Tectal plate cyst in adults

Cerebellar ependymal cyst: a case report

Rationale

Intracranial ependymal cysts are relatively rare. The current case report focuses on a patient who was diagnosed with an ependymal cyst and underwent surgical treatment. Postoperative pathological examination confirmed the presence of this lesion in the cerebellum.

Chief complaint

A 32-year-old female patient presented with a chief complaint of dizziness and headache with no triggers for the past 1 year. She also reported an increase in the frequency and intensity of symptoms in the past 2 weeks.

Diagnosis

Cranial magnetic resonance imaging (MRI) showed a rounded long T1 and T2 abnormal signal foci in the left posterior part of the brainstem under the cerebellar pallidum. The lesion had a clear boundary, was approximately 4.0 × 3.1 × 3.2 cm in size, and did not exhibit any definitive enhancement.

Interventions

Total resection of the lesion was carried out after completion of the preoperative examination.Treatment outcomes. The patient was discharged from the hospital on postoperative day 11 once their symptoms had disappeared. The sensory and motor functions of the limbs remained unaffected by treatment.

Experiences

Cerebellum ependymal cysts are rare, and most patients only experience discomfort due to cerebral edema. These lesions are also often difficult to differentiate from other intracranial cysts using imaging alone. The aim of this study was to report a rare case of ependymal cyst so that it may serve as a reference for diagnosis and treatment in the future.

Tectal plate cyst-associated hydrocephalus in an adult: Case report of a rare clinical entity

Obstructive hydrocephalus in adults can result from various etiologies, including rare cystic lesions such as tectal plate cysts. To depict a unique case of a tectal plate cyst causing hydrocephalus in an adult accompanied by persistent headaches, visual disturbances, and balance problems. In a clinical context, a 43-year-old female patient presented with a 2-week history of persistent headaches, accompanied by symptoms of dizziness, visual disturbances, and impaired balance. These headaches had exhibited a daily aggravation pattern over a year and were associated with concurrent manifestations of nausea, vomiting, and diplopia. Subsequent neuroimaging through a brain computed tomography (CT) scan disclosed the presence of hydrocephalus. Consultation with a neurologist and brain magnetic resonance imaging (MRI) yielded a diagnosis implicating a tectal plate cyst as the causative agent behind the obstructive hydrocephalus. The patient subsequently underwent surgical excision of the cyst. A follow-up assessment postoperation unveiled a marked improvement in the patient's clinical condition, characterized by the resolution of visual and gait impairments, as well as a notable reduction in the frequency and severity of headaches. This case highlights the importance of considering tectal plate cysts as an uncommon cause of hydrocephalus in the differential diagnosis of patients with persistent headaches and neurological symptoms. Early diagnosis and treatment with surgical removal of the cyst can significantly improve the patient's symptoms and prevent further complications such as hydrocephalus.

Quadrigeminal cistern arachnoid cyst as a probable cause of hemifacial spasm

Arachnoid cysts arising in the quadrigeminal cistern (ACQCs) are uncommon. A 68-year-old woman presented with an unsteady gait, facial spasm, and cerebellar ataxia. Non-contrast head computed tomography showed a cystic mass centered in the quadrigeminal cistern accompanying ventriculomegaly. On MRI, the cyst appeared hypointense on T1- and hyperintense on T2-weighted sequence. There was no restricted diffusion on diffusion-weighted imaging. The cerebral aqueduct was obstructed and the prepontine cistern was narrowed. The left vertebral artery (VA) coursed adjacent to the facial nerve at its origin. The patient underwent neuroendoscopic fenestration of the posterior wall of the third ventricle and ventral wall of the ACQC. Postoperatively, the patient's symptoms resolved. MRI showed a considerable reduction in the ACQC and expansion of the prepontine cistern, whereas the relationship between the left VA and the proximal segment of the facial nerve did not change. We assumed that the pre-existing close relationship between the VA and facial nerve might have been aggravated by the anterior displacement of the brainstem, thus causing the facial spasm.

Tectal pineal cyst in a 1-year-old girl

Glial cysts of the pineal gland can frequently be found in adults and children, but only rarely do they enlarge to become clinically relevant. We report a unique presentation of a pineal cyst in the midbrain tectum of a 16-month-old girl who initially presented with ptosis and strabismus. Preoperative imaging studies and intraoperative findings revealed no continuity between the tectal cyst and the pineal gland proper. We surmise that this tectal pineal cyst may have arisen from duplicated pineal gland tissue.

