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Neurosurgery Jan 2011An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been... (Review)
Review
BACKGROUND AND IMPORTANCE
An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion.
CLINICAL PRESENTATION
A slowly progressive hearing loss developed in a 35-year-old woman over 2 years; she reported experiencing tinnitus for 7 years. Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst.
INTERVENTION
The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The histological examination confirmed the diagnosis of an arachnoid cyst.
CONCLUSION
The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits.
Topics: Adult; Arachnoid Cysts; Ear, Inner; Endoscopy; Female; Hearing Loss; Humans; Magnetic Resonance Imaging; Otologic Surgical Procedures; Tinnitus
PubMed: 21099704
DOI: 10.1227/NEU.0b013e3181ff1fb7 -
World Neurosurgery Mar 2022Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended.... (Review)
Review
Arachnoid cysts are one of the benign spinal cystic lesions. Multiple nerve roots and spinal cord may be compressed by it, and operating is often recommended. Traditional surgical procedures often choose the posterior median approach, separating the paravertebral muscles, milling the lamina, fully exposing the cyst, partially or completely removing the cyst wall, looking for the leak, and then suturing and sealing. Here we present a case of giant spinal extradural arachnoid cyst in which a ultrafine flexible endoscope was used to visualize cystic spaces and identity the leaks. We repaired the leak after removing part of the cyst wall under the operating microscope, and the patient had an excellent recovery.
Topics: Arachnoid Cysts; Endoscopes; Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Spine
PubMed: 34973437
DOI: 10.1016/j.wneu.2021.12.090 -
Spinal Cord Series and Cases Mar 2022Intradural cysts of the spine are arachnoid cysts, neuroenteric cysts, and ependymal cysts. The usual finding in case of a neurenteric cyst is a ventrally located...
BACKGROUND
Intradural cysts of the spine are arachnoid cysts, neuroenteric cysts, and ependymal cysts. The usual finding in case of a neurenteric cyst is a ventrally located non-contrast-enhancing lesion that is isointense on T1-weighted sequence and hyperintense on T2-weighted imaging. An arachnoid cyst is hypointense in T1-weighted image and hyperintense in T2-weighted image, mimicking cerebrospinal fluid(CSF), and the location is dorsal to the cord. But a neurenteric cyst can mimic an arachnoid cyst in appearance.
CASE
A 48-yr old autorikshaw driver presented with weakness of fingers and lower limbs. All sensations were decreased below xiphisternum(T6). The gait was spastic. Magnetic Resonance Imaging(MRI) showed an extramedullary intradural cyst at C7-T1 level. It was hypointense on T1-weighted image and hyperintense on T2-weighted image. There was no enhancement with contrast. C7/T1 Laminectomy was done. On gentle retraction of the cord, a whitish cyst was seen. Some clear fluid was aspirated and cyst was excised en toto. Myelopathy improved over two weeks. Histopathological examination showed a cyst wall composed of fibrocollagenous tissue, and lined by pseudostratified epithelium containing many goblet cells and having focal ciliation. The findings were consistent with neurenteric cyst. Follow-up MRI after five years showed no recurrence.
CONCLUSION
To our knowledge, the peculiarities of the case are that the radiological features mimicked arachnoid cyst in having the intensity of CSF. But the ventral location was suggestive of a neurenteric cyst. Total excision could be done through the posterior approach after decompressing the cyst by aspiration.
Topics: Arachnoid Cysts; Cervical Vertebrae; Humans; Laminectomy; Neural Tube Defects; Spinal Cord Diseases
PubMed: 35288542
DOI: 10.1038/s41394-022-00500-2 -
World Neurosurgery Jan 2016Spinal arachnoid cysts are a rare cause of spinal cord compression. Intradural arachnoid cysts are rarer than extradural arachnoid cysts. Spinal arachnoid cysts are... (Review)
Review
BACKGROUND
Spinal arachnoid cysts are a rare cause of spinal cord compression. Intradural arachnoid cysts are rarer than extradural arachnoid cysts. Spinal arachnoid cysts are mostly congenital in origin. Arachnoid cysts due to trauma, lumbar puncture, or surgery are rarely reported. Most arachnoid cysts are located posterior to the spinal cord in the thoracic regions. The ideal treatment is laminectomy or laminoplasty with puncture, marsupialization, or excision. But the development of a cervico-thoracic spinal intradural extramedullary arachnoid cyst anteriorly located 28 years after laminectomy is a recognizable complication of laminectomy.
CASE DESCRIPTION
We report here a case of a 45-year-old man who underwent C6-T1 laminectomy at the age of 17 years for cervical intervertebral disc prolapse (C6/7, C7/T1) and compressive myelopathy. Twenty-eight years after laminectomy, he developed spastic quadriparesis and was diagnosed with a spinal intradural extramedullary anterior arachnoid cyst at the laminectomy site with compressive myelopathy.
