Somatomotor functional MRI in a hypertensive arachnoid cyst

Summary In this article the authors report the study by functional MRI, before and after surgery, of the motor cerebral cortex surrounding a large hypertensive arachnoid cyst. They stress that the functional modifications due to surgery are more relevant than suggested by the simple morphological data.     

Dissapearance of arachnoid cyst after rupturing into subdural space

Summary Arachnoid cysts are developmental anomalies usually diagnosed in childhood. The most important complications of arachnoid cysts are subdural haematomas and hygromas and intracystic haemorrhage. In our case we present a 7-year-old boy whose arachnoid cyst ruptured into the subdural space following a mild head injury and disappeared after draining the subdural haematoma by burr-holes.     

Cerebellar hemangioblastoma simulating arachnoid cyst on imaging and surgery

A case of posterior fossa hemangioblastoma simulating arachnoid cyst on imaging and peroperatively is presented. In vivo proton MR spectroscopy showed evidence of large lactate and resonance at 2.37 ppm not observed earlier in the cystic lesions, including arachnoid cyst. The demonstration of this resonance may help in characterization of these lesions that may be confused with arachnoid cysts on imaging and during surgery. Electronic Publication     

Posttraumatic intradiploic leptomeningeal cyst in an adult: Case report

We report the case of an adult with a posttraumatic intradiploic leptomeningeal cyst that caused a circumscribed osteolytic skull lesion. Local pain, the only symptom of the lesion, regressed after surgery. Intradiploic leptomeningeal cysts must be distinguished from intradiploic arachnoid cysts, which are of congenital origin.     

Spinal hydatid cyst mimicking arachnoid cyst on magnetic resonance imaging

BACKGROUND: Primary spinal hydatid cysts are uncommon and account for 1% of all cases of hydatid disease. Echinococcus granulosus is most often responsible for the cyst hydatid. Intradural, extramedullary involvement is rare. When the cysts do not demonstrate typical magnetic resonance imaging findings, the differential diagnosis is more complex. METHOD: Case report. FINDINGS: An isolated primary hydatid cyst of the spine in a 35-year-old man that appeared to be an arachnoid cyst on preoperative radiographic examination. CONCLUSION: Hydatid cysts that lack the typical radiographic appearance may be mistaken for arachnoid cysts. Misdiagnosis has serious implications for surgical intervention and long-term care.     

Rupture of a small middle cerebral artery aneurysm into middle fossa arachnoid cyst presenting as a chronic subdural haematoma

Summary The rupture of an aneurysm into an arachnoid cyst and subdural space is unusual. A 25-year-old man was admitted 2 weeks after having undergone a burr hole drainage for a chronic subdural haematoma elsewhere. An angiogram revealed a small aneurysm at the bifurcation of the middle cerebral artery. The aneurysm was clipped and the cyst communicated with the basal cisterns. To the best of our knowledge, this is the first report of an association of an aneurysm of the middle cerebral artery with an arachnoid cyst presenting as a chronic subdural haematoma. Correspondence: Hasan Kocaeli, Medical Centre, Department of Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, P.O. Box 670515, Cincinnati, OH 45267-0515, USA.     

Surgical therapy of symptomatic arachnoid cysts – an outcome analysis

Summary. Background. Arachnoid cysts may present with various symptoms and in different locations. Optimal treatment is still controversial, although cyst fenestration or shunt insertion are recognized as standard procedures. In this retrospective analysis the authors sought to determine which factors influence the outcome after surgery of symptomatic arachnoid cysts.Methods. 37 patients (24 male, 13 female, mean age 40.2 years) were treated within a ten year period in our institution. Mean follow-up was 39 months; follow-up was done on an ambulatory basis. For analysis patient charts were reviewed and cranial CT scans or MR investigations were examined to determine pre- and postoperative cyst volumes. Clinical outcome was graded into four subgroups using a scale based on the patients self-rating of success. Different factors were studied concerning their influence on outcome.Findings. Fenestration was performed in 28 cases, cysto-peritoneal or cysto-atrial shunting in 9 cases. A favourable outcome (subgroups 3 and 4) was achieved in 19 of 28 patients (fenestration) and in 6 of 9 patients (shunting), respectively. Mean reduction of the cyst volumes was 58% after fenestration and 74% after shunting revealing both methods to be effective. Degree of cyst volume reduction correlated significantly with clinical outcome. Patients with infratentorial cysts had more often a favourable outcome. Headache as the only symptom did not influence outcome.Conclusions. Surgery of symptomatic arachnoid cysts resulted in favourable outcome in two thirds of the patients. Both standard procedures, fenestration and shunting, are equally effective for treatment. Factors that influence outcome are the rate of volume reduction and cyst location.     

