Huge arachnoid cyst incorporating choroid plexus

Background We report a rare case of arachnoid cyst incorporating choroid plexus. This 7-month-old girl presented with macrocrania. Magnetic resonance (MR) imaging disclosed a cystic lesion arising from the left prepontine cistern extending to the left middle cranial fossa.Methods First, we performed resection of the membrane microscopically and obtained an adequate reduction of the cystic size. However, 4 months after the first operation, the cyst was enlarged again, and bulging of the portion of the craniotomy was noted. Thus, we performed neuroendoscopic transcortical ventriculo-cyst-cysternostomy and confirmed the choroid plexus inside of the arachnoid cyst.Discussion Postoperative course was uneventful. This is the first reported case of choroid plexus within an arachnoid cyst, determined neuroendoscopically.     

Posttraumatic intraventricular arachnoid cyst accompanied by pseudomeningoencephalocele in a child

Growing skull fracture (GSF) is a rare complication of head trauma. A posttraumatic intraventricular arachnoid cyst (AC), neither isolated nor accompanied by a GSF has not been reported previously. A seven-year-old girl was admitted after a severe head injury with a separated right parieto-occipital fracture and contusion. She responded well to conservative therapy. Seven weeks after discharge, she was re-admitted with a large parieto-occipital pseudomeningoencephalocele due to herniation of cerebrospinal fluid and neural tissue to the subgaleal space through the widened fracture defect, an extra-axial cyst at the posterior interhemispheric space and an intraventricular cystic mass. She underwent open surgery, and the intraventricular cystic mass was totally removed. The histological findings were consistent with an AC. One week after dural repair, hydrocephalus developed, and a ventriculo-peritoneal shunt was inserted. She did well during two-year follow-up. The present case is unique as an intraventricular AC following head trauma. When an intraventricular cystic lesion is encountered after severe head trauma, the possibility of an AC should be considered; especially with neighboring contused neural tissue and leptomeningeal cyst formation.     

Choroid plexus cyst of the left lateral ventricle with intermittent blockage of the foramen of Monro, and initial invagination into the III ventricle in a child

A cyst of the choroid plexus of the left lateral ventricle with intermittent blockage of the foramen of Monro and initially with invagination of the III ventricle in a child is described. In a 6-week-old boy a ventriculoatrial shunt was implanted for correction of an active asymmetrical hydrocephalus of unknown origin. When he was 3 months of age a water-soluble contrast CT ventriculography revealed a noncolloid cyst localised predominantly in the upper portion of the III ventricle. At that time the ventricular catheter obstructed with choroid plexus was removed; new bilateral catheters in a parieto-occipital region were implanted. In the course of the next 4 years, first the atrial catheter had to be extracted and then the peritoneal catheter was changed, in both cases because of obstruction. Periods of normal life alternated with periods of transient and intermittent symptoms of increased intracranial pressure, papilloedema, and myoclonic jerks. Repeated computed tomography (CT) and magnetic resonance imaging (MRI) showed stabilised hydrocephalus with an enlarged left lateral ventricle. When the boy was 16 years old MRI revealed a choroid plexus cyst in the left lateral ventricle 2 cm in diameter, with a ball-valve type of obstruction of the foramen of Monro. CT stereoendoscopic resection of the wall of a large cyst filled with cerebrospinal fluid was performed, and two additional adnexal small cysts were coagulated using the bipolar coagulator, Diomed 25 laser and scissors; the symptoms then regressed, except for superior bilateral altitudinal anopsia. Light and electron microscopy of the cyst wall is reported. The cyst was composed of collagenic connective tissue lined with a basal lamina lacking in epithelial cells. The preoperative and postoperative MRI are presented. Choroid plexus cysts localised in the anterior part of lateral ventricles are very rare, and all reported cases have been in male patients. According to the literature our case is only the third ever described in a child. Received: 9 March 1998 Revised: 12 May 1998     

A case of intraventricular arachnoid cyst

A rare case of arachnoid cyst in the trigone of a lateral ventricle is reported. The patient was an 8-year-old boy who had had four episodes of convulsions prior to admission. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a cystic lesion containing fluid resembling cerebrospinal fluid. Although he received a cyst-peritoneal shunt, the lesion did not decrease in size. Direct removal of the cyst was then scheduled. The entirc cyst was finally removed, although it was firmly attached to the choroid plexus. The enlarged trigone gradually decreased in postoperative CT. The effectiveness of a cyst-peritoneal shunt is not always satisfactory. We recommend total resection of the cyst without use of a shunt system.     

Three-dimensional and ultrastructural ICAM-1 distribution in the choroid plexus, arachnoid membrane and dural sinus of inflammatory rats induced by LPS injection in the lateral ventricles

To investigate immunological environment in the cerebrospinal fluid (CSF) system, ultrastructural and three-dimensional localization of intercellular adhesion molecule-1 (ICAM-1) was studied in the choroid plexus, arachnoid membrane and dural sinus of LPS-stimulated rats with immuno-SEM and TEM. The choroid plexus epithelial cells expressed rich ICAM-1 along the microvilli. The arachnoid trabeculae fibroblast-like cells demonstrated ICAM-1 expression on both sides facing the subarachnoid space moderately. The dural sinus endothelial cells, however, showed only few ICAM-1 expression and no specific localization. These results suggest that the choroid plexus and arachnoid membrane may play an important mutual role for leukocyte migration in the CSF system, and that the CSF system may function in immunoreaction independently of the vascular system with the aid of up-regulated ICAM-1 expression.     

