFS) due to an arachnoid cyst at the cerebellopontine angle is rare. Here, the authors reported such a case and analyzed the mechanism of facial nerve...
BACKGROUND
Hemifacial spasm (HFS) due to an arachnoid cyst at the cerebellopontine angle is rare. Here, the authors reported such a case and analyzed the mechanism of facial nerve hyperactivity by reviewing the literature.
OBSERVATIONS
A 40-year-old man presented with right HFS for the past 3 years. Preoperative magnetic resonance imaging revealed a right cerebellopontine angle cystic mass with high intensity on T2-weighted images, low intensity on T1-weighted and diffusion-weighted images, and no contrast effects. Cyst excision and decompression of the facial nerve using a lateral suboccipital approach to monitor abnormal muscle response (AMR) resulted in permanent relief. The cyst was histologically compatible with an arachnoid cyst.
LESSONS
In the present case, when the cyst was dissected, the AMR disappeared and no offending arteries were detected around the root exit zone. Therefore, the cyst itself was responsible for HFS, for which AMR was useful. Limited cases of HFS due to arachnoid cysts without neurovascular compression have been previously reported. The authors suggested that pulsatile compression by the cyst results in facial nerve hyperactivity and secondary HFS.
PubMed: 36303502
DOI: 10.3171/CASE2275 -
Cureus Mar 2023Arachnoid cysts are relatively rare and usually asymptomatic. It can only be diagnosed through radiological imaging modalities. Some patients may develop symptoms such...
Arachnoid cysts are relatively rare and usually asymptomatic. It can only be diagnosed through radiological imaging modalities. Some patients may develop symptoms such as seizures, headache, dizziness, or psychiatric symptoms. We present a case of a 25-year-old male, previously healthy, who presented with sudden, repetitive episodes of seizure without regaining his consciousness. Computed tomography (CT) head scan showed a large cystic lesion that showed a rightward midline shift. Treatment was done surgically via endoscopic fenestration, and the patient remained symptom-free for one year. Most arachnoid cysts tend to remain asymptomatic throughout a patient's life span, allowing them to lead everyday normal lives; however, when these symptoms surface, they tend to be of a sudden nature requiring urgent surgical intervention. Our report follows the case of a young patient whose symptoms appear suddenly with triggers that led to status epilepticus. Our patient continued to suffer from multiple seizure attacks despite being on multiple anti-convulsive medications, and his symptoms eventually subsided via surgical intervention.
PubMed: 37102020
DOI: 10.7759/cureus.36552 -
Child's Nervous System : ChNS :... Jul 2020Quadrigeminal arachnoid cyst (QAC) associated with encephalocele is rare; and while some treatments have been developed in recent years, no definite therapeutic approach... (Review)
Review
INTRODUCTION
Quadrigeminal arachnoid cyst (QAC) associated with encephalocele is rare; and while some treatments have been developed in recent years, no definite therapeutic approach for QAC has been established. Endoscopic treatment for arachnoid cyst is gaining popularity because it is relatively less invasive to the normal brain tissues.
CASE PRESENTATION
The patient, a 4-year-old girl, presented with QAC associated with congenital occipital encephalocele. At the age of 1 month, repair of the perinatal encephalocele had been performed at another institute. An asymptomatic arachnoid cyst remained in the posterior fossa, which was closely monitored with follow up. At age 4 years, the patient started to complain of headache, which gradually increased in both strength and frequency. Magnetic resonance imaging (MRI) revealed cerebellar compression due to cyst enlargement. We performed neuroendoscopic cyst fenestration with an occipital bone approach. Post-operative MRI showed reduced size of the cyst, and the headache dramatically improved and resolved.
DISCUSSION
The standard treatment of QAC is still controversial; however, our successful use of endoscopic fenestration toward the third ventricle indicates its efficacy and safety. QACs have been classified into 3 types based on their expansion mechanisms; our case might suggest another possible mechanism of QAC development.
CONCLUSION
In our case, endoscopic cyst fenestration was successful for QAC with perinatal encephalocele. However, long-term follow-up and analysis of similar cases are needed to determine its effectiveness.
Topics: Arachnoid Cysts; Child, Preschool; Encephalocele; Female; Humans; Magnetic Resonance Imaging; Neuroendoscopy; Third Ventricle
PubMed: 32328704
DOI: 10.1007/s00381-020-04626-2 -
Asian Journal of Surgery Jun 2023
Review
Topics: Humans; Spinal Cord Diseases; Arachnoid Cysts; Magnetic Resonance Imaging
PubMed: 36641278
DOI: 10.1016/j.asjsur.2022.12.110