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Asian Journal of Neurosurgery Mar 2023Fourth ventricular and juxta fourth ventricular arachnoid cysts (ACs) are rare clinical entities. Conventionally, ACs are managed with either micro-surgical excision...
Fourth ventricular and juxta fourth ventricular arachnoid cysts (ACs) are rare clinical entities. Conventionally, ACs are managed with either micro-surgical excision or cerebrospinal fluid (CSF) diversionary procedures such as a shunt. Effective treatment modality still remains controversial. Advances in neuroendoscopy have helped in the effective management of this benign condition in a minimally invasive method. Description of a subset of patients with fourth ventricular and juxta fourth ventricular ACs and hydrocephalus who underwent transaqueductal cysto-ventriculostomy with a flexible neuroendoscope was the objective of this study. This study included the data of patients with fourth ventricular and juxta fourth ventricular ACs and hydrocephalus operated between 2008 and 2019. Of 350 intraventricular neuroendoscopic procedures done during the last 11 years, 8 had obstructive hydrocephalus due to fourth ventricular and juxta ventricular arachnoid cyst. Endoscopic transaqueductal cystoventriculostomy and transaqueductal shunt placement was done in all using a flexible neuro-endoscope. Patients were aged 20 days to 15 months; in the neonate, the diagnosis was established during routine antenatal screening. Surgical procedure was done using a flexible neuro-endoscope. All improved symptomatically, radiologically and are on regular follow-up to date. One patient had postoperative meningitis, which gradually improved with antimicrobial therapy. None required alternative form of treatment such as shunt or craniotomy and microsurgical excision. Endoscopic transaqueductal cysto-ventriculostomy is a safe, effective and minimal invasive modality in the hands of an experienced neurosurgeon for the management of fourth ventricular and juxta ventricular arachnoid cysts.
PubMed: 37056875
DOI: 10.1055/s-0043-1760858 -
Surgical Neurology International 2022Spinal intradural extramedullary arachnoid cysts represent about 1-3% of all primary spinal space-occupying lesions often causing spinal cord and/or radicular nerve...
BACKGROUND
Spinal intradural extramedullary arachnoid cysts represent about 1-3% of all primary spinal space-occupying lesions often causing spinal cord and/or radicular nerve compression. Spontaneous intralesional hemorrhages are extremely rare and are typically found within intracranial arachnoid cysts. Here, a 55-year-old female presented with a spontaneous hemorrhage into a cervical spine arachnoid cyst warranting surgical intervention (i.e., fenestration/excision/occlusion).
CASE DESCRIPTION
A 55-year-old female presented with 3 weeks of dull pain in the cervicothoracic region. She subsequently developed paresthesias and progressive lower extremity weakness with (urinary incontinence. The cervical magnetic resonance revealed a right anterolateral intradural extramedullary "cystic" lesion extending from C7 to T2; it contained a heterogeneous signalon T2W sequences, and a fluid-fluid level was documented on the T2-GRE and FLAIR sequences. At surgery, consisting of a laminectomy, two hemorrhagic cystic lesions were identified and removed. Histological findings were consistent with hemorrhagic into an arachnoid cyst.
CONCLUSION
Only rarely hemorrhages develop in intraspinal intradural extramedullary spinal arachnoid cysts.
PubMed: 36324927
DOI: 10.25259/SNI_343_2022 -
Journal of Craniovertebral Junction &... 2019Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the...
INTRODUCTION AND STUDY DESIGN
Spinal arachnoid cyst is an uncommon entity, presenting with radiculopathy or paraparesis. These cysts are usually found in intradural extramedullary region; and the extradural region is a rare location. The exact pathogenesis in the existence of these cysts in the extradural region is still debated. In this article, we have retrospectively analyzed the clinical profile of the rare extradural arachnoid cyst (EDAC).
METHODOLOGY
In this study, 19 patients of EDAC operated at our institute between January 2006 to June 2016 are analyzed. All patients with the Oswestry disability index score of >20 were managed surgically (open laminectomy and cyst excision). The clinical outcome was assessed at using 5-point satisfaction scale and McCormick grading.
