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Acta Neurochirurgica Jan 2024Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts...
BACKGROUND
Cysto-ventricular catheters (CVC) have emerged as promising treatment option for cystic craniopharyngioma and arachnoid cysts, but their effectiveness in treating cysts originating from glioma or brain metastasis (BM) remains limited. This study aimed to analyze the efficacy of CVC in patients with glioma and BM as well as procedure-associated morbidity.
METHODS
This single-center retrospective study included all patients treated with CVC placement for acquired space-occupying cysts deriving from previously treated glioma or BMs between 1/2010 and 12/2021.
RESULTS
A total of 57 patients with a median age of 47 years (IQR 38-63) were identified. Focal neurological deficits were the predominant symptoms in 60% of patients (n = 34), followed by cephalgia in 14% (n = 8), and epileptic seizures in 21.1% (n = 12). Accurate CVC placement was achieved in all but one case requiring revision surgery due to malposition. Three months after CVC implantation, 70% of patients showed symptomatic improvement. Multivariate logistic regression analysis identified the development of space-occupying cysts later in the course of the disease (OR 1.014; p = 0.04) and a higher reduction of cyst-volume postoperatively (OR 1.055; p = 0.05) were significant predictors of postoperative symptomatic improvement following CVC placement. Local cyst recurrence was observed in three cases during follow-up MRI after an average time of 5 months (range 3-9 months). Further complications included secondary malresorptive hydrocephalus in three cases and meningeosis neoplastica in one patient.
CONCLUSIONS
Stereotactic implantation of CVC is an efficient treatment option for patients suffering from symptomatic space-occupying cysts from BMs or glioma, independently from their CNS WHO grade. However, a vigilant approach is crucial regarding potential complications and treatment failures.
Topics: Humans; Adult; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Brain Neoplasms; Glioma; Arachnoid Cysts; Catheters; Pituitary Neoplasms
PubMed: 38277007
DOI: 10.1007/s00701-024-05931-4 -
Journal of Pediatric Orthopedics Apr 2024Back pain, as a clinical marker in scoliosis, has been associated with underlying pathology for many years, warranting further magnetic resonance imaging (MRI). Failures...
BACKGROUND
Back pain, as a clinical marker in scoliosis, has been associated with underlying pathology for many years, warranting further magnetic resonance imaging (MRI). Failures of segmentation, mixed defects, female gender, rib anomalies, congenital thoracic anomalies, and neurocutaneous markers are known risk factors for abnormal MRI pathology findings in patients with congenital early-onset scoliosis (Congenital-EOS). Yet, back pain has not been evaluated as a risk factor for underlying MRI pathology in patients with Congenital-EOS. This study aimed to assess back pain as a risk factor for underlying pathology in Congenital-EOS using MRI as a diagnostic tool.
METHODS
A retrospective database review from the Pediatric Spine Study Group (PSSG) of all patients with Congenital-EOS who reported a back pain complaint, and underwent a spinal MRI study before surgical intervention was performed. Patients were divided into those with an underlying MRI pathology and those without. Demographics were compared between groups.
RESULTS
From a total of 2355 patients with Congenital-EOS registered in PSSG, 107 patients reported a back pain complaint, with only 42 patients fulfilling the inclusion criteria (being evaluated with an MRI study). Overall group mean age was 8.1±4.5 years, with 25 of the 42 patients (60%) being females. Twenty-four of 42 patients (57%) had a comorbidity reported such as cardiac problems, musculoskeletal complaints, neurological deficits/myelopathy, gastrointestinal symptoms, developmental delay, respiratory problems, craniofacial abnormalities, and chromosomal conditions. An underlying MRI pathology was found in 21 of 42 patients with Congenital-EOS (50%) with back pain. The underlying MRI pathologies found were tethered spinal cord, spinal canal stenosis, syringomyelia, Arnold-Chiari malformation, and arachnoid cyst.
CONCLUSIONS
Abnormal MRI findings are common in patients with Congenital-EOS who report back pain. Gender, age, major coronal curve angle, thoracic or lumbar predominance deformity, and comorbidities type or amount were not associated with abnormal MRI findings.
LEVEL OF EVIDENCE
Level II-Prognostic study.