Calcifying pseudoneoplasm of the inferior colliculus: an unusual location for a rare tumor: case report

OBJECTIVE

Quadrigeminal plate lesions are rare and usually present with a silent clinical course. Tumors, vascular lesions, inflammatory and infectious processes have been described in this region. Calcifying pseudoneoplasms, also reported as fibro-osseous lesions, cerebral calculi, and brain stones, are unusual lesions in the central nervous system. They can be revealed by cranial radiography, computed tomography, and magnetic resonance imaging as calcified masses and should be differentiated from neoplastic, inflammatory, and vascular lesions. To the best of our knowledge, the occurrence of a calcifying pseudoneoplasm located at the quadrigeminal plate has not yet been reported.

CLINICAL PRESENTATION

A 67-year-old woman with a 6-month history of several daily attacks of dizziness presented to our service. Magnetic resonance imaging studies revealed a tumor in the right inferior colliculus. This lesion was isointense on T1-weighted imaging, hypointense on T2-weighted imaging, and homogeneously enhanced with contrast.

INTERVENTION

The lesion at the quadrigeminal plate was completely removed, and the patient was successfully treated without any new neurological deficit. At the time of follow-up, all preoperative symptoms had resolved.

CONCLUSION

We report the first case of a calcifying pseudoneoplasm of the inferior colliculus. Complete surgical removal of this type of tumor is feasible. We propose surgical treatment in this location when this tumor becomes symptomatic.

Endoscopic management of quadrigeminal arachnoid cysts

OBJECTIVE

Quadrigeminal cistern arachnoid cysts are rare lesions, accounting for 5% to 10% of all intracranial arachnoid cysts and 9% of all supratentorial localizations. We reviewed the patients with quadrigeminal arachnoid cyst (QAC) who were treated with neuroendoscopic intervention.

MATERIALS AND METHODS

Seventeen patients with QAC had been operated on between 2000 and 2007 in our institution. Four patients had undergone shunting prior to neuroendoscopic surgery. There were nine girls and seven boys with age ranging from 7 days to 17 years (mean, 40 months). All patients had hydrocephalus. A wide ventriculocystostomy (VC) and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. An aqueductal stent was also placed in two of the patients. Psychometric evaluation was administered postoperatively when possible. Follow-up of the patients ranged from 6 to 96 months (mean, 51.8 months).

RESULTS

Of the 17 patients, 12 underwent endoscopic procedure as the primary surgery. Five patients had been previously shunted. Macrocrania and psychomotor retardation were the main symptom and sign in all infants with QAC. Older children presented with the symptoms and signs of intracranial hypertension. Of the eight patients who were 6 months old or younger, only one did not need a ventriculo-peritoneal (VP) shunt. Endoscopic procedures were successful in all patients older than 6 months of age (P=0.005).

CONCLUSION

The patients presenting in their infancy had a psychomotor retardation, and all patients except for one, younger than 6 months of age, needed a VP shunt. Neuroendoscopic procedure is effective particularly in the patients with QAC older than 6 months of age.

Neuro-endoscopic management of mesencephalic intraparenchymal cyst: a case report

BACKGROUND

Intraparenchymal cyst of the mesencephalon is rare, and its natural course is unclear. The optimal treatment for this entity is still undetermined.

CASE DESCRIPTION

A 54-year-old woman was found to have asymptomatic multilobulated mesencephalic cysts. Two years after the initial diagnosis, she experienced headache and double vision, when MRI showed the enlargement of the multilobulated cystic lesions which markedly compressed the mesencephalon and the aqueduct, resulting in noncommunicating hydrocephalus. She underwent diagnostic endoscopic biopsy and ETV by flexible endoscopic system, which revealed the mesensephalic cyst wall at the dorsal part of the third ventricle floor. A part of the cyst membrane was carefully excised by endoscopic forceps without injuring the surrounding structures. Histopathological examination revealed that the cyst wall was exclusively neuroglial tissue, and the presence of neoplasm was ruled out. Her symptoms were relieved immediately after surgery, and postoperative MRI showed both the shrinkage of mesencephalic cysts and the improvement of hydrocephalus. There is no recurrence of her symptoms, and MRI findings have been stable during the 3 year follow-up period.

CONCLUSION

Intraparenchymal cysts of the mesencephalon have an expanding nature. Once those cysts become symptomatic, we recommend endoscopic procedure including decompression and biopsy of the cyst with ETV.