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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 -
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 -
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 -
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 -
Neurology India 2023
Topics: Humans; Subdural Effusion; Arachnoid Cysts; Magnetic Resonance Imaging
PubMed: 38174499
DOI: 10.4103/0028-3886.391360 -
Asian Journal of Neurosurgery Dec 2023Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or...
Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cyst usually locates in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the seventh in the literature, we describe two cases of a hydatid cyst in the cerebellopontine cistern. Magnetic resonance imaging findings revealed a nonneoplastic cystic lesion mimicking an arachnoid cyst. The hydatid nature of the cyst was unexpected preoperatively. In both cases, the cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathological examination confirmed the cysts to be in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications. Previous published cases were also discussed.
PubMed: 38161603
DOI: 10.1055/s-0043-1775860 -
Asian Journal of Neurosurgery Sep 2023A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in...
A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region. Spinal arachnoid cysts may cause debilitating symptoms. The disease is completely curable if the detection and classification are early as in our case.
PubMed: 38152537
DOI: 10.1055/s-0043-1774376 -
Asian Journal of Neurosurgery Sep 2023This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to...
This article reports the management of a case of a 32-year-old male who presented with progressive weakness in the lower limbs and spastic paraparesis secondary to an intramedullary arachnoid cyst (IMAC). For literature review, the authors used the phrase "intramedullary arachnoid cyst" in PubMed search engine. 23 articles describing cases with IMAC were included in this review, with a total of 26 patients. We report a case with long term recurrant intramedullary arachnoid cyst and present a review on spinal intramedullary arachnoid cyst. IMAC is showing bimodal incidence and trending to occur below 10 years and after 30 years. However, rarely, it should be considered in the differential diagnosis of intramedullary cystic lesions. Authors suggest doing laminoplasty or fusion for the pediatric patients to prevent kyphoscoliosis deformity in the long run, but doing early surgery to gain better outcome. Resection of the cyst wall should be done as much as possible; if it could not be achieved, then marsupialization or cysto-subarachnoid shunt should be considered. Aspiration alone or fenestration is not enough to eradicate the cyst. Long-term and prospective studies are recommended to achieve the best treatment options. Review supports early surgical treatment of symptomatic IMACs with resection of the cyst wall as much as possible.
PubMed: 38152523
DOI: 10.1055/s-0043-1774380