Spinal extradural arachnoid cyst

Summary Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. They usually present with progressive signs and symptoms caused by spinal cord compression if they enlarge. A comprehensive review about spinal extradural arachnoid cyst is made including the author’s own case of a 59-year-old woman with a 6-month history of progressive back pain radiating to both legs. Key points concerning the possible pathogenesis including symptomatology, diagnosis, and the implications for treatment are highlighted. Surgical treatment is curative and this rare clinical entity should be considered in the differential diagnosis of spinal extradural lesions.     

Spontaneous disappearance of a middle fossa arachnoid cyst associated with subdural hematoma

The case of a 7-year-old boy with a middle fossa arachnoid cyst that spontaneously disappeared is presented. Computed tomography (CT) scan revealed an arachnoid cyst in the right middle fossa with a thin subdural hematoma on the same side. As the subdural hematoma spontaneously resolved, the cyst became smaller and finally disappeared without surgical intervention after 18 months on the follow-up CT scans. Possible mechanisms of the spontaneous disappearance of an arachnoid cyst are discussed.     

Spontaneous disappearance of a large middle fossa arachnoid cyst

A case of a large middle fossa arachnoid cyst that spontaneously disappeared is reported. The possible mechanisms involved in the "natural cure" of this lesion and the indications for surgical versus conservative treatment of middle fossa arachnoid cysts are discussed.     

Giant prebulbomedullary arachnoid cyst. Case report and review of the literature

Usual locations of arachnoid cyst are the middle cranial fossa in 50-60%, cerebellopontine angle (10%) and suprasellar area (10%). Most of these malformations are asymptomatic. Premedullar arachnoid cysts are extremely rare. All previous cases reported were operated. We report a case of an asymptomatic giant craniocervical junction arachnoid cyst with a follow up of five years. In 2002, an adolescent consulted for persistent cervical pain. Encephalic MR showed a giant ventral craniocervical junction arachnoid cyst. Neurologic examination was normal. Conservative treatment was decided with a clinical follow up and repeated MR in case of persistent cervicalgia. Craniocervical junction arachnoid cysts are anecdotic. Medical care cannot be standardized. Pathogenesis and management are discussed.     

Intramedullary arachnoid cyst in association with cervical spondylosis: case report

Background context

Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently.

Purpose

Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis.

Study design

To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis.

Methods

Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity.

Result

Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status.

Conclusion

Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.     

Spontaneous resolution of arachnoid cysts: review and features of an unusual case

Summary Most intra-cranial arachnoid cysts are quiescent and remain asymptomatic throughout life. Within the natural course of arachnoid cyst evolution, spontaneous resolution has been known to occur rarely, but its frequency is probably underestimated due to lack of systematic detection and long-term observation. We illustrate the spontaneous regression of arachnoid cysts with a patient which was conjointly diagnosed with an arachnoid cyst and a post-traumatic epidural haematoma. Cyst regression was observed 16 months later, upon examination following a second benign cranial trauma. Mechanisms underlying the resolution of the arachnoid cyst are discussed.     

Suprasellar arachnoid cysts in children report of three cases

Summary Three cases of suprasellar arachnoid cysts in children are reported. Incidence, aetiology, pathogenesis, symptomatology, diagnosis, treatment, and other problems of these uncommon lesions are discussed.Communication presented at the XXXIst Meeting of the Portuguese-Spanish Neurosurgical Society. Santiago de Compostela, Spain. May 1979.     

Unusual computed tomographic findings in a case of arachnoid cyst in the middle cranial fossa

A rare case is reported of arachnoid cyst in the middle cranial fossa associated with intracystic hemorrhage and subdural hematoma. The preoperative computed tomography scans showed no difference in density among the cyst, the hematoma, and the brain parenchyma. The serial computed tomography scans after the accident were the most helpful in making the correct diagnosis.     

