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Bison HS, Janetos TM, Russell EJ, Volpe NJ. Cranial Nerve Palsies in the Setting of Arachnoid Cysts: A Case Series and Literature Review. J Neuroophthalmol 2024; 44:242-246. [PMID: 37656595 DOI: 10.1097/wno.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
BACKGROUND Arachnoid cysts (ACs) are benign lesions typically believed to not cause neurologic defects in the adult population and are most often found incidentally on imaging. We describe 2 patients with ACs potentially leading to isolated cranial nerve (CN) dysfunction. METHODS We describe 2 patients, 1 with a fourth nerve palsy and the other with a sixth nerve palsy found to have ACs on MRI brain imaging in locations that potentially caused a compressive CN palsy. We review previous literature of ACs presenting with CN III, IV, or VI palsy. RESULTS Patient 1 was a 62-year-old man who presented with a 22-year history of diplopia with strabismus examination consistent with a congenital CN IV palsy. Despite multiple surgeries, his CN IV palsy insidiously worsened. An AC in the posterior fossa with mass effect on the quadrigeminal plate and asymmetric atrophy of the right superior oblique was identified on imaging. Patient 2 was an 80-year-old man who presented with an 18-year history of diplopia and was found to have a left esotropia and abduction deficit consistent with complete CN VI palsy. An AC in the left cavernous sinus was identified on imaging. He underwent strabismus surgery with satisfactory resolution of diplopia. We identified a total of 18 previously published cases: 8 reports of CN III palsy, 4 reports of CN IV palsy, and 6 reports of CN VI palsy. Patient ages ranged from 1 to 67 with a median of 34.5. In 16/18 (89%) cases, the diagnosis of ACs was made within 1 year of symptom onset. Surgical removal of the AC was successful in resolving diplopia in 7/12 (58%) cases. In no case was strabismus surgery performed as primary treatment. CONCLUSIONS Although ACs are typically congenital asymptomatic lesions, we present a case series of 2 patients with ACs in anatomic locations that potentially caused chronic, progressive, isolated CN palsies leading to strabismus. Our literature review revealed that most published cases detailing this clinical scenario resulted in neurosurgical fenestration of ACs with mixed results. Our cases represent 2 patients with AC-associated CN palsy treated with strabismus surgery.
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Affiliation(s)
- Henry S Bison
- Departments of Ophthalmology (HSB, TMJ, NJV) and Radiology (EJR), Northwestern University Feinberg School of Medicine, Chicago, Illinois; and Department of Ophthalmology and Visual Sciences (HSB), University of Maryland School of Medicine, Baltimore, Maryland
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2
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Akalan N. Article by Adolfsson et al. "Cognition in children with arachnoid cysts - A five-year follow-up after microneurosurgical fenestration". Acta Neurochir (Wien) 2024; 166:222. [PMID: 38787461 DOI: 10.1007/s00701-024-06123-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Nejat Akalan
- Department of Neurosurgery, Medipol University, Istanbul, Turkey.
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Papadakis JE, Slingerland AL, Rangwala SD, Proctor MR, Shah AS, See AP. Optic Nerve Edema in Pediatric Middle Cranial Fossa Arachnoid Cysts: Report of 51 Patients From a Single Institution. Pediatr Neurol 2024; 156:182-190. [PMID: 38788281 DOI: 10.1016/j.pediatrneurol.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Middle fossa arachnoid cysts (MFACs) are rare, congenital lesions that may rupture and cause symptoms of elevated intracranial pressure. We sought to describe the presence of and factors associated with optic nerve edema in MFACs, focusing on the utility of ophthalmologic evaluations for guiding cyst management. METHODS We reviewed clinical and radiographic information for all patients with MFACs with ophthalmologic evaluations at our institution. Headache, cranial nerve palsy, emesis, altered mental status, fatigue, and seizures were considered MFAC-related symptoms. Univariate and multivariable analyses evaluated factors associated with optic edema. RESULTS Fifty-one patients between 2003 and 2022 were included. Cysts were a median volume of 169.9 cm3 (interquartile range: 70.5, 647.7). Evidence of rupture with subdural hematoma/hygroma occurred in 19 (37.3%) patients. Eighteen (35.3%) patients underwent surgery for their cyst and/or rupture-associated intracranial bleed. Eleven (21.6%) patients had optic edema; all were symptomatic and experienced cyst rupture. Ten of these patients received surgery. Postoperatively, optic edema resolved in 80% of cases. Cyst volume and symptoms were not associated with optic edema; however, patients with ruptured cysts, particularly those with traumatic rupture, were more likely to have optic edema and receive surgery (P < 0.001). CONCLUSIONS We found optic edema in 21.6% of evaluated MFACs, and this comprised of 57.9% of ruptured cases. Optic edema was not found in unruptured cysts. Cyst fenestration improved optic edema and patient symptoms. In conjunction with clinical history and neuroimaging, optic edema may help guide MFAC management, particularly in patients with cyst rupture.
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Affiliation(s)
- Joanna E Papadakis
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna L Slingerland
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shivani D Rangwala
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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Datta D, Pathak D, Ghosh P, Hazra S. Subdural hemorrhage in middle cranial fossa arachnoid cysts: a report of two cases at two ends of the spectrum. Childs Nerv Syst 2024; 40:263-266. [PMID: 37535073 DOI: 10.1007/s00381-023-06107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Abstract
Arachnoid cysts are usually asymptomatic, benign lesions commonly occurring in the middle cranial fossa. However, the cysts may rupture in rare cases causing intracystic or subdural hemorrhages with significant mass effect. We report two cases of middle cranial fossa arachnoid cyst with subdural hemorrhage with very different clinical course. The first case presented with significant mass effect with cerebral herniation and had significant neurological morbidity post-surgery. The second case had minimal symptoms and was managed conservatively with offer of elective surgery. The report underscores the importance of prompt diagnosis and appropriate surgical intervention in managing arachnoid cysts with hemorrhage, highlighting the potential for diverse clinical presentations and outcomes.
