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Korean Journal of Neurotrauma Oct 2016A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects...
A spinal extradural arachnoid cyst (SEAC) results from a rare small defect of the dura matter that leads to cerebrospinal fluid accumulation and communication defects between the cyst and the subarachnoid space. There is consensus for the treatment of the dural defect, but not for the treatment of the cyst. Some advocate a total resection of the cysts and repair of the communication site to prevent the recurrence of a SEAC, while others recommended more conservative therapy. Here we report the outcomes of selective laminectomy and closure of the dural defect for a 72-year-old and a 33-year-old woman. Magnetic resonance imaging of these patients showed an extradural cyst from T12 to L4 and an arachnoid cyst at the posterior epidural space of T12 to L2. For both patients, we surgically fenestrated the cyst and repaired the dural defect using a partial hemi-laminectomy. The patient's symptoms dramatically subsided, and follow-up radiological images show a complete disappearance of the cyst in both patients. Our results suggest that fenestration of the cyst can be a safe and effective approach in treating SEACs compared to a classical complete resection of the cyst wall with multilevel laminectomy.
PubMed: 27857934
DOI: 10.13004/kjnt.2016.12.2.185 -
Child's Nervous System : ChNS :... Jan 2023Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe.... (Review)
Review
PURPOSE
Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition.
METHODS
A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations.
RESULTS
A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated.
CONCLUSIONS
The "spontaneous" or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.
Topics: Child; Adolescent; Humans; Arachnoid Cysts; Rupture; Magnetic Resonance Imaging; Craniocerebral Trauma; Hematoma
PubMed: 36169701
DOI: 10.1007/s00381-022-05685-3 -
BMJ Case Reports Jan 2016
Topics: Adult; Arachnoid Cysts; Eyelashes; Female; Hair Removal; Humans; Keratitis; Lymphedema; Magnetic Resonance Imaging
PubMed: 26759405
DOI: 10.1136/bcr-2015-213651 -
Fetal Diagnosis and Therapy 2016To investigate the incidence of associated anomalies, aneuploidy, cyst progression, need for surgery and neurodevelopmental outcome in fetuses with extra-axial... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate the incidence of associated anomalies, aneuploidy, cyst progression, need for surgery and neurodevelopmental outcome in fetuses with extra-axial supratentorial intracranial cysts.
DATA SOURCES
Medline, Embase and CINAHL databases were searched and the following outcomes analyzed: associated central nervous system (CNS) and extra-CNS anomalies detected at the scan, chromosomal anomalies, additional CNS anomalies detected only at prenatal MRI, additional CNS anomalies detected only after birth, cyst progression in utero, neurological outcome and need for surgery. Two authors reviewed all abstracts independently. Results were reported as proportions, and between-study heterogeneity was explored using the I² statistic; fixed or random effect models were used accordingly.
RESULTS
Ten studies involving 47 fetuses were included in the meta-analysis. Arachnoid cysts (n = 24) had associated CNS anomalies and extra-CNS in 73% (95% CI 56-88) and 14% (95% CI 4-29), respectively. The most common associated anomalies were ventriculomegaly and callosal abnormalities. Chromosomal abnormalities were present in 6% (95% CI 0-30), but fetuses with isolated cysts were always euploid (0/7; 95% CI 0-29). Fetal MRI and postnatal examination identified 5 additional cases (21%, 95% CI 1-57). Cavum veli interpositi (CVI) cysts had associated CNS and extra-CNS anomalies in 31% (95% CI 13-52) and 6% (95% CI 0-29), respectively. No chromosomal or callosal anomalies were found in these cases. In isolated CVI cysts, no cases of associated anomalies were detected postnatally. Intrauterine regression occurred in 23% of CVI cysts and in none of the arachnoid cysts. In children with arachnoid cyst, the occurrence of hydrocephaly and mass effect on the adjacent structures were observed in 23.9% (95% CI 8.3-4.4) and 26.8% (95% CI 4.0-60.1), respectively. None of the cases included had abnormal motor outcome or intelligence. The rate of surgery was 34.7% (95% CI 16.0-56.4). None of the children with a prenatal diagnosis of isolated CVI cyst experienced any of the adverse outcomes explored in this review.
