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Aorta (Stamford, Conn.) Jun 2023A 70-year-old man was referred for redo root and ascending aortic surgery. Preoperative investigations depicted a large arachnoid cyst occupying the left frontotemporal...
A 70-year-old man was referred for redo root and ascending aortic surgery. Preoperative investigations depicted a large arachnoid cyst occupying the left frontotemporal region and myelodysplasia with persistent thrombocytopenia. We describe successful operative management of this patient in the context of such rare intracranial pathology.
PubMed: 37619570
DOI: 10.1055/s-0043-1770959 -
The Spine Journal : Official Journal of... Dec 2023Spinal arachnoid cysts (SACs) are rare, cerebrospinal fluid-filled sacs lined by an arachnoid membrane in the spinal canal. Symptoms can develop due to pressure on the...
BACKGROUND CONTEXT
Spinal arachnoid cysts (SACs) are rare, cerebrospinal fluid-filled sacs lined by an arachnoid membrane in the spinal canal. Symptoms can develop due to pressure on the spinal cord or adjacent spinal nerves by the cyst itself or by interrupted flow of cerebrospinal fluid. If noninvasive management fails or neurological deterioration occurs, surgical treatment is recommended. However, data is lacking on long-term outcomes after surgery.
PURPOSE
To determine long-term outcomes in patients surgically treated for SACs.
STUDY DESIGN
Population-based cohort-study.
PATIENT SAMPLE
All consecutive patients treated for either intra- or extradural SACs with surgery between 2005 and 2020 at the author's institution were included.
OUTCOME MEASURES
American Spinal Injury Association Impairment Scale (AIS) and modified Japanese Orthopedic Association score (mJOA).
METHODS
Data was primarily extracted from electronic patient medical notes. Telephone interviews were performed to assess long-term postoperative outcomes. All analyses were conducted using the statistical software program R version 4.0.5. Statistical significance was set at p<.05.
RESULTS
Thirty-four patients were included. Cyst excision was performed in 11 (32%) cases, and fenestration in the remaining 23 (68%). The median follow-up time was 8.0 years. Surgery resulted in a significant long-term improvement in both AIS (p=.012) and mJOA (p=.005). Sensory deficit was the symptom that most often improved (81%), followed by pain (74%) and motor function (64%). AIS deteriorated in two patients, of which one case was attributed to a surgical complication. Local cyst recurrence requiring reoperation was seen in 4 (12%) cases, all of them following cyst fenestration. One patient (3%) required reoperation for progression of the cyst progression at a different level.
CONCLUSION
This study reports outcomes of surgically treated SACs with the longest follow-up time to date. Microsurgical cyst excision or fenestration were safe treatment options, and the neurological improvements seen in the immediate postoperative phase were maintained at long-term follow-up.
Topics: Humans; Arachnoid Cysts; Cohort Studies; Spinal Cord Diseases; Laminectomy
PubMed: 37604309
DOI: 10.1016/j.spinee.2023.08.011 -
Cureus Jul 2023This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA).
PURPOSE
This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA).
MATERIAL AND METHODS
The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances.
RESULTS
The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%.
CONCLUSION
CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.
PubMed: 37588326
DOI: 10.7759/cureus.41945 -
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 -
Surgical Neurology International 2023Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm . It is prevalent in regions with...
Surgical nuances of giant neurocysticercosis according to intracranial location in the Southwest region of the Dominican Republic, presentation of cases, and literature review.
BACKGROUND
Neurocysticercosis (NCC) is the most common infestation of the central nervous system, caused by the larval stage of the pig tapeworm . It is prevalent in regions with poor sanitation and underdevelopment, such as Latin America.
CASE DESCRIPTION
We present four cases in which they harbored an intraventricular/intraparenchymal, frontal convexity, cerebellomedullary, and intraparenchymal NCC cyst of medium size, respectively. Three of them underwent complete removal of the cyst by craniotomy; the fourth had a shunt for obstructive hydrocephalus first, followed by excision of a suboccipital cyst 8 months later.