Stereotactic cyst/ventricular-peritoneal shunting for the treatment of prepontine arachnoid cyst: case report

BACKGROUND: Prepontine (suprasellar) arachnoid cysts are uncommon in clinical practice, so experiences in their management are limited and the best method of treatment for them remains unclear. Here we report our experience in using stereotactic cyst/ventricular-peritoneal shunting for the treatment of prepontine arachnoid cyst. CASE DESCRIPTION: A 42-year-old woman with prepontine arachnoid cyst was treated with cyst/ventricular-peritoneal shunting: the ventricular catheter was precisely inserted at a point where it could drain from the cyst and the ventricle at the same time. The postoperation CT scan showed that the cyst and the enlarged ventricle shrunk markedly. During a 1-year follow-up period, she remained symptom-free and had returned to full-time work. CONCLUSION: Stereotactic cyst/ventricular-peritoneal shunting appears to be an effective method for treating prepontine arachnoid cyst.     

Quality of life in adult patients with primary intracranial arachnoid cysts

Summary Background. Primary arachnoid cysts are benign developmental lesions of arachnoid mater. Arachnoid cysts may be detected due to various neurological symptoms, or they may be encountered as incidental findings of neuroimaging. Consequently, a significant share of the patients seems asymptomatic. There are diverging opinions about the clinical importance of cyst sizes, cyst location and degree of volume reduction after surgery, hence contributing to controversies regarding indications for surgical treatment. We present the first study assessing internationally established parameters of quality of life and mental health in a clinical-outcome analysis of adult patients with arachnoid cysts. Method. Ninety-two adult patients with arachnoid cysts who had been referred to our department over the last 16 years were included. Forty-seven patients had undergone surgery and 45 patients had not been operated on. Data for analysis was based on both medical records and questionnaires sent out by mail. Quality of life was assessed by the Short Form 36 Health Survey (SF-36), and mental health was further evaluated by the Hospital Anxiety and Depression Scale (HADS). Seventy-one percent of patients responded to our questionnaires. Findings. There was a great variation in the presenting symptoms, seemingly without any relation to cyst localisation. Patients with arachnoid cysts seem to have a reduced quality of life and a very high prevalence of anxiety compared to a healthy normal population. Men presented lower outcome scores than women. Subjects with symptoms, that we retrospectively labeled biologically comprehensible, tended to have higher quality of life, less anxiety and better subjective symptom relief after surgery. Conclusion. Our arachnoid cyst population had a low employment status, decreased quality of life scores and prevalent symptoms of anxiety. We argue that the arachnoid cysts are, in most cases, not directly related to these studied parameters. We speculate that our findings may reflect the demographic characteristics of adults likely of being diagnosed with incidental cysts. A better clinical outcome for patients with biologically plausible symptoms supports a neurobiological approach in the selection of patients suited for surgery.     

Neurogenic bladder in an infant due to spinal arachnoid cyst

Abstract The urinary bladder of patients with occult spinal defects may become dysfunctional, exposing the renal parenchyma to irreversible damage. However, during infancy clinical signs are often misdiagnosed. The treatment should be aimed at protecting kidneys from severe bladder dysfunction. We report a case of a female infant with an arachnoid cyst diagnosed at the age of 6 months, who suffered from intractable, repeated febrile urinary tract infections (UTI) for the previous 3 months. The images obtained by ultrasonography and voiding cystoureterography techniques were typical of a neurogenic bladder. The spinal cord was examined by magnetic resonance imaging (MRI), which revealed an arachnoid cyst that was surgically treated when the child was 8 months old. The postoperative results were excellent: spinal cord MRI was normal after 1 year, and the child experienced only one UTI episode in the next 2 years. Such an etiology of neurogenic bladder has never been reported in a 6-month-old child.     

Sacral extradural arachnoid cyst: a rare cause of low back and perineal pain

Sacral extradural arachnoid cysts are rare. The clinical and radiological features of this condition are characteristic. One such rare case with low back and perineal pain is presented and the literature is reviewed. This patient presented with pain in the low back and perineal region, which was aggravated by standing, walking and straining. The patient also had numbness in both lower limbs, precipitated by standing and walking. Both the symptoms were relieved by lying down. Magnetic resonance imaging (MRI) revealed a sacral extradural arachnoid cyst. Sacral laminectomy with opening of the arachnoid cyst and ligation of the fistulous tract was done. Postoperatively, there was complete clinical recovery. Though rare, this entity should be considered in the differential diagnosis of low back and perineal pain. Surgical treatment is curative.