Topics: Humans; Female; Child; Child, Preschool; Male; Scoliosis; Retrospective Studies; Clinical Relevance; Magnetic Resonance Imaging; Syringomyelia; Back Pain
PubMed: 38269603
DOI: 10.1097/BPO.0000000000002622 -
The American Journal of Case Reports Jan 2024BACKGROUND Arachnoid cysts and pilocytic astrocytomas are distinct intracranial entities with differing clinical presentations, origins, and management strategies....
BACKGROUND Arachnoid cysts and pilocytic astrocytomas are distinct intracranial entities with differing clinical presentations, origins, and management strategies. Arachnoid cysts are benign fluid-filled sacs associated with congenital or acquired causes, while pilocytic astrocytomas are low-grade brain tumors, primarily affecting pediatric and young adult populations, originating from astrocytes. However, diagnosing pilocytic astrocytomas can be challenging due to their radiological features, sometimes resembling more common intracranial lesions, such as arachnoid cysts. This case underscores the need for vigilance and a multidisciplinary approach when confronted with neuroimaging findings that diverge from typical patterns. CASE REPORT We present a case of a 3-year-old girl who presented with persistent headaches, vomiting, and difficulty walking. Initial radiological assessment suggested an arachnoid cyst, given the patient's symptoms and imaging characteristics. Subsequently, the patient underwent a craniotomy, with intraoperative findings revealing a cystic lesion without a solid mural nodule, which was excised completely. Postoperatively, histopathological examination confirmed a diagnosis of extra-axial pilocytic astrocytoma. The patient's symptoms resolved, and she was discharged without neurological deficits. CONCLUSIONS Diagnosing extra-axial pilocytic astrocytomas presents challenges, due to their radiological similarities with more common intracranial lesions, like arachnoid cysts. This case underscores the importance of histopathological examination to confirm the diagnosis accurately. Surgical resection remains the primary treatment for extra-axial pilocytic astrocytomas, often resulting in a favorable prognosis.
Topics: Child, Preschool; Female; Humans; Arachnoid Cysts; Astrocytoma; Biopsy; Brain Neoplasms; Magnetic Resonance Imaging; Neuroimaging
PubMed: 38245829
DOI: 10.12659/AJCR.941990 -
Pediatric Neurosurgery 2024Intracranial arachnoid cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored; however, a small percentage...
INTRODUCTION
Intracranial arachnoid cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored; however, a small percentage may enlarge and require surgical intervention. This study aimed to identify clinical risk factors in patients with IAC who underwent surgery versus those who did not.
METHODS
We conducted a retrospective chart review from 2009 to 2021 at a free-standing children's hospital. A total of 230 patients diagnosed with an IAC aged 0-21 years of age were included in the study. Data on demographics, imaging, and neurological follow-up were analyzed.
RESULTS
Out of 230 patients, 45 (19.6%) underwent surgery. At time of IAC diagnosis, the surgical patients were younger (median age 1.1 years), and their median cyst volume was larger (41.7 cm3), compared to nonsurgical patients (median age 5.9 years, volume 11.8 cm3, respectively). Headache was the most common reason for initial imaging in nonsurgical patients (54/185, 29.2%) while prenatal ultrasound (11/45, 24.4%) and macrocephaly (11/45, 24.4%) were the most common reasons for surgical patients. The majority of both surgical and nonsurgical patients had the IAC incidentally found (41/45, 91.1% and 181/185, 97.8%, respectively). Surgery relieved symptoms in 38/45 (84.4%) patients. Cyst volume and age were predictors of increased odds of having surgery.
DISCUSSION/CONCLUSION
Patients who underwent surgery were younger and had larger cyst volumes at time of diagnosis. The majority of the IAC were found incidentally and remained stable over prolonged follow-up. The majority of the patients experienced relief of symptoms postsurgical intervention. There is a greater odds of having surgical treatment with decreased age and greater cyst volume at diagnosis, and therefore these patients should be monitored closely for development of symptoms indicating need for surgical intervention.