CONCLUSIONS
So, although laminectomy with excision is usually practiced to treat spinal arachnoid cysts, laminectomy itself is a cause of development of intradural arachnoid cysts.
Topics: Adolescent; Arachnoid Cysts; Cervical Vertebrae; Humans; Intervertebral Disc Displacement; Laminectomy; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Quadriplegia; Spinal Cord Compression; Spinal Cord Diseases; Thoracic Vertebrae; Time Factors; Tomography, X-Ray Computed
PubMed: 26428320
DOI: 10.1016/j.wneu.2015.09.058 -
World Neurosurgery Jan 2018Spinal arachnoid cysts (SACs) are filled with cerebrospinal fluid, and they include the arachnoid membrane, making it difficult to distinguish the walls of the cyst from...
BACKGROUND
Spinal arachnoid cysts (SACs) are filled with cerebrospinal fluid, and they include the arachnoid membrane, making it difficult to distinguish the walls of the cyst from the arachnoid membrane and excise the cyst as a lump. Here we report a technique for the intraoperative visualization of SACs, involving the use of pyoktanin blue.
METHODS
Four patients with spinal intradural arachnoid cysts underwent total excision of the cysts between October 2016 and April 2017. In 1 case, magnetic resonance imaging revealed the cyst clearly, but in the other cases, the cysts were unclear. All cysts were injected with 1% pyoktanin blue (Wako Pure Chemical Industries, Osaka, Japan) diluted 500 times with physiological saline before excision. When it was difficult to distinguish the cyst from the normal arachnoid membrane, 1% pyoktanin blue diluted 1000 times with physiological saline was injected into both the cyst and the subarachnoid space, and the spread of the stain was observed.
RESULTS
The cysts were better visualized after pyoktanin blue injection than before injection. When it was difficult to distinguish the cyst from the normal arachnoid space, pyoktanin blue injection was useful for judging the cyst space. There were no perioperative complications, and the patients' symptoms improved partially or completely after treatment.
CONCLUSIONS
Our technique of pyoktanin blue injection into SACs could make their excision easy and safe.
Topics: Adult; Aged; Arachnoid Cysts; Coloring Agents; Female; Humans; Intraoperative Care; Magnetic Resonance Imaging; Male; Neurosurgical Procedures; Spinal Cord Diseases
PubMed: 28919564
DOI: 10.1016/j.wneu.2017.09.031 -
Spine Aug 2002A case report with a review of the literature is presented demonstrating the imaging findings of a patient with recent onset, progressive spinal cord compression at T6... (Review)
Review
STUDY DESIGN
A case report with a review of the literature is presented demonstrating the imaging findings of a patient with recent onset, progressive spinal cord compression at T6 caused by a giant arachnoid cyst that was successfully treated.
OBJECTIVE
To present the imaging findings of a giant anterior cervicothoracic intradural arachnoid cyst using several methods before and after treatment.
SUMMARY OF BACKGROUND DATA
This case demonstrates the imaging findings of the largest described anterior cervical arachnoid cyst straddling the cervicothoracic junction. It presented with spinal cord compression in a 26-year-old diagnosed by MRI and successfully treated surgically.
METHODS
The patient experienced progressive left-sided sensory and motor deficits below T6. Pain and temperature sensation were decreased. Reflexes were increased in both lower extremities with clonus. Preoperative MRI was followed by laminectomy and cyst fenestration with subsequent postoperative myelogram and CT.
RESULTS
Imaging confirmed the presence of a giant arachnoid cyst straddling the cervicothoracic junction. Postoperative imaging documented relief of spinal cord compression. Symptoms improved progressively after surgery. By the time of discharge all residual neurologic deficits had resolved.
CONCLUSION
Anterior arachnoid cysts straddling the cervicothoracic junction have yet to be reported, and arachnoid cysts involving the cervical region are extremely rare. Imaging demonstrated the cyst and its response to treatment. This patient responded well to surgery and was discharged without neurologic sequelae.
Topics: Adult; Arachnoid Cysts; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Neck; Spinal Cord Compression; Spinal Cord Neoplasms; Thorax; Tomography, X-Ray Computed
PubMed: 12163738
DOI: 10.1097/00007632-200208010-00021 -
Nihon Ronen Igakkai Zasshi. Japanese... 2022The patient was an 83-year-old woman with a history of breast cancer, distal right radial edge bone fracture, and cervical spine symptoms who had been diagnosed with an...
