-
Journal of Neurosurgery. Case Lessons Aug 2023Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or...
BACKGROUND
Intradural spinal arachnoid cysts (SACs) are a rare cause of spinal cord compression. Treatment is centered on decompression of the spinal cord via laminectomy or laminoplasty followed by resection or fenestration of the cyst. Although laminectomy or laminoplasty access may be needed to achieve the desired result, either procedure can be associated with more extensive surgical dissections and long-term spinal stability concerns, including postsurgical kyphosis.
OBSERVATIONS
The authors present a case of a cervical intradural SAC in a 4-month-old girl presenting with symptomatic compression. The patient was treated by laminotomy and endoscopic fenestration of the SAC with resolution of symptoms and no disease progression 10 months postoperatively, when the patient was 14 months old.
LESSONS
Microsurgical endoscopic fenestration of an intradural SAC can provide a less invasive means of treatment while avoiding the risks associated with more invasive approaches.
PubMed: 37581591
DOI: 10.3171/CASE23217 -
Neurosurgical Focus: Video Apr 2023This case demonstrates an endoscopic fenestration of an enlarging giant occipital arachnoid cyst. The patient is a 42-year-old woman presenting with headache,...
This case demonstrates an endoscopic fenestration of an enlarging giant occipital arachnoid cyst. The patient is a 42-year-old woman presenting with headache, progressive vision loss, and nausea and vomiting. MRI demonstrates a large, nonenhancing cystic lesion in the right occipital lobe measuring up to 8.3 cm, consistent with an arachnoid cyst. This surgical video illustrates the technique for an endoscopic fenestration into the native ventricular system utilizing stereotactic MRI-guided stealth navigation. Postoperatively, the patient had full recovery with improvement of headaches and vision and was discharged on postoperative day 1 without complications. The video can be found here: https://stream.cadmore.media/r10.3171/2023.1.FOCVID22129.
PubMed: 37089746
DOI: 10.3171/2023.1.FOCVID22129 -
Revista Brasileira de Ortopedia Feb 2021Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article,...
Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article, we report a patient presenting a compressive thoracic myelopathy due to an unusual intradural arachnoid cyst with posttraumatic manifestation and its resolution, in addition to a literature review on the subject. These cysts mainly occur at the thoracic spine, followed by the lumbar, lumbosacral and thoracolumbar spines. Traumatic cysts are caused by an injury to the inner dural layer. These lesions produce neurological deficits through a mass effect on the spinal cord. Concomitant compressive myelopathy is even rarer. In case of myelopathy, cyst resection or drainage is the treatment of choice, and it must be performed immediately. Although rare, arachnoid cysts can be a complication of spine fractures; as such, orthopedists and neurosurgeons, who commonly see these injuries, must be prepared for this unusual situation.
PubMed: 33627910
DOI: 10.1055/s-0040-1714225 -
Surgical Neurology International 2022Radiological diagnoses of posterior fossa cystic abnormalities during antenatal and postnatal periods pose significant challenges as they may have similar early imaging... (Review)
Review
BACKGROUND
Radiological diagnoses of posterior fossa cystic abnormalities during antenatal and postnatal periods pose significant challenges as they may have similar early imaging features. Some of the frequently described entities are arachnoid cysts and Dandy-Walker malformations. Blake's pouch cyst is relatively underdiagnosed. The main aim of the study was to explore these diagnostic challenges in the context of various descriptive terminologies and their prognostic implications.
METHODS
We illustrate this through our case, where fetal magnetic resonance imaging (MRI) at 36 weeks gestation showed small right cerebellum without hydrocephalus or hemorrhage. Possible differential diagnoses included Dandy-Walker malformation or posterior fossa malformations, facial hemangiomas, arterial anomalies, cardiac and eye anomalies, sternal clefting, and supraumbilical raphe.
RESULTS
Postnatal sonography noted posterior fossa cyst without hydrocephalus in a normal term infant, who went on to develop symptomatic hydrocephalus by 15 weeks. Computed tomography brain scan confirmed large subtentorial posterior fossa cyst and extensive internal hydrocephalus. Despite emergent ventriculoperitoneal shunt insertion, head circumference continued to rise. MRI scan showed persistent cyst. Subsequently, infant underwent endoscopic fenestration of the cyst with balloon septostomy and now has an age appropriate developmental profile.