CONCLUSIONS
Extra-axial supratentorial cysts diagnosed in utero are frequently associated with other neural and extra-neural anomalies. However, this may represent the consequence of a selection bias. Interhemispheric arachnoid cysts were typically associated with callosal anomalies. Abnormal karyotypes were seen only in fetuses with multiple anomalies. Arachnoid, but not CVI, cysts frequently increased in size throughout gestation.
Topics: Arachnoid Cysts; Central Nervous System Cysts; Humans; Hydrocephalus; Incidence; Kaplan-Meier Estimate; Neurodevelopmental Disorders; Prognosis; Treatment Outcome; Ultrasonography, Prenatal
PubMed: 27105003
DOI: 10.1159/000445718 -
Nature Medicine Mar 2023Using a systems-level, multi-omics approach, we reveal several genes associated with arachnoid cysts and identify four phenotypic subtypes of arachnoid cysts, the...
Using a systems-level, multi-omics approach, we reveal several genes associated with arachnoid cysts and identify four phenotypic subtypes of arachnoid cysts, the severity of which correlates with the presence of protein-damaging de novo variants. All candidate genes are expressed in the developing brain and encode molecules implicated in chromatin modification or transcriptional regulation.
Topics: Humans; Epigenomics; Arachnoid Cysts; Magnetic Resonance Imaging
PubMed: 36932244
DOI: 10.1038/s41591-023-02239-1 -
Revista de Neurologia Oct 2017
Topics: Adult; Arachnoid Cysts; Humans; Male; Meningoencephalitis; Syringomyelia; Tuberculoma, Intracranial; Tuberculosis, Central Nervous System
PubMed: 28990650
DOI: No ID Found -
International Journal of Surgery Case... May 2022Arachnoid cyst in the middle fossa can cause many symptoms include headache and seizure. When drugs therapy can not relieve or control the symptoms, it is necessary to...
INTRODUCTION
Arachnoid cyst in the middle fossa can cause many symptoms include headache and seizure. When drugs therapy can not relieve or control the symptoms, it is necessary to determine whether the surgical procedure can improve patient's outcome.
CASE PRESENTATION
First case, 28 years old female suffered from severe headache and sometimes unconsciousness for a few minutes. Magnetic resonance images showed the lesion hypo-intense on T1-weight and hyper-intense on T2-weight images. Left M1 middle cerebral artery lay down inside the cyst. The second case, a man 18 years old had seizures every three months. He took phenytoin 600 mg a day but in the last one month seizures repeated up to five times. The brain MRI results showed a hypointense lesion of T1-weight and hyperintense at T2-weight in the right temporal region measuring approximately 5 × 4 cm and compressing the temporal bone to form a convex shape. The third case, a man 23 years old had complaints of seizures since 6 months. The patient received the drug phenytoin 3x200mg and valproic acid 1 g daily but the seizures still exist. The brain MRI showed hyperintense lesion in the right temporal region. Microscopic fenestration craniotomy was performed in all cases and at one year of follow-up the headache disappeared. Seizure attacks have never occurred again with only low doses of phenytoin.
CONCLUSION
The result of microscopic fenestration craniotomy in patients with headaches and seizures due to middle fossa arachnoid cysts is good and can be considered for controlling seizures in selected cases.
PubMed: 35461185
DOI: 10.1016/j.ijscr.2022.107101 -
Journal of Neurosurgery. Case Lessons Apr 2023Arachnoid cysts are congenital or acquired structures found within the brain and are rarely symptomatic for adults. The literature documenting enlarging arachnoid cysts...
BACKGROUND
Arachnoid cysts are congenital or acquired structures found within the brain and are rarely symptomatic for adults. The literature documenting enlarging arachnoid cysts in adults is also discussed.