CONCLUSION
The intraventricular/intraparenchymal lesion was more complex to treat than its subarachnoid counterparts because the average brain should be transected and dissected away to achieve total removal. Waterjet dissection, arachnoid microdissection, and cyst drainage allowed minor brain damage than capsule coagulation and traction. Populated prospective studies are needed better to understand the surgical nuances of these rare entities.
PubMed: 37560572
DOI: 10.25259/SNI_385_2023 -
Brain Tumor Research and Treatment Jul 2023Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts may occasionally rupture because of minor head trauma. We describe the radiologic...
Arachnoid cysts are usually asymptomatic and discovered incidentally. However, cysts may occasionally rupture because of minor head trauma. We describe the radiologic follow-up of 5 patients with ruptured arachnoid cysts featuring spontaneous resolution, subdural hygroma formation, and cystic and subdural hemorrhage. From January 2004 through July 2020, 5 patients (1.3%) with ruptured arachnoid cysts were evaluated out of 388 patients with arachnoid cysts encountered at our institution at that time. The 5 patients were all male, and they ranged in age from 6-17 years (median, 12 years). The median duration of radiologic follow-up was 3.5 years (range, 2.3-10.1 years). All of the ruptured arachnoid cysts were overlying the temporal lobe with Galassi type II. The median cyst diameter was 4.9 cm (range, 4.4-8.9 cm). Four patients had a history of recent minor head trauma. There were no particular neurologic symptoms in their past medical history in all patients. In the follow-up, two patients' cysts resolved spontaneously without hemorrhage. One patient's cyst resolved post-burr-hole drainage for chronic subdural hemorrhage. Another patient, whose cyst led to a hemorrhage and chronic subdural hemorrhage, recovered following a craniotomy, hematoma removal, and cyst fenestration. Another patient, presenting with hygroma, cystic hemorrhage, and chronic subdural hemorrhage, was treated with burr-hole drainage. Three patients recovered postoperatively. Arachnoid cysts rarely rupture, and surgical intervention is required for some cases associated with hemorrhage. Postoperatively, all patients had good outcomes without complications in this series.
PubMed: 37550821
DOI: 10.14791/btrt.2023.0013 -
Acta Neurochirurgica Sep 2023Spinal arachnoid cysts (SACs) arise either intra- or extradurally and are usually solitary, while cases of multiple SACs have been scarcely reported in the literature.... (Review)
Review
Spinal arachnoid cysts (SACs) arise either intra- or extradurally and are usually solitary, while cases of multiple SACs have been scarcely reported in the literature. Herein, we report on a rare case of multiple and recurring intradural spinal arachnoid cysts (SACs) causing severe spinal cord compression and neuropathic radicular pain, in a 35-year-old female with a 10-year follow-up. Two separate attempts at surgery were performed but only provided temporary relief since the cysts recurred and new ones formed along the entirety of the spinal cord. Finally, a conservative approach with physiotherapy and a combination of analgesic medications was pursued.
Topics: Female; Humans; Adult; Arachnoid Cysts; Spinal Cord Diseases; Spinal Cord Compression; Neuralgia; Recurrence; Magnetic Resonance Imaging
PubMed: 37526744
DOI: 10.1007/s00701-023-05732-1 -
Cureus Jun 2023Intrasellar arachnoid cysts represent around 1% of all selar lesions. Generally, patients are asymptomatic and when they exhibit visual and/or hormonal disturbances,...
Intrasellar arachnoid cysts represent around 1% of all selar lesions. Generally, patients are asymptomatic and when they exhibit visual and/or hormonal disturbances, the indication for surgery is prompted. A 51-year-old woman with a known purely intrasellar arachnoid cyst diagnosed 23 years prior to presentation, evolved with gradual campimetric evaluation. Magnetic resonance imaging showed significant growth of the lesion, now extending into the left middle fossa through the cavernous sinus. The patient underwent cyst fenestration via the transsphenoidal approach. This is the first case in the literature of a patient with an intrasellar arachnoid cyst extending into the middle cranial fossa.
PubMed: 37519516
DOI: 10.7759/cureus.41022