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Spine Mar 1997This case report describes the unique occurrence of acquired intradural spinal arachnoid cyst after lumbar puncture, which was proven radiographically and surgically. (Review)
Review
STUDY DESIGN
This case report describes the unique occurrence of acquired intradural spinal arachnoid cyst after lumbar puncture, which was proven radiographically and surgically.
OBJECTIVES
To review and explore complications of lumbar puncture in the context of subsequent cyst development and to review the incidence, presentation, pathogenesis, and management of spinal intradural arachnoid cysts.
SUMMARY OF BACKGROUND DATA
The etiology of the spinal intradural arachnoid cyst remains obscure; some such cysts are ascribed anecdotally to previous trauma or arachnoiditis, whereas the majority are idiopathic and assumed by many authors to be congenital.
METHODS
A 20-Year-old woman with back and leg pain underwent lumbar myelography that yielded normal results with no evidence of arachnoid cyst at that time. Within 5 months, clinical symptoms of cauda equina compression and an S1 radiculopathy developed. Subsequent myelography and magnetic resonance imaging revealed a lumbar spinal arachnoid cyst. There was no history of intervening trauma or arachnoiditis. The lumbar puncture was thought to be the cause of the arachnoid cyst.
RESULTS
A laminectomy was performed with complete excision of the arachnoid cyst. The patient had an unremarkable postoperative course with excellent relief of her symptoms.
CONCLUSIONS
This case provides supporting evidence for the traumatic etiology of spinal intradural arachnoid cyst. The development of an intradural spinal arachnoid cyst should be included as a possible complication of lumbar puncture.
Topics: Adult; Arachnoid Cysts; Female; Humans; Magnetic Resonance Imaging; Myelography; Spinal Puncture
PubMed: 9076891
DOI: 10.1097/00007632-199703010-00023 -
Acta Neurochirurgica Dec 2017We describe a rare case and novel management strategy of painful trigeminal neuropathy caused by an arachnoid cyst confined to Meckel's cave. A 57-year-old female... (Review)
Review
We describe a rare case and novel management strategy of painful trigeminal neuropathy caused by an arachnoid cyst confined to Meckel's cave. A 57-year-old female presented with several years of progressive trigeminal pain and signs of trigeminal deafferentation, including sensory loss, corneal anesthesia and mastication muscle atrophy. Medical treatment with carbamazepine provided partial and temporary pain control. Surgical treatment was eventually performed by aspiration of the arachnoid cyst through the foramen ovale using a percutaneous approach. The patient experienced relief of pain and improvement of numbness and muscle strength. To our knowledge, this is the first case description of a percutaneous drainage of a Meckel's cave arachnoid cyst.
Topics: Arachnoid Cysts; Drainage; Female; Foramen Ovale; Humans; Middle Aged; Neurosurgical Procedures; Therapeutics; Trigeminal Neuralgia
PubMed: 28762108
DOI: 10.1007/s00701-017-3262-5 -
Korean Journal of Radiology 2013Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of...
Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.
Topics: Adult; Arachnoid Cysts; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Neurosurgical Procedures; Oculomotor Nerve; Oculomotor Nerve Diseases
PubMed: 24043981
DOI: 10.3348/kjr.2013.14.5.829 -
Surgical Neurology Jan 2003Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult. (Review)
Review
BACKGROUND
Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult.
CASE DESCRIPTION
We recently experienced a case of symptomatic interhemispheric arachnoid cyst in a 62-year-old woman. We reviewed interhemispheric arachnoid cysts in the elderly and the management of symptomatic interhemispheric arachnoid cysts in elderly patients. Symptomatic interhemispheric arachnoid cysts in the elderly are predominantly located on the right side, have a long history of progressive symptomology, occur predominantly in females, and have no communication with the subarachnoid space. Interhemispheric arachnoid cysts are usually not associated with agenesis of the corpus callosum in elderly patients, whereas interhemispheric nonarachnoid cysts are usually associated with agenesis of the corpus callosum, which will be clearly demonstrated on magnetic resonance imaging.
CONCLUSIONS
It is highly possible that an interhemispheric cyst without agenesis of the corpus callosum in an adult is an arachnoid cyst.
Topics: Arachnoid Cysts; Cerebral Ventriculography; Craniotomy; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Tomography, X-Ray Computed
PubMed: 12633971
DOI: 10.1016/s0090-3019(02)00876-5 -
Journal of Neurosurgery. Pediatrics Jul 2013Arachnoid cysts are common, accounting for approximately 1% of intracranial mass lesions. Most are congenital, clinically silent, and remain static in size....