OBSERVATIONS
An elderly woman presented with acutely worsening headaches, photophobia, cognitive function, and a seizure-like episode. The patient had a known arachnoid cyst with a decade of radiographic stability, which was now idiopathically enlarging. The patient had a previous history of traumatic brain injuries but no reported trauma around the time of presentation. Due to the severity of midline shift and symptomatology, the decision was made to treat the patient surgically with fenestration and shunting. She recovered well postoperatively.
LESSONS
During the workup for a symptomatic elderly patient, enlargement of a previously asymptomatic arachnoid cyst should remain on the differential until specifically ruled out, even in the absence of recent trauma. While rare, enlarging arachnoid cysts result in neurological findings and impact the quality of life for patients.
PubMed: 37039295
DOI: 10.3171/CASE2379 -
Journal of Korean Neurosurgical Society May 2017To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched... (Review)
Review
To review recent advances in endoscopic techniques for treating intraventricular lesions via transcortical passage. Articles in PubMed published since 2000 were searched using the keywords 'endoscopy,' 'endoscopic,' and 'neuroendoscopic.' Of these articles, those describing intraventricular lesions were reviewed. Suprasellar arachnoid cysts (SACs) can be treated with ventriculo-cystostomy (VC) or ventriculo-cysto-cisternostomy (VCC). VCC showed better results compared to VC. Procedure type, fenestration size, stent placement, and aqueductal patency may affect SAC prognosis. Colloid cysts can be managed using a transforaminal approach (TA) or a transforaminal-transchoroidal approach (TTA). However, TTA may result in better exposure compared to TA. Intraventricular cysticercosis can be cured with an endoscopic procedure alone, but if pericystic inflammation and/or ependymal reaction are seen, third ventriculostomy may be recommended. Tumor biopsies have yielded successful diagnosis rates of up to 100%, but tumor location, total specimen size, endoscope type, and vigorous coagulation on the tumor surface may affect diagnostic accuracy. An ideal indication for tumor excision is a small tumor with friable consistency and little vascularity. Tumor size, composition, and vascularity may influence a complete resection. SACs and intraventricular cysticercosis can be treated successfully using endoscopic procedures. Endoscopic procedures may represent an alternative to surgical options for colloid cyst removal. Solid tumors can be safely biopsied using endoscopic techniques, but endoscopy for tumor resection still results in considerable challenges.
PubMed: 28490160
DOI: 10.3340/jkns.2017.0101.008 -
Surgical Neurology International 2022Idiopathic spinal epidural arachnoid cysts (SEACs) are rare and may cause myelopathy and cord compression. They typically arise from a congenital defect in the dura that... (Review)
Review
BACKGROUND
Idiopathic spinal epidural arachnoid cysts (SEACs) are rare and may cause myelopathy and cord compression. They typically arise from a congenital defect in the dura that communicates with the intrathecal subarachnoid space. Although the ideal treatment of SEACs is direct dural repair and cyst excision, there is as yet no clear standard of care for the management of these lesions.
METHODS
A 47-year-old female presented with myelopathy attributed to an magnetic resonance imaging-documented posterior epidural T12-L2 cyst (i.e., 1.1 × 6 × 3.3 cm) lesion. The patient underwent a direct dural repair of the fistulous communication between the subarachnoid space and the cyst, along with cyst drainage/ excision through a right-sided laminotomy. Postoperatively, the patient was asymptomatic. We additionally reviewed the literature regarding the management of SEACs.
RESULTS
Our review yielded 14 articles involving 18 patients with predominantly thoracolumbar (57%) SEACs that were either communicating (61%) or not communicating (39%) with the subarachnoid space. They averaged 35.5 years of age and exhibited a male preponderance (66%). Symptoms typically included pain (78%), followed by weakness/myelopathy (42%). Surgery frequently included bilateral laminectomies (57%) followed by unilateral laminectomies (50%) that typically resulted in symptom resolution.
CONCLUSION
SEACs are rare typically thoracolumbar lesions that may cause myelopathy which resolves following direct dural closure/subarachnoid fistulous occlusion.
PubMed: 36761263
DOI: 10.25259/SNI_928_2022