Topics: Humans; Arachnoid Cysts; Male; Female; Child; Child, Preschool; Infant; Risk Factors; Retrospective Studies; Adolescent; Young Adult; Infant, Newborn; Neurosurgical Procedures
PubMed: 38228110
DOI: 10.1159/000536284 -
Radiology Case Reports Mar 2024Pneumosinus dilatans (PSD) is an abnormal dilatation and enlargement of one or more paranasal sinuses, extending beyond the anatomic bony boundaries, without defect or...
Pneumosinus dilatans (PSD) is an abnormal dilatation and enlargement of one or more paranasal sinuses, extending beyond the anatomic bony boundaries, without defect or thinning of its bony walls. It is documented by only a few reports. Usually asymptomatic, it is in general found incidentally on imaging. It is important for radiologists to recognize the diagnosis and rule out eventual associated conditions such as meningiomas, orbital tumors, arachnoid cysts, and fibrous dysplasia. We report the case of PSD diagnosed incidentally in a 51-year-old female patient who presented to the emergency department with confusion.
PubMed: 38226049
DOI: 10.1016/j.radcr.2023.11.069 -
Surgical Neurology International 2023Meningiomas are rare tumors in children. Although magnetic resonance imaging (MRI) diagnosis is usually easy, its cystic form can wrongly suggest other diagnoses, such...
BACKGROUND
Meningiomas are rare tumors in children. Although magnetic resonance imaging (MRI) diagnosis is usually easy, its cystic form can wrongly suggest other diagnoses, such as an epidermoid or arachnoid cyst. We describe an unusual case of cervical cystic meningioma in a child.
CASE DESCRIPTION
A 5-year-old patient was consulted for progressive weakness of all four limbs, making walking impossible. Neurological examination revealed cervical stiffness without meningeal signs and tetrapyramidal syndrome with incomplete tetraplegia. A cervical spine MRI showed a circumscribed intradural extramedullary lesion at the level of C2-C3, which led to a suspicion of a compressive arachnoid cyst. A gross total resection was performed through a posterior approach. During surgery, it was an extramedullary intradural cystic formation containing a clear liquid and a shell adherent to the Dura mater. Postoperative MRI shows satisfactory spinal cord decompression without evidence of residual tumor. The postoperative course was uneventful, with the resumption of independent walking on the 21 day. Histopathologic examination and immunohistochemistry revealed a grade I meningothelial meningioma according to the 2021 World Health Organization classification of tumors of the central nervous system.
CONCLUSION
Cystic meningiomas can sometimes suggest another diagnosis on imaging, especially since they are rare in children.
PubMed: 38213462
DOI: 10.25259/SNI_672_2023 -
Pediatric Neurosurgery 2024Open-lip-type schizencephaly is characterized by trans-cerebral clefts filled with cerebrospinal fluid (CSF) between the subarachnoid space at the hemisphere surface and...
INTRODUCTION
Open-lip-type schizencephaly is characterized by trans-cerebral clefts filled with cerebrospinal fluid (CSF) between the subarachnoid space at the hemisphere surface and the lateral ventricles. Disorders related to CSF retention, including hydrocephalus and arachnoid cysts, have reportedly been associated with open-lip schizencephaly and have induced intracranial hypertension in some cases. However, detailed neuroimaging and surgical treatment findings have rarely been described.
CASE PRESENTATION
We report 2 cases of open-lip schizencephaly with an expanding CSF-filled cavity overlying the ipsilateral cerebral hemisphere that manifested as signs of intracranial hypertension. Detailed three-dimensional heavily T2-weighted imaging revealed thin borders between the CSF-filled cavity and the subarachnoid space, but no separating structures between the cavity and the lateral ventricle, suggesting that the cavity was directly connected to the lateral ventricle through the schizencephalic cleft but not to the subarachnoid space. Neuroendoscopic observation in case 1 confirmed this finding. Endoscopic fenestration of the cavity to the prepontine cistern was ineffective in case 1. Shunting between the lateral ventricle (case 1) or CSF-filled cavity (case 2) and the peritoneal cavity slightly decreased the size of the CSF-filled cavity.
DISCUSSION
We speculate that the thin borders along the margin of the CSF-filled cavity are membranes that previously covered the schizencephalic cleft and are now pushed peripherally. In addition, we believe that the cavity is a ventricular diverticulum protruding through the cleft and that shunting operation is effective against such expanding cavity. Detailed magnetic resonance imaging can be useful for evaluating patients with schizencephaly associated with CSF retention disorders.