The patient was an 83-year-old woman with a history of breast cancer, distal right radial edge bone fracture, and cervical spine symptoms who had been diagnosed with an arachnoid cyst 9 years previously. She was examined by a nearby doctor, because of an approximately 1-year history of reduced verbal output; she also begun experiencing difficulties with walking. However, she was diagnosed with aging, a history of cervical spondylosis, and the effects of past fractures.At the time of this consultation, she was conscious and lucid, with mild right-sided hemiparesis, was unable to write, and had mild motor aphasia. Head magnetic resonance imaging revealed an arachnoid cyst (longer axis: 10 cm) in the left frontal lobe that did not take up contrast media. There was also a midline shift. The cause of the right hemiparesis and motor aphasia was probably compression of the left frontal lobe by the arachnoid cyst.We performed excision of the cyst wall by craniotomy and placed a cyst-peritoneal shunt under general anesthesia. At approximately one week after surgery, the patient was able to write and her motor aphasia improved. She was discharged 20 days after the operation.It is rare for an arachnoid cyst to increase in size after childhood. In the present case, surgical treatment led to a good outcome in an elderly patient with a symptomatic arachnoid cyst. Arachnoid cysts rarely increase in size. These cysts may become symptomatic in elderly people after lying clinically dormant for a long time.
Topics: Aged; Aged, 80 and over; Aphasia, Broca; Arachnoid Cysts; Child; Female; Humans; Magnetic Resonance Imaging; Paresis
PubMed: 35650055
DOI: 10.3143/geriatrics.59.219 -
Neuro-Chirurgie Dec 2022Suprasellar Arachnoid Cysts (SAC) are rare heterogeneous entities. Though prenatally diagnosed, they are rarely treated pre-birth. Symptomatic cases are mainly seen in...
INTRODUCTION
Suprasellar Arachnoid Cysts (SAC) are rare heterogeneous entities. Though prenatally diagnosed, they are rarely treated pre-birth. Symptomatic cases are mainly seen in infants.
CASE DESCRIPTION
We describe a case of a prenatally symptomatic suprasellar arachnoid cyst treated postnatally. The cyst was diagnosed on a routine ultrasound at 22 weeks, was rapidly evolving in the ultrasounds and the MRI of the 29th week. It then became symptomatic at 30 weeks with episodes of fetal bradycardia, independent to the uterine contractions. Antenatal treatment was discussed but delivery decided in emergency despite the prematurity via C-section. Though well tolerated postnatally, the cyst continued to grow. Endoscopic ventriculo-cysto-cisternostomy was performed on the 5th day of birth. Despite progressive reduction of the cyst, residual brainstem compression and evolving ventriculomegaly lead to a transient extrathecal internal shunting.
DISCUSSION/CONCLUSION
Our case suggests that prenatally diagnosed cysts require a close follow-up. Treatment options and timing should be adapted to anatomy, cyst evolution and symptoms whether it is before or after birth.
Topics: Infant; Female; Humans; Pregnancy; Arachnoid Cysts; Hydrocephalus; Neurosurgical Procedures; Endoscopy; Magnetic Resonance Imaging
PubMed: 35907443
DOI: 10.1016/j.neuchi.2022.07.004 -
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 -
Current Opinion in Otolaryngology &... Oct 2007The present review summarizes the current theories on arachnoid cyst formation, the common presentations of cysts surrounding or eroding the temporal bone from the... (Review)
Review
PURPOSE OF REVIEW
The present review summarizes the current theories on arachnoid cyst formation, the common presentations of cysts surrounding or eroding the temporal bone from the middle and posterior cranial fossae, the diagnostic strategies and the management considerations and options.
RECENT FINDINGS
Arachnoid cysts are most common in the middle cranial fossa and rarely present in association with the petrous apex. They are frequently found incidentally on imaging studies performed in the workup for unrelated symptoms. When they do cause symptoms, these are usually nonspecific. Thus it is important to establish the relationship between the two. Peripetrosal arachnoid cysts may cause cranial nerve deficits in addition to symptoms related to intracranial hypertension. Small asymptomatic cysts are managed conservatively with serial imaging. Large symptomatic cysts are often managed surgically with shunting, open excision or open or neuroendoscopic fenestration or marsupialization. The management of large asymptomatic cysts depends on the patient and cyst characteristics.
SUMMARY
Peripetrosal arachnoid cysts are often incidental findings. Careful selection of surgical candidates is of utmost importance. Multiple surgical options with similar success rates are available. The rates and profile of their complications may differ. Overall, approximately 70% of patients experience improvement in their symptoms with surgery.
Topics: Arachnoid Cysts; Diagnostic Imaging; Humans; Neurosurgical Procedures; Otorhinolaryngologic Surgical Procedures
PubMed: 17823548
DOI: 10.1097/MOO.0b013e328270b8c5