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Affiliation(s)
- Debajyoti Datta
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India.
| | - Debajyoti Pathak
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
| | - Partha Ghosh
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
| | - Sutirtha Hazra
- Department of Neurosurgery, Institute of Neurosciences, Kolkata, India
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Lee JH, Holste KG, Selzer BJ, Garton HJL, Muraszko KM, Maher CO. Sports Participation and Sports-Related Neurologic Injuries in Pediatric Patients With Arachnoid Cysts. Neurosurgery 2023; 93:979-985. [PMID: 37199501 DOI: 10.1227/neu.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with arachnoid cysts (ACs). OBJECTIVE To prospectively survey patients with ACs to define the risk of sports-associated neurologic injury in untreated and treated patients. METHODS A prospectively administered survey was given to all patients diagnosed with an AC who presented to a single pediatric neurosurgery clinic between December 2010 and December 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurologic injury. The type and date of surgery for the AC were noted if surgery was performed. RESULTS Of the 303 patients with completed surveys, 189 patients participated in sports, and 94 patients had prospective data available. There was no significant difference in cyst location or Galassi score between patients who did and did not participate in contact vs noncontact sports and those who did and did not experience a concussion. A cumulative total of 2700.5 seasons of sports were played (2499.7 in untreated and 200.8 in treated patients). There were 44 sports-related concussions among 34 patients: 43 in untreated patients and 1 in a treated patient. For all participants, the concussion rate was 16.3 per 1000 seasons of all sports and 14.8 per 1000 seasons of contact sports. The concussion rate after AC treatment was 4.9 per 1000 seasons of all sports. Three patients experienced sports-related AC rupture or hemorrhage, none of which required surgery or resulted in lasting neurologic symptoms or deficits. CONCLUSION The rates of sports-related concussion and cyst rupture in patients with AC in both treated and untreated populations were low. We advocate for a generally permissive posture toward sports participation in this population.
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Affiliation(s)
- Johan H Lee
- School of Medicine, University of Michigan, Ann Arbor , Michigan , USA
| | - Katherine G Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Bela J Selzer
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Hugh J L Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Cormac O Maher
- Department of Neurosurgery, Stanford University, Stanford , California , USA
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Abstract
PURPOSE The purpose of this review article is to outline the natural history, pathogenesis, anatomic considerations and surgical decision-making in caring for patients with intracranial arachnoid cysts. METHODS A review of the literature for intracranial arachnoid cysts was performed using Embase, PubMed, and Web of Science databases, including review of the bibliographies of eligible articles and the author's own experience. RESULTS Among those reviewed, 59 relevant original articles were included as well as illustrative cases from the authors own experience. CONCLUSIONS Arachnoid cysts are congenital lesions characterized by split arachnoid membrane, thick collagen in the cyst wall, absent traversing trabecular processes within the cyst, and hyperplastic arachnoid cells in the cyst wall. The underlying etiology is not entirely known, and they occur in greater proportion in males and in greater incidence with various genetic conditions including Down syndrome, mucopolysaccharidosis, schizencephaly, neurofibromatosis, autosomal dominant polycystic kidney disease (ADPKD), acrocallosal syndrome, and Aicardi syndrome. Most intracranial arachnoid cysts are incidentally found and occur in the middle cranial fossa, with the remaining occurring in the cerebellopontine angle, suprasellar cistern, quadrigeminal cistern, convexity, and posterior fossa/cisterna magna. The current article outlines the natural history, prevalence, demographic factors, and treatment decisions in managing patients with intracranial arachnoid cysts.
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Affiliation(s)
- A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 566, Baltimore, MD, 21287, USA
| | - Alan R Cohen
- Department of Neurosurgery, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Phipps 566, Baltimore, MD, 21287, USA.
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Morgan T, Ciubuc J, Murray D, Murray M, Murray R. Adult Radiographic Presentation of Corpus Callosal Agenesis With a Single Interhemispheric Cyst and Dandy-Walker Malformation: A Case Report. Cureus 2023; 15:e38396. [PMID: 37265886 PMCID: PMC10231846 DOI: 10.7759/cureus.38396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Agenesis or dysgenesis of the corpus callosum may occur due to ischemic, toxic, traumatic, or another insult to the fetus in the first trimester. Occasionally, such a malformation is associated with an interhemispheric cyst, among other central nervous system anomalies. Holoprosencephaly tends to mimic this radiographic presentation, which is where key imaging findings are helpful to differentiate between these entities. We present a 56-year-old male patient who was found to have a monoventricle, corpus callosum agenesis, interhemispheric cyst, and a Dandy-Walker malformation. The patient presented with a right acetabular fracture with computed tomography (CT) of the brain revealing the congenital brain abnormalities. The patient's past medical history was notable for a seizure disorder identified during early adulthood. The CT scan of the head revealed a large monoventricle with an associated midline dorsal interhemispheric cyst and a Dandy-Walker malformation. The absence of both the corpus callosum and septum pellucidum was noted, with the presence of a monoventricle, leading to an initial differential of holoprosencephaly. Further review of the findings suggested instead a rare congenital presentation consisting of corpus callosum agenesis and an interhemispheric cyst. This case highlights a unique radiographic presentation of multiple brain anomalies, rarely presented in non-pediatric literature, which may help determine appropriate surgical and medical management for similarly affected adult individuals.