RESULTS
All 13 operated patients had EDACs with communication with the intradural compartment. In 11 (84.6%) patients, cyst wall was excised completely, in 2 (15.3%) patients underwent partial excision of cyst wall; dural communication was closed in all patients ( = 13). None of the patients had clinical deterioration or radiological recurrence till the last follow-up. Mean follow-up was 52.2 months (range 1-160); all patients were satisfied after surgery (median score was 3).
DISCUSSION
Symptomatic EDACs account <2% of all spinal tumors. The EDACs have communication with the intradural compartment. In our article, we have discussed the approach and management of EDAC, including minimally invasive percutaneous procedures.
CONCLUSION
One should aim for preoperative or intraoperative localization of dural communication and try to disconnect the extradural cyst from the intradural connection to prevent recurrence. Surgical treatment is complete excision of the cyst.
PubMed: 31000984
DOI: 10.4103/jcvjs.JCVJS_12_19 -
The Permanente Journal 2015A 14-year-old boy presented with 3 months of generalized headache that had increased in intensity and frequency with associated light-headedness. Primary arachnoid cysts...
A 14-year-old boy presented with 3 months of generalized headache that had increased in intensity and frequency with associated light-headedness. Primary arachnoid cysts result from developmental abnormalities; more rare secondary cysts develop as a result of head injury, meningitis, tumors, or as a complication of brain surgery.
Topics: Adolescent; Arachnoid Cysts; Humans; Male; Tomography, X-Ray Computed
PubMed: 25902350
DOI: 10.7812/TPP/14-191 -
Neurosurgical Review Jun 2023Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study...
Spinal arachnoid web (SAW) is a rare disease entity characterized as band-like arachnoid tissue that can cause spinal cord compression and syringomyelia. This study aimed to analyze the surgical management of the spinal arachnoid web in patients with syringomyelia, focusing on surgical strategies and outcomes. A total of 135 patients with syringomyelia underwent surgery at our department between November 2003 and December 2022. All patients underwent magnetic resonance imaging (MRI), with a special syringomyelia protocol (including TrueFISP and CINE), and electrophysiology. Among these patients, we searched for patients with SAW with syringomyelia following careful analysis of neuroradiological data and surgical reports. The criteria for SAW were as follows: displacement of the spinal cord, disturbed but preserved CSF flow, and intraoperative arachnoid web. Patients were evaluated for initial symptoms, surgical strategies, and complications by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. Of the 135 patients, 3 (2.22%) fulfilled the SAW criteria. The mean patient age was 51.67 ± 8.33 years. Two patients were male, and one was female. The affected levels were T2/3, T6, and T8. Excision of the arachnoid web was performed in all cases. No significant change in intraoperative monitoring was noted. Postoperatively, none of the patients presented new neurological symptoms. The MRI 3 months after surgery revealed that the syringomyelia improved in all cases, and caliber variation of the spinal cord could not be detected anymore. All clinical symptoms improved. In summary, SAW can be safely treated by surgery. Even though syringomyelia usually improves on MRI and symptoms also improve, residual symptoms might be observed. We advocate for clear criteria for the diagnosis of SAW and a standardized diagnostic (MRI including TrueFISP and CINE).
Topics: Humans; Male; Female; Adult; Middle Aged; Syringomyelia; Spinal Cord Compression; Magnetic Resonance Imaging; Arachnoid Cysts
PubMed: 37358703
DOI: 10.1007/s10143-023-02071-8 -
Clinical Case Reports Sep 2020Arachnoid cysts vary in their size and location. Large cysts may cause symptoms requiring surgery. It is important to assess whether patients with arachnoid cysts and...
Arachnoid cysts vary in their size and location. Large cysts may cause symptoms requiring surgery. It is important to assess whether patients with arachnoid cysts and neurologic symptoms can benefit from such surgical interventions.
PubMed: 32983518
DOI: 10.1002/ccr3.3004 -
BMJ Case Reports Feb 2019Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the...
Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.
Topics: Adult; Arachnoid Cysts; Back Pain; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraparesis; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Subarachnoid Hemorrhage; Treatment Outcome
PubMed: 30819681
DOI: 10.1136/bcr-2018-227666 -
Revista de Neurologia Jun 2016Bilateral cerebellopontine arachnoid cysts are very rare, and only three cases have been previously reported.
INTRODUCTION
Bilateral cerebellopontine arachnoid cysts are very rare, and only three cases have been previously reported.
CASE REPORT
A 14-year-old previously healthy girl presented to our outpatient clinic with a 6-weeks history of frontal headache. They typically would start in the occipital region and then radiate bifrontally. The neurological examination was unremarkable. Magnetic resonance imaging revealed an extra-axial bilateral lesion in bilateral cerebellopontine angle, larger on left side. The lesions were homogeneously hypointenese on T1-weighted imaging and hyperintense on T2-weighted imaging without evidence of contrast enhancement and without evidence of restriction on diffusion-weighted imaging. No surgical treatment was indicated.
CONCLUSIONS
Bilateral arachnoid cysts of the cerebellopontine angle are very infrequent and the main indication for surgery is the existence of clinical symptoms or neurological deficit coincident with the locations of the cysts.
Topics: Adolescent; Arachnoid Cysts; Cerebellopontine Angle; Female; Headache; Humans; Magnetic Resonance Imaging; Neurologic Examination
PubMed: 27270677
DOI: No ID Found -
Indian Journal of Otolaryngology and... Aug 2022Profound hearing loss requiring cochlear implantation and arachnoid cyst requiring placement of Cysto-Peritoneal Shunt (CPS) are two commonly seen entities. However,...
Profound hearing loss requiring cochlear implantation and arachnoid cyst requiring placement of Cysto-Peritoneal Shunt (CPS) are two commonly seen entities. However, there are very few published cases of patients requiring both of them. The present report describes the importance of multidisciplinary surgical planning in one such patient.
PubMed: 36032920
DOI: 10.1007/s12070-020-02145-9 -
Neurology India 2021Intraventricular tumors pose a surgical challenge because of the difficulty in reaching their deep location through safe corridors and their adherence or proximity to... (Review)
Review
BACKGROUND
Intraventricular tumors pose a surgical challenge because of the difficulty in reaching their deep location through safe corridors and their adherence or proximity to vital neurovascular structures. Although microneurosurgery is the mainstay of surgical management, neuroendoscopy aided by adjuncts, namely, navigation and ultrasonic aspirators, has made a great contribution to improving surgical results.
OBJECTIVE
This article reviews the experience of a neurosurgical unit with endoscopic procedures for intraventricular tumors. The current indications, benefits, and complications of neuroendoscopy are described.
MATERIALS AND METHODS
This is a retrospective, observational study of lateral and third ventricular tumors tackled either purely with an endoscope or with its assistance over 19 years in a single unit at Bombay Hospital Institute of Medical Sciences, Mumbai.
RESULTS
Of a total of 247 operated patients with intraventricular tumors, 85 cases operated using an endoscope were included. The majority of the patients had a tumor in the third ventricle (n = 62), whereas 23 patients had tumor in the lateral ventricle. The most common pathologies were colloid cyst and arachnoid cyst (n = 18). An endoscope was used for microsurgical assisted excision of tumors in 31 cases, biopsy in 24, cyst fenestration in 23, and pure endoscopic excision in seven cases.
CONCLUSION
Microsurgery remains the gold standard for the removal of giant, vascular intraventricular tumors. However, endoscopic fenestration or excision of cysts and biopsy have become better alternatives in many cases. Endoscope-assisted microsurgery affords safety and helps in achieving a more complete excision.
Topics: Cerebral Ventricle Neoplasms; Colloid Cysts; Humans; Microsurgery; Neuroendoscopy; Observational Studies as Topic; Third Ventricle
PubMed: 34979645
DOI: 10.4103/0028-3886.333458