Arachnoid cysts are common, accounting for approximately 1% of intracranial mass lesions. Most are congenital, clinically silent, and remain static in size. Occasionally, they increase in size and produce symptoms due to mass effect or obstruction. The mechanism of enlargement of arachnoid cysts is controversial. One-way slit valves are often hypothesized as the mechanism for enlargement. The authors present 4 cases of suprasellar prepontine arachnoid cysts in which a slit valve was identified. The patients presented with hydrocephalus due to enlargement of the cyst. The valve was located in the arachnoid wall of the cyst directly over the basilar artery. The authors believe this slit valve was responsible for the net influx of CSF into the cyst and for its enlargement. They also present 1 case of an arachnoid cyst in the middle cranial fossa that had a small circular opening but lacked a slit valve. This cyst did not enlarge but surgery was required because of rupture and the development of a subdural hygroma. One-way slit valves exist and are a possible mechanism of enlargement of suprasellar prepontine arachnoid cysts. The valve was located directly over the basilar artery in each of these cases. Caudad-to-cephalad CSF flow during the cardiac cycle increased the opening of the valve, whereas cephalad-to-caudad CSF flow during the remainder of the cardiac cycle pushed the slit opening against the basilar artery and decreased the size of the opening. Arachnoid cysts that communicate CSF via circular, nonslit valves are probably more likely to remain stable.
Topics: Arachnoid; Arachnoid Cysts; Child, Preschool; Drainage; Female; Headache; Humans; Hydrocephalus; Hypertrophy; Infant; Magnetic Resonance Imaging; Male; Microsurgery; Middle Aged; Neuroendoscopy; Neurosurgical Procedures; Subdural Effusion; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 23662935
DOI: 10.3171/2013.4.PEDS12609 -
Neurosurgery Sep 2007To evaluate the clinical, endocrinological, and radiological presentation of nine cases of surgically verified intrasellar arachnoid cysts and to discuss the... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the clinical, endocrinological, and radiological presentation of nine cases of surgically verified intrasellar arachnoid cysts and to discuss the physiopathological mechanisms of formation of these cysts.
METHODS
Among 1540 patients presenting with pituitary lesions, nine presented with an intrasellar arachnoid cyst. Their charts were retrospectively reviewed.
RESULTS
Presenting symptoms included headache (n = 2), visual symptoms (n = 3), menstrual irregularities (n = 2), rapid weight gain (n = 1), vertigo (n = 1), and/or confusion (n = 1). Two cysts were discovered incidentally. T1-weighted magnetic resonance imaging scans showed an intrasellar cystic lesion in all cases, with a huge suprasellar extension in six cases. The cyst was of the same intensity as the cerebrospinal fluid (CSF) in only two patients. A transsphenoidal approach allowed the transdural aspiration of fluid and injection of a water-soluble contrast agent under mild pressure. In three patients, the contrast infiltrated along the pituitary stalk toward the subarachnoid spaces; in the other patients, it remained in the intrasellar compartment. Cyst membranes were removed as completely as possible with fenestration toward the subarachnoid spaces in communicating cysts. In spite of tight packing of the sella and sphenoid sinus, CSF fistulae requiring reoperation developed in two patients.
CONCLUSION
The clinical picture of an intrasellar arachnoid cyst resembles that of a nonfunctional pituitary adenoma. Magnetic resonance imaging scans typically show a cystic intrasellar lesion with suprasellar extension, containing isointense or, more often, hyperintense fluid on T1-weighted sequences. In spite of the risk of CSF fistulae, the preferred surgical approach is transsphenoidal. A physiopathological mechanism is proposed according to anatomic variations of the sellar diaphragma allowing penetration of subarachnoid spaces into the sellar compartment and their enlargement by a ball-valve mechanism.
Topics: Adult; Aged; Aged, 80 and over; Arachnoid Cysts; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radiography; Sella Turcica
PubMed: 17881962
DOI: 10.1227/01.NEU.0000290896.69825.40 -
No Shinkei Geka. Neurological Surgery Apr 2019We report 3 cases of symptomatic intraparenchymal arachnoid cysts in adults, including 2 in elderly patients. Case 1:An 81-year-old woman developed right-sided...