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Affiliation(s)
- Tyler Morgan
- Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - John Ciubuc
- Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | | | - Matthew Murray
- Surgery, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Richard Murray
- Diagnostic Radiology, Texas Tech University Health Sciences Center, Amarillo, USA
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Beltagy MAE, Enayet AER. Surgical indications in pediatric arachnoid cysts. Childs Nerv Syst 2023; 39:87-92. [PMID: 36284010 DOI: 10.1007/s00381-022-05709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Arachnoid cysts are developmental lesions consisting of CSF collections within the subarachnoid space. There are many theories and hypotheses about their pathogenesis and histopathology and this may also explain the diversities seen in clinical behaviors of these cysts, their natural history and consequently their management where there is a great controversy about selecting patients for surgical intervention. The most common location in pediatrics is the Sylvian or middle cranial fossa and this made it gain more concern and greater debate about its management where its diagnosis is often accidently or associated with nonspecific symptoms. AIM Our aim in this article was to review the main surgical indications for pediatric arachnoid cysts in the literature. CONCLUSION We concluded that the decision for surgical intervention for pediatric arachnoid cysts is not a simple one and highly debatable and should be taken cautiously especially with sylvian arachnoid cysts that may reach a large size without symptoms. However, there is a consensus that the occurrence of symptoms definitely correlated to the presence of these cysts or their rupture with consequent subdural hematoma or hygroma are indications for surgical intervention. Large cysts in locations compressing CSF pathways causing hydrocephalus are also candidates for surgical fenestration. The surgical gain from prophylactic surgery is questionable particularly when asymptomatic.
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Affiliation(s)
- Mohamed A El Beltagy
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. .,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Abd El Rhman Enayet
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Peraud A, Ibel R. Controversies in the Treatment of Arachnoid Cysts with Special Emphasis on Temporal Arachnoid Cysts. Adv Tech Stand Neurosurg 2023; 46:175-192. [PMID: 37318575 DOI: 10.1007/978-3-031-28202-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intracranial arachnoid cysts (ACs) are benign lesions. The incidence in children is 2.6%. ACs are often diagnosed incidentally. Because of the broad use of CT and MR imaging, the frequency of AC diagnosis has increased. In addition, prenatal diagnosis of ACs is becoming more common. This places clinicians in a difficult situation with regard to the optimal treatment, since the presenting symptoms are often vague and operative management includes not negligible risks. It is generally accepted that conservative management is indicated in cases with small and asymptomatic cysts. In contrast, patients with definite signs of raised intracranial pressure should be treated. There are however clinical situations in whom the decision about the preferred treatment is difficult to make. Unspecific symptoms such as headaches and neurocognitive or attention deficits can be challenging to evaluate, whether they are related to the presence of the AC or not. The treatment techniques intent to establish a communication between the cyst and the normal cerebrospinal spaces or consist of a diversion of the cyst fluid by a shunt system. Which surgical method (open craniotomy for cyst fenestration, endoscopic fenestration, or shunting) is preferred differs between neurosurgical centers or the pediatric neurosurgeon in charge. Each treatment option has a unique profile of advantages and disadvantages which should be considered when discussing treatment with the patients or their caregivers.
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Affiliation(s)
- Aurelia Peraud
- Section Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Ulm, Germany.
| | - Rebecca Ibel
- Section Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Ulm, Ulm, Germany
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Shinohara N, Hirokawa D, Fukuyama R, Hayashi T, Sato H. Neuroendoscopic fenestration for intracranial unilocular cysts and isolated lateral ventricles: four pediatric cases. Childs Nerv Syst 2022; 38:1803-1807. [PMID: 35083514 DOI: 10.1007/s00381-022-05451-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Abstract
The purpose of treatment for unilocular intracranial cysts (UICs) is to release elevated intracranial pressure. Neuroendoscopic fenestration (NF) is one of the most effective and minimally invasive options for treating UICs, especially in young children; however, the optimal location and number of fenestrations, the necessity of using endoscopic third ventriculostomy (ETV) in combination with fenestration, and the course of treatment are not well known. We retrospectively reviewed the hospital records between 2012 and 2019. The patients were studied in terms of sex, age at surgery, preoperative symptoms, cyst localization and size, course of treatment, ventricular diameter, developmental assessment, anatomical location, and the number of fenestrations. There were four eligible patients in the relevant period: two boys and two girls. The median age at the time of surgery was 16 months. With regard to the location of the cysts, there were two cases of cavum velum interpositum (CVI), one case of quadrigeminal cistern, and one case of an isolated lateral ventricle. The most common preoperative finding was an enlarged head circumference. All the patients were treated with NF, including one case of reoperation after open head surgery. Postoperatively, we used the frontal and occipital horn ratio (FOHR) to evaluate the ventricular size. The average reduction in the FOHR was 0.003. In the most recent developmental assessment or examination during the follow-up period, two patients showed normal development, and two patients showed developmental delay. Based on our past experience and reports, we believe that it is recommended to perform two fenestrations for a single cyst. This is because it creates a flow of cerebrospinal fluid (CSF) within the cyst into normal CSF reflux. For lesions with obstruction of the aqueduct, such as cysts in the quadrigeminal cistern, ETV should be considered if it can be performed safely, in preparation for the worsening of hydrocephalus due to obstruction by enlargement of the cyst.