CONCLUSION
There is considerable discordance between antenatal and postnatal neuroimaging findings as highlighted in our case. Diagnostic conundrum here was whether this was an arachnoid or Blake's pouch cyst. Differentiating between posterior fossa fluid collections is crucial for management, prognosis, and parental counseling. Close postnatal follow-up is essential to avert complications due to acute hydrocephalus.
PubMed: 36324928
DOI: 10.25259/SNI_602_2022 -
Acta Neurochirurgica Jan 2024The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for...
OBJECTIVE
The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults.
METHODS
In our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6-18 years; AG3, ≥ 18 years).
RESULTS
Sixty-two patients (median age 26.5 years, range 0-82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1-87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis.
CONCLUSIONS
In patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.
Topics: Child; Infant; Male; Adult; Humans; Child, Preschool; Infant, Newborn; Adolescent; Young Adult; Middle Aged; Aged; Aged, 80 and over; Arachnoid Cysts; Retrospective Studies; Endoscopy; Ventriculostomy; Microsurgery; Treatment Outcome
PubMed: 38280116
DOI: 10.1007/s00701-024-05950-1 -
Radiology Case Reports Oct 2022The "Scalpel sign" is a radiological sign which can be identified on magnetic resonance imaging and indicates dorsal compression of the spinal cord [1]. Prior...
The "Scalpel sign" is a radiological sign which can be identified on magnetic resonance imaging and indicates dorsal compression of the spinal cord [1]. Prior descriptions of a "Scalpel sign" have been reported in the literature and the awareness and identification of this pathognomonic sign may aid in the rapid diagnosis and treatment of patients with dorsal arachnoid web, dorsal arachnoid cyst or ventral cord herniation. We describe 3 cases which highlight these rare conditions for which this sign is pathognomonic and summarize the pertinent literature related to these disorders [1,2].
PubMed: 35923346
DOI: 10.1016/j.radcr.2022.06.100 -
BMC Psychiatry Sep 2019Intracranial arachnoid cysts are usually benign congenital findings of neuroimaging modalities, sometimes however, leading to focal neurological and psychiatric... (Review)
Review
BACKGROUND
Intracranial arachnoid cysts are usually benign congenital findings of neuroimaging modalities, sometimes however, leading to focal neurological and psychiatric comorbidities. Whether primarily clinically silent cysts may become causally involved in cognitive decline in old age is neither well examined nor understood.
CASE PRESENTATION
A 66-year old caucasian man presenting with a giant left-hemispheric frontotemporal cyst without progression of size, presented with slowly progressive cognitive decline. Neuropsychological assessment revealed an amnestic mild cognitive impairment (MCI) without further neurological or psychiatric symptoms. The patient showed mild medio-temporal lobe atrophy on structural MRI. Diffusion tensor and functional magnetic resonance imaging depicted a rather sustained function of the strongly suppressed left hemisphere. Amyloid-PET imaging was positive for increased amyloid burden and he was homozygous for the APOEε3-gene. A diagnosis of MCI due to Alzheimer's disease was given and a co-morbidity with a silent arachnoid cyst was assumed. To investigate, if a potentially reduced CSF flow due to the giant arachnoid cyst contributed to the early manifestation of AD, we reviewed 15 case series of subjects with frontotemporal arachnoid cysts and cognitive decline. However, no increased manifestation of neurodegenerative disorders was reported.
CONCLUSIONS
With this case report, we illustrate the necessity of a systematic work-up for neurodegenerative disorders in patients with arachnoid cysts and emerging cognitive decline. We finally propose a modus operandi for the stratification and management of patients with arachnoid cysts potentially susceptive for cognitive dysfunction.