Topics: Humans; Male; Schizencephaly; Female; Diverticulum; Magnetic Resonance Imaging; Hydrocephalus; Infant; Cerebral Ventricles
PubMed: 38198761
DOI: 10.1159/000536188 -
Operative Neurosurgery (Hagerstown, Md.) Jan 2024
PubMed: 38198191
DOI: 10.1227/ons.0000000000001061 -
International Journal of Surgery Case... Feb 2024Dandy-Walker malformation is a rare congenital anomaly of the brain that mainly affects the cerebellum region. It is characterised by abnormal dilatation of the fourth...
Radiological characteristics of the posterior fossa of the fetal skull and presentation of a rare case of antenatal screening for Dandy-Walker malformation using antenatal fetal ultrasound and MRI.
INTRODUCTION AND IMPORTANCE
Dandy-Walker malformation is a rare congenital anomaly of the brain that mainly affects the cerebellum region. It is characterised by abnormal dilatation of the fourth ventricle of the brain and partial or total absence of the cerebellar vermis. This malformation may also be accompanied by other anomalies of the brain. Ante-natal diagnosis is becoming increasingly frequent given the performance of medical imaging, in particular ante-natal ultrasound and MRI. The object of this article is to clarify the possible causes of rare cystic malformations of the posterior cerebral fossa, which are very rare congenital malformations.
CASE PRESENTATION
a 30 year old patient, second gesture, mother of a live child by caesarean section, referred to us at 32 weeks of amenorrhoea at the university hospital centre for management of a cystic malformation of the posterior cerebral malformation detected on 2nd trimester ultrasound and confirmed as a Dandy Walker malformation on 3rd trimester fetal MRI.
CLINICAL DISCUSSION
The Dandy-Walker malformation can be described on prenatal MRI as vermian hypoplasia and can be detected as early as the 1st trimester of pregnancy using ultrasound, This cystic malformation poses a problem of differential diagnosis with other pathologies which also result in a cystic image of the posterior cerebral fossa, in particular Black's pouch cyst, arachnoid cyst and mega magna cistern, which requires careful interpretation of cerebral MRI of the foetus.
CONCLUSION
Imaging techniques play a fundamental role in diagnosis. Prenatal ultrasound and MRI can reveal a Dandy-Walker malformation as early as the 2nd month of pregnancy. MRI is ideal for differentiating differential diagnoses.
PubMed: 38184950
DOI: 10.1016/j.ijscr.2023.109037 -
Case Report: Novel biallelic moderately damaging variants in in a patient with cerebellar dysplasia.Frontiers in Pediatrics 2023Rotatin, encoded by the gene, is a centrosomal protein with multiple, emerging functions, including left-right specification, ciliogenesis, and neuronal migration....
Rotatin, encoded by the gene, is a centrosomal protein with multiple, emerging functions, including left-right specification, ciliogenesis, and neuronal migration. Recessive variants in are associated with a neurodevelopmental disorder with microcephaly and malformations of cortical development known as "Microcephaly, short stature, and polymicrogyria with seizures" (MSSP, MIM #614833). Affected individuals show a wide spectrum of clinical manifestations like intellectual disability, poor/absent speech, short stature, microcephaly, and congenital malformations. Here, we report a subject showing a distinctive neuroradiological phenotype and harboring novel biallelic variants in : the c.5500A>G, p.(Asn1834Asp), (dbSNP: rs200169343, ClinVar ID:1438510) and c.19A>G, p.(Ile7Val), (dbSNP: rs201165599, ClinVar ID:1905275) variants. In particular brain magnetic resonance imaging (MRI) showed a peculiar pattern, with cerebellar hypo-dysplasia, and multiple arachnoid cysts in the lateral cerebello-medullary cisterns, in addition to left Meckel cave. Thus, we compare his phenotypic features with current literature, speculating a possible role of newly identified variants in his clinical picture, and supporting a relevant variability in this emerging condition.
PubMed: 38178912
DOI: 10.3389/fped.2023.1326552