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Affiliation(s)
- Naoki Shinohara
- Department of Neurosurgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
| | - Daisuke Hirokawa
- Department of Neurosurgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan.
| | - Ryutaro Fukuyama
- Department of Neurosurgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
| | - Tomoko Hayashi
- Department of Neurosurgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
| | - Hironobu Sato
- Department of Neurosurgery, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, Kanagawa, 232-8555, Japan
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Characteristic and management of pediatric arachnoid cysts: A case series. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1028090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background/Aim: Arachnoid cysts (ACs) are the collection of fluid, which is similar in composition to cerebrospinal fluid, within the congenitally duplicated arachnoid membrane. ACs are clinically silent lesions, but sometimes they can manifest themselves with headache, convulsion, focal neurological deficits, cognitive decline, torticollis, and macrocephaly. Although the appropriate surgical approach is less clear, there is a consensus on the need for surgical treatment in symptomatic ACs. This study aims to reveal the advantages and disadvantages of cystoperitoneal shunt and microsurgical fenestration techniques.
Methods: One hundred ninety-one consecutive patients from 1 month to 15 years old with AC were evaluated for suitability. Sixteen patients who underwent surgery were included in the study. Medical records of the patients with AC managed at our institutions were retrospectively collected and analyzed. Sixteen of 191 patients underwent surgical treatment via craniotomy for microsurgical cyst fenestration (CF) and cysto-peritoneal shunting (CS). CF was performed with partial cyst wall excision in all patients.
Results: Seizure was the most common presentation in the patients, followed by headache and trauma, respectively. In our series the most common indications of the surgery were increased intracranial pressure (IICP). CF was performed in nine patients, and CS was performed in seven as the primary treatment. CS-related complications, such as infection (n = 2), dysfunction (n = 2) and intraabdominal abscess (n = 1) were the most commonly observed complications. No infections were observed after CF, but subdural hematoma was observed in one child.
Conclusions: Although the most common symptoms in cases with arachnoid cysts are headache, rare symptoms, such as torticollis, may exist. Due to this, clinicians should reveal the cyst-complaint relationship first. Given the increased complications of CS, in addition to shunt independency and being free from shunt-related complications, the microsurgical CF with wide excision of the membranes seems to be the more preferable surgical option.
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Watson I, McDonald PJ, Steinbok P, Graeber B, Singhal A. Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21462. [PMID: 36303495 PMCID: PMC9379718 DOI: 10.3171/case21462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arachnoid cysts are benign, often asymptomatic intracranial mass lesions that, when ruptured, may cause seizures, raised intracranial pressure, hemorrhage, and/or loss of consciousness. There is no widely agreed upon treatment, and there is debate as to whether a nonoperative or surgical approach is the best course of action. The carbonic anhydrase inhibitor acetazolamide may be an effective nonoperative approach in treating ruptured arachnoid cysts. OBSERVATIONS The Pediatric Neurosurgery Clinical Database at BC Children’s Hospital from 2000 to 2020 was queried, and four pediatric patients who were treated with acetazolamide after presentation with a ruptured middle cranial fossa arachnoid cyst were identified. All patients showed some degree of symptom improvement. Three of the patients showed complete reabsorption of their subdural collections in the ensuing 6 months. One patient had an inadequate response to acetazolamide and required surgical management. LESSONS Acetazolamide is a safe and reasonable primary treatment option in pediatric patients with ruptured middle cranial fossa arachnoid cysts, and it may help avoid the need for surgery.
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Affiliation(s)
- Isabella Watson
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Patrick J. McDonald
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Section of Neurosurgery, University of Manitoba, Manitoba, Canada
| | - Paul Steinbok
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Brendon Graeber
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
- Department of Radiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Ashutosh Singhal
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
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Ono K, Mukae N, Nishimura A, Arimura K, Mizoguchi M, Yoshimoto K, Iihara K. Impaired visual acuity as an only symptom of shunt malfunction, long time after initial cyst-peritoneal shunting for arachnoid cyst: A case report. Surg Neurol Int 2022; 13:68. [PMID: 35242434 PMCID: PMC8888301 DOI: 10.25259/sni_1077_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/02/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Long-term outcomes after surgical treatment of arachnoid cysts (ACs) have not been reported adequately. Impaired visual acuity is not a common symptom of shunt dependency syndrome due to cyst-peritoneal (CP) shunt malfunction for ACs. We report a case of CP shunt malfunction, who presented only impaired visual acuity as a symptom, long after the initial surgical treatment.
Case Description:
A 16-year-old boy was surgically treated for the left frontal AC with CP shunting at 2 years of age. Extension of the peritoneal shunt catheter was performed at 15 years of age. A year later, he started experiencing impairment of visual acuity without headaches, which worsened to bilateral light perception. The presence of bilateral optic atrophy was confirmed. The AC in the left frontal lobe had enlarged very slightly, with shortening of the intracystic catheter, and the cerebrospinal fluid pressure was elevated to 30 cmH2O. He was treated with lumboperitoneal shunting. The visual acuity showed limited improvement.
Conclusion:
The possibility of CP shunt malfunction and shunt dependency syndrome should be considered, even if the patient presented only impaired visual acuity and no significant changes in the size of the ACs are observed.