Topics: Aged; Alzheimer Disease; Arachnoid Cysts; Cognitive Dysfunction; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Positron-Emission Tomography; Temporal Lobe
PubMed: 31488095
DOI: 10.1186/s12888-019-2247-8 -
Cureus May 2022Retrocerebellar arachnoid cysts are uncommon intracranial tumors, especially rare in adults. Although asymptomatic in the majority of cases, they may cause a variety of...
Retrocerebellar arachnoid cysts are uncommon intracranial tumors, especially rare in adults. Although asymptomatic in the majority of cases, they may cause a variety of symptoms including convulsions. The causal involvement of these cysts in postictal psychosis, however, remains a topic that is not well-explained in the literature. An 85-year-old Asian man presented with recurrent episodes of convulsions for the last seven months along with preceding headaches and postictal psychotic symptoms. MRI of the head revealed a retrocerebellar arachnoid cyst. He was commenced on symptomatic pharmacological therapy after he refused surgical intervention and remained symptom-free till his discharge from the hospital before being eventually lost to follow-up. This case report focuses on the rare occurrence of a retrocerebellar arachnoid cyst with seizures and postictal psychosis and illustrates the necessity of further case studies and research to identify and explore the potential causal relationship between arachnoid cysts and psychosis.
PubMed: 35698697
DOI: 10.7759/cureus.24935 -
Turk Psikiyatri Dergisi = Turkish... 2020Arachnoid cysts are benign congenital malformations of the arachnoid which account for approximately 1.4% of the intracranial lesions. Although it is usually...
Arachnoid cysts are benign congenital malformations of the arachnoid which account for approximately 1.4% of the intracranial lesions. Although it is usually asymptomatic, it may be accompanied by headache, hydrocephalus and seizure. Psychiatric disorders associated with arachnoid cysts are rare. In this article, we present a giant arachnoid cyst with hypomania symptoms and marked cognitive impairment. A 44-year-old female patient was admitted to our outpatient clinic with a 4-year history of headache, nervousness and attention problems. Magnetic resonance imaging revealed a giant arachnoid cyst with a size of 5.5x10.5x12.5 cm was found in the left hemisphere of the patient. Considering the patient's irritability, increase in the amount of speech, flight of ideas, sleep disturbance and attention disorders, the diagnosis of hypomania was made. The neuropsychological tests showed that the speed of information processing, mental flexibility and attention functions decreased, and executive functions were impaired. The patient was consulted to the neurosurgery department. But no surgical treatment was offered. Drug therapy for hypomanic symptoms and cognitive impairment was planned, but could not be started since the patient did not attend to the follow-up exams. Albeit the lack of followup constitutes a limitation for our report, we believe that the size of the cyst, significant impairment of cognitive functions and the presence of hypomania symptoms might contribute significantly to the literature. Other cases with arachnoid cyst displaying cognitive impairment were summarized in our article.
Topics: Adult; Arachnoid Cysts; Brain Neoplasms; Cognitive Dysfunction; Diagnosis, Differential; Female; Headache; Humans; Magnetic Resonance Imaging; Mania; Neuropsychological Tests; Neurosurgical Procedures
PubMed: 32594501
DOI: 10.5080/u23937 -
Insights Into Imaging Jan 2019CSF flow disorders are frequently encountered in children. The advent of MR technology with the emergence of new pulse sequences allowed better understanding of CSF flow... (Review)
Review
CSF flow disorders are frequently encountered in children. The advent of MR technology with the emergence of new pulse sequences allowed better understanding of CSF flow dynamics. In this pictorial review, we aim to conduct a comprehensive review of the MR protocol used to study CSF flow disorders and to discuss the utility of each pulse sequence in the adopted protocol. We will focus on the key anatomical structures that should be examined to differentiate hydrocephalus form ventricular dilatation ex-vacuo. The MR features of obstructive and communicating hydrocephalus will be discussed, in addition to the manifestations of CSF disorders associated with posterior fossa malformations (Dandy-Walker malformation, Chiari, and Blake's pouch cyst). Moreover, the value of MRI in the assessment of patients following interventional procedures (ventriculoperitoneal shunt and third ventriculostomy) will be addressed.
PubMed: 30689061
DOI: 10.1186/s13244-019-0686-x