We report 3 cases of symptomatic intraparenchymal arachnoid cysts in adults, including 2 in elderly patients. Case 1:An 81-year-old woman developed right-sided hemiparesis and hemianopsia due to the enlargement of left occipital arachnoid cyst, which had been incidentally diagnosed 3 years ago. Under the guidance of neuronavigation, we inserted a rigid endoscope into the cyst and perforated the cyst wall toward the posterior horn of the lateral ventricle, making a good communication between the cyst and the ventricle for cerebrospinal fluid. Her symptoms improved within 3 days after the surgery, and the cyst mass reduced. Case 2:A 57-year-old woman was incidentally found to have a right frontal arachnoid cyst. She had a 3-month long history of low mood and loss of interest in work. We perforated the transparent septum via the cyst wall toword the left lateral ventricle in a neuro-endoscopic procedure. After the surgery, she regained interest in work, and her symptom was considered to be indicative of depression due to arachnoid cyst. Case 3:A 94-year-old woman in a geriatric facility developed left-sided hemiparesis due to the enlargement of a right temporal arachnoid cyst, which had been detected 10 years ago. Neuro-endoscopic perforation of the cyst wall toward the lateral ventricle remarkably improved her symptoms. Arachnoid cysts can become symptomatic in the long term, not only in the young but also in the elderly. Neuro-endoscopic fenestration is an effective treatment for symptomatic intraparenchymal cysts, especially in elderly patients. The neuronavigation system was useful in the planning of the trajectory and in the detection of the target point of fenestration.
Topics: Aged; Aged, 80 and over; Arachnoid Cysts; Endoscopy; Female; Humans; Lateral Ventricles; Magnetic Resonance Imaging; Middle Aged; Paresis; Treatment Outcome
PubMed: 31061232
DOI: 10.11477/mf.1436203963 -
Journal of Clinical Neuroscience :... Apr 2011Extradural arachnoid cysts of the spine are a rare cause of spinal cord and nerve root compression, usually in the mid to lower thoracic spine and at the thoraco-lumbar... (Review)
Review
Extradural arachnoid cysts of the spine are a rare cause of spinal cord and nerve root compression, usually in the mid to lower thoracic spine and at the thoraco-lumbar junction in a posterior position. Local pain and myelopathy occur predominantly in young adults, and MRI reveals a well-demarcated extradural lesion, iso-intense to cerebrospinal fluid. We report a 33-year-old woman with an extradural arachnoid cyst from T11 to L1 and review the surgical techniques reported in the literature.
Topics: Adult; Arachnoid Cysts; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Spinal Cord Compression; Thoracic Vertebrae
PubMed: 21256754
DOI: 10.1016/j.jocn.2010.07.126 -
Child's Nervous System : ChNS :... Dec 2017Arachnoid cysts are benign developmental anomalies of arachnoid membrane origin that can occur anywhere along the neuro-axis. They are believed to develop from the...
INTRODUCTION
Arachnoid cysts are benign developmental anomalies of arachnoid membrane origin that can occur anywhere along the neuro-axis. They are believed to develop from the splitting or duplication of the arachnoid membrane by CSF that is trapped by a ball-valve mechanism. Intracranial arachnoid cysts have only been described as intradural lesions while spinal arachnoid cysts can be both intradural or extradural.
CASE REPORT
After an extensive literature review, we report the first case of an intracranial, extradural arachnoid cyst in a 5-yearold girl. The child presented with a 2-week history of suspected seizure-like activity and imaging revealed a large midline extradural CSF-containing arachnoid cyst causing severe compression of the superior sagittal sinus and underlying brain. Venous flow through the sagittal sinus was nearly obliterated. Osseous changes and bone growth adjacent to the cyst was also noted on imaging and intraoperatively. She underwent a bifrontal craniotomy and cyst excision with decompression of underlying brain and reestablishment of venous flow through the sagittal sinus.
Topics: Arachnoid Cysts; Child, Preschool; Decompressive Craniectomy; Epidural Space; Female; Humans; Skull
PubMed: 28744688
DOI: 10.1007/s00381-017-3556-1 -
World Neurosurgery Dec 2017Spinal arachnoid cysts are uncommon distinct pouches of cerebrospinal fluid (CSF) or CSF-like fluid found adjacent to normal CSF spaces commonly extradural and rarely...
Spinal arachnoid cysts are uncommon distinct pouches of cerebrospinal fluid (CSF) or CSF-like fluid found adjacent to normal CSF spaces commonly extradural and rarely intradural. They are usually asymptomatic and discovered incidentally. We present a patient with rapid upper motor neuron neurologic deterioration over the course of 1 week. Findings on magnetic resonance imaging revealed various central nervous system demyelination lesions and thoracic arachnoid cyst with cord compression. This acute presentation, in the absence of trauma, is not in favor of the natural history of the intradural thoracic arachnoid cysts. The patient's sensory, gait, and lower limb neurologic deficits improved after surgery with residual mild but stable upper limb deficits. Our patient likely had a static compensated cyst made symptomatic by demyelination as an additional central nervous system lesion.
Topics: Adult; Arachnoid Cysts; Demyelinating Diseases; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Oligoclonal Bands; Spinal Cord Compression; Thoracic Vertebrae
PubMed: 28823673
DOI: 10.1016/j.wneu.2017.08.036