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Affiliation(s)
- Kotaro Ono
- Department of Neurosurgery, Japan Community Health care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Nobutaka Mukae
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ataru Nishimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Mizoguchi
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Director General, National Cerebral and Cardiovascular Center Hospital, Suita, Osaka, Japan
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Maxwell CR, Joshi N, Feller CN, McAree M, Hedayat HS. Reversal of cognitive, behavioral, and language impairments after the left frontal arachnoid cyst fenestration in a pediatric patient. Surg Neurol Int 2021; 12:371. [PMID: 34513138 PMCID: PMC8422412 DOI: 10.25259/sni_135_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Arachnoid cysts (ACs) are cerebrospinal fluid-containing cysts located between the surface of the brain or spinal cord and arachnoid layer of the leptomeninges. ACs have been known to cause cognitive, language, and behavioral deficits and currently there is no standard treatment paradigm. Surgical indications include papilledema, increasing growth with mass effect causing neurological deficit, or rapid head growth, however, cognitive symptoms related to mass effect may not always be considered. Case Description: We present a 3-year-old male with an AC of the left anterior fossa causing frontal lobe compression with resultant behavioral, language, and cognitive deficits. Conclusion: Surgical intervention for AC decompression may be indicated when there are cognitive, behavioral, or language delays related to the mass effect and location of the AC. Neuropsychiatric testing or more advanced imaging studies may further support surgical treatment. After craniotomy for fenestration of the left frontal AC, there was drastic improvement in cognitive, language, and behavioral symptoms in our pediatric patient.
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Affiliation(s)
- Christina R Maxwell
- Department of Neurosurgery, Global Neurosciences Institute, Philadelphia, Pennsylvania
| | - Neal Joshi
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Christina N Feller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Michael McAree
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
| | - Hirad S Hedayat
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Surgical fenestration might not be the best option for very young patients with middle fossa arachnoid cysts. Childs Nerv Syst 2021; 37:1307-1312. [PMID: 33083873 DOI: 10.1007/s00381-020-04935-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Surgical fenestration is widely accepted as a primary treatment for middle fossa arachnoid cysts (MFACs) in pediatric patients. However, postoperative subdural effusion and/or hydrocephalus always affect treatment outcomes. In this study, we presented our experience of treating MFACs with surgical fenestration in pediatric patients and analyzed the cases complicated by postoperative subdural effusion and/or hydrocephalus, to give insight into the clinical characteristics predisposing the complications. METHODS We retrospectively analyzed 21 pediatric cases with MFACs treated by surgical fenestration suffering postoperative subdural effusion and/or hydrocephalus in our department from November 2011 to April 2019. We reviewed the clinical characteristics and treatment outcomes. RESULTS A total of 21 patients, among a total of 53 pediatric patients with MFACs treated by surgical fenestration, developed subdural effusion and/or hydrocephalus postoperatively. The mean age at the time of the initial surgery was 49 months. A total of 75% (6/8) of the patients under 2 years old and 13.3% (6/45) of the older patient group sustaining postoperative subdural effusion and/or hydrocephalus required further surgeries, respectively (Fisher's exact test, p = 0.001). Notably, among the 21 cases with postoperative subdural effusion and/or hydrocephalus, all the 6 patients under 2 years old needed additional surgeries, while of the other 15 older patients, only 40% (6/15) needed further surgical interventions (Fisher's exact test, p = 0.019). CONCLUSION The immature CSF absorption in MFAC patients younger than 2 years old might predispose them to the relatively serious postoperative subdural effusion and/or hydrocephalus. For very young patients with giant MFACs, surgical fenestration might not be the best option.
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Surgical treatment and clinical outcome of large pediatric interhemispheric cysts with callosal agenesis: A systematic literature review with four additional patients. Clin Neurol Neurosurg 2021; 204:106600. [PMID: 33799088 DOI: 10.1016/j.clineuro.2021.106600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Large interhemispheric cysts (IHC) with partial or complete agenesis of corpus callosum (ACC) constitute a heterogeneous group of rare disorders. Neurosurgical treatment, in the terms of if, when and how to operate, remains unclear METHODS: We performed a surgical literature review of series or reports of IHCs with callosal anomalies; we evaluated whether revision surgeries were necessary and considered the dimensional change in the cyst postoperatively and the developmental outcome. We also reported our experience with sfour patients treated by programmable cysto-peritoneal (CP) shunting. Patients' clinical history, neuroradiological and neuropsychological performances were evaluated pre and post operatively. RESULTS The review included 133 patients with surgically-treated IHCs. Although most authors are in agreement to perform surgery if the patients present signs of raised ICP and to not intervene in those completely asymptomatic, for other signs and symptoms the debate is still open; only few authors performed cognitive tests pre and post-operatively. Shunting procedures were successful in 60% of our reviewed cases and often lead to a major cyst collapse. Craniotomy achieves good results but is extremely invasive. Endoscopy is minimally invasive and our review demonstrated a success rate of 66%. However, endoscopy does not ensue a complete cyst collapse. Our series and review seem to suggest a possible link between parenchymal re-expansion and cognitive outcome. CONCLUSIONS Early and effective surgery seems to obtain a greater cerebral parenchyma re-expansion and long-term cognitive evolution. Endoscopy is safe and reliable, but more data is needed on the impact of uncomplete cyst collapse on neurocognitive outcome.
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Deopujari CE, Shaikh ST, Karmarkar VS, Sudke AY, Mohanty CB, Biyani NK. Experience with Management of Intracranial Arachnoid Cysts. J Neurol Surg A Cent Eur Neurosurg 2021; 82:43-52. [PMID: 33157563 DOI: 10.1055/s-0040-1718522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the demographics, clinical presentation, and surgical outcome of intracranial arachnoid cysts and to review the surgical options. METHODS This is a retrospective observational study of 56 cases of symptomatic arachnoid cysts among all age groups treated between 2004 and 2020 at the Bombay Hospital, Mumbai. Endoscopic fenestration, microsurgical cyst excision, and shunt insertion were the interventions performed. Clinical presentation, cyst reduction post-intervention, and complications were studied. The follow-up period varied from 1 month to 16 years. Statistical analysis was done for 43 patients with a minimum of 3 years' follow-up. RESULTS In all, 75% of patients were <18 years of age. Of these, the majority were between the age of 1 and 10 years. There were 14 cases of temporal, 13 cases of retrocerebellar, 10 cases of quadrigeminal cistern, and 7 cases each of interhemispheric and suprasellar arachnoid cysts. The most common clinical presentation was headache and vomiting. Concomitant hydrocephalus was seen on imaging in 24 cases. Endoscopic fenestration of cyst was the most routinely performed procedure (35 cases). Four patients of endoscopic fenestration underwent a redo endoscopic procedure on follow-up. Post-operative reduction in cyst size was found to be significantly better after endoscopic fenestration (p < 0.05). CONCLUSION Though the best available treatment for arachnoid cysts remains controversial, surgery has been found to be beneficial in symptomatic cases. Endoscopic fenestration is considered the first-line surgical option and it may be followed by shunt, if necessary. Shunts may be preferred in very young children where there is associated hydrocephalus/macrocephaly.
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Affiliation(s)
| | - Salman T Shaikh
- Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
| | | | - Amol Y Sudke
- Department of Neurosciences, Bai Jerbai Wadia Hospital, Mumbai, Maharashtra, India
| | - Chandan B Mohanty
- Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
| | - Naresh K Biyani
- Department of Neurosurgery, Bombay Hospital, Mumbai, Maharashtra, India
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El Refaee E, Elbaroody M. Endoscopic Fenestration of Arachnoid Cysts Through Lateral Pontomesencephalic Membranotomy: Technical Note and Case Series. World Neurosurg 2020; 148:54-64. [PMID: 33385600 DOI: 10.1016/j.wneu.2020.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The ideal treatment method for cranial arachnoid cysts stills controversial, each of endoscopic and microscopic techniques has its pros and cons. METHODS We described cystocisternostomy technique for arachnoid cysts through fenestration medial to the edge of tentorium through lateral pontomesencephalic membrane and illustrated it's outcomes. We performed endoscopic lateral pontomesencephalic membranotomy in nine children with zero angled rigid endoscope (STORZ).The age ranged from eight months up to nine years. The cysts were Galassi type III in eight cases (five of them giant hemispheric) and Galassi type II in one case. Clinical presentations were delay in milestones, seizures, loss of consciousness, unsteady gait, and persistent headache. RESULTS The cysts decreased in size in five cases after three months and nearly disappeared after three and 15 months in two cases, and in 18 months in the other two. Preoperative symptoms improved in all cases. Insignificant subdural hygroma was found in five cases, one case developed hydrocephalus four months later treated with a ventriculoperitoneal shunt; contralateral massive subdural hematoma occurred in one case four months after surgery evacuated with two burr holes with good clinical outcome. There was neither cerebrospinal fluid leakage, cranial nerve palsy nor mortality. CONCLUSIONS The fenestration through the lateral pontomesencephalic membrane created a shortcut of cerebrospinal fluid flow to the basal cisterns especially cerebellopontine cistern and represents a reliable option with an acceptable success rate. It creates a good drainage to the large cysts.
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Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Mohammad Elbaroody
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Cognition in Children with Arachnoid Cysts. J Clin Med 2020; 9:jcm9030850. [PMID: 32244990 PMCID: PMC7141502 DOI: 10.3390/jcm9030850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background: This study aims to evaluate if children with temporal arachnoid cysts (AC) have cognitive symptoms and if neurosurgery improves these. Methods: A prospective case series study including consecutive pediatric patients with temporal AC. The children underwent neuroradiology, neuroopthalmologic evaluation, and a standard electroencephalography (EEG). Additionally, a neuropsychologist performed a standardized set of evaluations, with a one-year follow-up consisting of Weschler Intelligence Scale for Children version IV (WISC-IV), FAS (for verbal fluency), Boston Naming Test (BNT, for visual naming ability) and NEPSY-II (Developmental NEuroPSYchological Assessment) for verbal memory. Results: Fifteen children, 9 boys and 6 girls, were evaluated and 11 underwent surgery. The Full Scale IQ subscore (FSIQ) improved from M = 84.8 to M = 93.0 (p = 0.005). The preoperative Verbal Comprehension Index (VCI) was in the low average range (M = 86.7), improving to a level within the average range (M = 94.7, p = 0.001). Preoperative Perceptual Speed Index (PSI) was in the below average range (M = 81.5), improving to a level within the average range (M = 92.5, p = 0.004). Conclusion: ACs are a common finding in a pediatric neurosurgical setting. Our data suggest that some temporal AC have a negative effect on general cognitive ability and that this impairment can be improved by surgery. We suggest a standardized evaluation, including comprehensive and validated neuropsychological assessment tools, to thoroughly assess symptoms as well as the postoperative outcome.
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20
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Tabakow P, Weiser A, Chmielak K, Blauciak P, Bladowska J, Czyz M. Navigated neuroendoscopy combined with intraoperative magnetic resonance cysternography for treatment of arachnoid cysts. Neurosurg Rev 2019; 43:1151-1161. [PMID: 31313009 PMCID: PMC7347696 DOI: 10.1007/s10143-019-01136-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/27/2019] [Accepted: 06/12/2019] [Indexed: 11/09/2022]
Abstract
Endoscopic cystocysternostomy or cystoventriculostomy is the treatment of choice in patients with symptomatic intracranial arachnoid cysts. There are no objective diagnostic tests for reliable intraoperative evaluation of the effectiveness of performed stomies. The aim of this prospective open-label study is to demonstrate for the first time the usefulness of intraoperative cysternography performed with the low-field 0.15-T magnetic resonance imager Polestar N20 during endoscopic cysternostomies. The study was performed in patients operated for middle fossa arachnoid cysts (n = 10), suprasellar cysts (n = 4), paraventricular or intraventricular cysts (n = 6), and a pineal cyst (n = 1). The operations were performed with use of a navigated neuroendoscope. Intraoperative magnetic resonance (iMR) cysternography was performed before and after the cystostomy. In each case, iMR cysternography was safe and could show clearly the cyst morphology and the effectiveness of performed endoscopic cystostomies. In six cases, iMR cysternography had a significant influence of the surgical decision (p = 0.027). The rate of inconsistency between the intraoperative observations and iMR imaging–based findings was 29%. A good contrast flow through the fenestrated cyst walls correlated with a good long-term clinical outcome (ρ = 0.54, p < 0.05) and good long-term radiological outcome (ρ = 0.72, p < 0.05). Intraoperative low-field MR cysternography is a safe and reliable method for assessment of the efficacy of performed endoscopic cystostomies and has significant influence on the surgical decision. It may be reliably used for prediction of the long-term clinical and radiological outcome.
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Affiliation(s)
- Pawel Tabakow
- Department of Neurosurgery, Wroclaw Medical University, Borowska str. 213, 50-556, Wroclaw, Poland.
| | - Artur Weiser
- Department of Neurosurgery, Wroclaw Medical University, Borowska str. 213, 50-556, Wroclaw, Poland
| | - Krzysztof Chmielak
- Department of Neurosurgery, Wroclaw Medical University, Borowska str. 213, 50-556, Wroclaw, Poland
| | - Przemyslaw Blauciak
- Department of Neurosurgery, Wroclaw Medical University, Borowska str. 213, 50-556, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska str. 213, 50-556, Wroclaw, Poland
| | - Marcin Czyz
- Department of Neurosurgery, University Hospitals of Birmingham, Birmingham, UK
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Kim KH, Lee JY, Phi JH, Cho BK, Shin MS, Kim SK. Neurocognitive profile in children with arachnoid cysts before and after surgical intervention. Childs Nerv Syst 2019; 35:517-522. [PMID: 30610479 DOI: 10.1007/s00381-018-4026-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/12/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Treatment indications for arachnoid cysts are not clear. Some surgeons take improvement in neurocognitive function into account as a surgical indication for arachnoid cysts. However, only a few studies have evaluated the relationship between arachnoid cysts and neurocognitive function. Furthermore, studies that analyze neurocognitive function as an effect of arachnoid cyst surgery are even rarer. The purpose of this study was to analyze the neurocognitive function scores of children with arachnoid cysts before and after surgery and to examine whether surgical treatment led to improved neurocognitive function. METHODS From June 2009 to August 2012, data for 24 children diagnosed with arachnoid cysts who underwent surgery at Seoul National University Children's Hospital were analyzed. Pre-operative and post-operative cyst volume was assessed and neurocognitive function was tested using the Korean version of the Wechsler Intelligence Scale for Children-Revised (WISC-R) and the Bender-Gestalt Test (BGT). Comparison of pre- and post-operative profiles by laterality of the arachnoid cyst was performed. RESULTS Patients had age-appropriate full-scale intelligent quotients (FSIQ), verbal IQ (VIQ), and performance IQ (PIQ) pre-operatively, which were maintained after surgery. Of the subtests, Block Design showed significant improvement post-operatively (p = 0.021). This means that visuo-spatial integration and mental construction abilities were improved after surgery. Patients with left or right arachnoid cysts did not show statistically significant changes in FSIQ, VIQ, or PIQ after surgery (110.21 versus 113.95, p = 0.307; 108.92 versus 111.54, p = 0.368; 107.88 versus 111.04, p = 0.152, respectively). Subanalysis showed that the pre- and post-operation VIQ mean scores of the patients with right arachnoid cysts were significantly higher (p < 0.054) than those of the patients with left arachnoid cysts, and there was no significant change after the surgery. INTERPRETATION There was no significant association among cyst volume reduction, laterality, and clinical neurocognitive function improvement. The present findings indicate a limited role for surgical intervention in improving the intellectual abilities of children with arachnoid cysts.
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Affiliation(s)
- Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, Republic of Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Min-Sup Shin
- Department of Psychiatry and Behavioral Science, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea. .,Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, Republic of Korea.
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Mustansir F, Bashir S, Darbar A. Management of Arachnoid Cysts: A Comprehensive Review. Cureus 2018; 10:e2458. [PMID: 29888162 PMCID: PMC5991924 DOI: 10.7759/cureus.2458] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022] Open
Abstract
Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled spaces lined with arachnoid membranes. Large arachnoid cysts are often symptomatic because they compress surrounding structures; therefore, they must be treated surgically. As several surgical management options exist, we explore the best approach according to each major type of arachnoid cyst: middle cranial fossa cyst, suprasellar cyst, intrahemispheric cyst, and quadrigeminal cyst.
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Takeshige N, Eto T, Nakashima S, Sakata K, Uchikado H, Abe T, Morioka M. Rare case of a rapidly enlarging symptomatic arachnoid cyst of the posterior fossa in an infant: A case report and review of the literature. Surg Neurol Int 2018; 9:57. [PMID: 29576908 PMCID: PMC5858048 DOI: 10.4103/sni.sni_245_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Intracranial arachnoid cysts are space-occupying lesions that typically remain stable or decrease in size over time. Cysts in infants younger than 1 year of age are remarkably different from those in older children and adults in terms of cyst localization and enlargement. Arachnoid cysts of the posterior fossa (PFACs) are very rare in infants and do not typically grow or present with clinical symptoms, such that surgical treatment is generally considered to be unnecessary. Here, we describe an extremely rare case of an infant with a rapidly enlarging symptomatic PFAC that was successfully treated with surgery. Case Description: A 4-month-old boy presented with increasing head circumference and a rapidly enlarging arachnoid cyst in the left posterior fossa with ventriculomegaly, which was documented using serial imaging over the preceding 2 months. We performed a microscopic resection of the cyst membrane to remove the mass effect as soon as possible and facilitate normal development. To confirm dural closure and prevent cerebrospinal fluid leakage, we also performed short-term (7 days) percutaneous long-tunneled external ventricle drainage after the surgery. Magnetic resonance imaging over a 4-year follow-up period revealed adequate reduction of the ventricle and cyst. The patient no longer exhibited progressive macrocrania and showed normal development. Conclusion: To our knowledge, this is the second successful case of surgical treatment of an enlarging symptomatic PFAC in an infant. Our surgical strategy for the treatment of this rare case can serve as a guide for surgeons in similar future cases.
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Affiliation(s)
- Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Tomoko Eto
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Shinji Nakashima
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Hisaaki Uchikado
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan
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24
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Surgery for intracranial arachnoid cysts in children-a prospective long-term study. Childs Nerv Syst 2016; 32:1257-63. [PMID: 27000761 DOI: 10.1007/s00381-016-3064-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Intracranial arachnoid cysts are cystic malformations found in both adults and children. While many are asymptomatic, some cause symptoms and warrant surgical treatment. In this prospective population-based study, we aimed to study the short- and long-term outcome after surgical intervention in children with arachnoid cysts referred to our centre. METHODS Twenty-seven pediatric patients (13 f. 14 m, mean age 9.4 years) with de novo cysts were consecutively included during a 5-year period. The presenting symptoms were headache (n = 12), balance disturbance and dizziness (n = 6), seizures (n = 6), hydrocephalus (n = 5), and macrocephaly (n = 1). Twenty-two patients underwent surgical treatment with either microsurgical (n = 17) or endoscopic fenestration (n = 5) of the cyst wall. Cyst volume was measured with OsiriX® software pre- and postoperatively. Short-term and long-term follow-up of all patients was conducted 3 months and 8.6 years (7-10.5 years) postoperatively. RESULTS Three months after surgery, 59 % of the patients were improved regarding at least one major complaint, and average cyst volume was reduced to 33.3 ml (0-145 ml). At the long-term follow-up of 8.6 years, 77 % of the patients were improved regarding at least one symptom but subjective symptoms remained in 59 %. There was no permanent postoperative morbidity. We found no association between radiological reduction of cyst volume and clinical improvement. CONCLUSION Our findings support a restrictive attitude to surgery for intracranial arachnoid cysts, in the absence of objectively verified symptoms and signs or obstruction of CSF pathways.
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Kimiwada T, Hayashi T, Narisawa A, Shirane R, Tominaga T. Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children. J Neurosurg Pediatr 2015; 16:533-539. [PMID: 26230463 DOI: 10.3171/2015.3.peds14573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.
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Affiliation(s)
| | | | | | - Reizo Shirane
- Department of Neurosurgery, Miyagi Children's Hospital
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Tan Z, Li Y, Zhu F, Zang D, Zhao C, Li C, Tong D, Zhang H, Chen Q. Children With Intracranial Arachnoid Cysts: Classification and Treatment. Medicine (Baltimore) 2015; 94:e1749. [PMID: 26554773 PMCID: PMC4915874 DOI: 10.1097/md.0000000000001749] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We performed a dynamic study of arachnoid cysts (ACs) using magnetic resonance cisternography (MRC) and proposed a classification of ACs.Twenty-three suitable patients in our hospital entered into this study according to our inclusion criteria. MRC images were collected in all the subjects at 1 and 24 hours after the administration of intrathecal gadolinium-diethylenetriamine penta-acetic acid (Gd-DTPA). We allocate the enrolled patients into 2 groups, MRC group and surgery group. The MRC results were considered before treatment in 1 group (MRC group, 13 patients), whereas another group was surgically treated without considering the MRC results (surgery group, 10 patients). We calculated the enhanced area of cyst using modified MacDonald Criteria from the images and measured the surrounding subarachnoid area as the reference.We found that it was practically useful to quantify 3 types of ACs, complete communicating, incomplete communicating, and noncommunicating, according to MRC results in this study. All the subjects in both groups are closely observed before the treatment and the follow-up using the MRI examination. In the surgery group, 5 patients were found that the area of cysts shrank in the follow-up stage. However, there was no significant difference in the percentage shrinkage area between the 2 groups.We concluded that MRC with Gd-DTPA as a contrast agent is of significant clinical value for the diagnosis and treatment of children with intracranial ACs. This classification based on dynamic MRC is useful for making surgical recommendations.
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Affiliation(s)
- Zhen Tan
- From the Department of Pediatric Neurosurgery, ShenZhen Children Hospital, ShenZhen (ZT, FZ, DZ, CL, DT, QC); Institute of Anatomy, Southern Medical University, GuangZhou (YL); Department of Pediatric Radiology, ShenZhen Children Hospital (CZ); and Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China (HZ)
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Salma A, Hassounah M, Alshail E, Althubaiti I. Letter to the Editor: Arachnoid cyst and the hemorrhagic complications of open decompression. J Neurosurg Pediatr 2015. [PMID: 26207669 DOI: 10.3171/2015.1.peds1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Asem Salma
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Maher Hassounah
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Essam Alshail
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ibrahim Althubaiti
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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