Surgical approaches to meningiomas of the lateral ventricles

Background

Intraventricular meningiomas account for 0.5–3% of all intracranial meningiomas. The majority occur in the atrium of the lateral ventricle. Surgical experience with intraventricular meningiomas is rare in the literature, and several surgical approaches exist.

Methods

Between 1987 and 2007, 13 patients underwent resection of intraventricular meningiomas. All patients had tumors of the lateral ventricles. These patients were retrospectively identified and their records reviewed.

Results

Eleven tumors were found in the atrium, one in the frontal horn, and one in the body of the lateral ventricle. In 9 of 13 cases, the tumor occurred in the left lateral ventricle. Patients commonly presented with headache and cognitive difficulties. A visual field deficit was noted preoperatively in one patient. Four patients underwent preoperative angiography, but no patients underwent embolization. Gross total resection was achieved in all cases: 6 via a middle temporal gyrus approach, 5 via a superior parietal lobule approach, and 2 via a transcallosal approach. Image-guided stereotaxis was used in 6 cases. Pathology was benign in 12 of 13 cases; atypical features were identified in one case. There was no operative mortality, and no patients showed evidence of recurrence. Postoperatively, 3 patients developed new cognitive-linguistic deficits that subsequently resolved. One of these patients developed a new visual field deficit after surgery.

Conclusions

Several approaches are available for the surgical treatment of intraventricular meningiomas. Tumor location, extension, and laterality drive the selection algorithm for these approaches. Preoperative angiography is rarely useful, and surgical cure is the rule.     

儿童蛛网膜囊肿伴癫癎的外科治疗(附13例报告)

目的 探讨儿童颅内蛛网膜囊肿（ａｒａｃｈｎｏｉｄ ｃｙｓｔ,ＡＣ）与癫癎的关系以及外科治疗方法。方法 手术治疗颅内蛛网膜囊肿伴癫癎的儿童１３例,其中额叶２例,顶叶１例,颞叶８例,枕叶２例,囊肿直径在３ｃｍ以下３例,３～６ｃｍ ９例,６ｃｍ以上１例,均采用颅内蛛网膜囊肿加致癎灶切除。结果 １３例病人中,完全不发作有４例,显著改善有７例,无变化２例。结论 儿童颅内蛛网膜囊肿伴癫癎具有脑皮质结构性异常,采用颅内蛛网膜囊肿加致癎灶切除效果较为理想。     

Xanthogranulomatous colloid cyst of the third ventricle

Summary This is a case report of a xanthogranulomatous colloid cyst of the 3rd ventricle. Posible etiologies for this rare entiry, along with the clinical problems that may be associated with it, and the differential diagnosis are discussed.     

Familial posterior fossa arachnoid cyst

Background Arachnoid cysts are a relatively common incidental finding on CT scans of the brain. They most commonly occur in the middle cranial fossa, where familial occurrence has rarely been reported. Posterior fossa arachnoid cysts are more unusual.Case histories We report the presence of quadrigeminal cistern arachnoid cysts in siblings.     

Slit ventricle syndrome after cyst-peritoneal shunting for temporal arachnoid cyst in children--a clinical entity difficult to detect on neuroimaging study

Slit ventricle syndrome, known to occur from malfunction of the shunt procedure for hydrocephalus, is reported after cyst-peritoneal shunt for temporal arachnoid cyst. Two children aged 12 and 10 years, who underwent cyst-peritoneal shunting for a large temporal arachnoid cyst at the age of 10 and 5 years, respectively, recently experienced several episodes of severe headache. Prior to admission, repeated CT scans did not reveal any morphological change in either of these two patients. Evidence of high intracranial pressure by lumbar tap revealed shunt malfunction. Both patients became free of neurological complaints and deficits after shunt revision. Despite elevated intracranial pressure due to shunt malfunction, neuroimaging studies showed no morphological changes in slit ventricle syndrome. Delay in both the diagnosis and prompt treatment may result in complete loss of visual acuity and even death. It is important to suspect this complication in patients with persistent elevated intracranial pressure symptoms and signs after any shunting procedure, regardless of unchanged neuroimaging studies. Once this is suspected, lumbar tap may be necessary and the choice of treatment is shunt revision.     

Development of a middle fossa arachnoid cyst A theory on its pathogenesis

The progression of congenital arachnoid cysts has seldom been documented. We report the case of a child who was diagnosed with arrested hydrocephalus at the age of 13 months. Neuroimaging studies performed when the girl was 22 months old showed the appearance of an arachnoid cyst in the right middle fossa, while the previously enlarged ventricles seemed to have decreased in size. To the best of our knowledge, the paradoxical expansion of an arachnoid pouch following a reduction in the size of the ventricular system has not previously been documented. We advance the hypothesis that the development of some cases of arachnoid cyst might be pathogenically related to impaired CSF dynamics associated with pre-existing hydrocephalus. We also briefly review the pertinent literature on the formation and evolution of congenital cerebral arachnoid cysts. Received: 4 September 1998     

颅内蛛网膜囊肿伴发癫痫的手术治疗

目的 通过对37例颅内蛛网膜囊肿(intracranial arachnoid cyst,IAC)伴发癫痫患者手术治疗情况的回顾分析,以期对此类患者手术方法的选择提供依据.方法 25例患者归为囊肿手术组,方法有囊肿壁切除术、囊肿-腹腔分流术和囊肿造瘘术;12例患者归为癫痫手术组,行囊肿壁切除术同时,切除囊肿周围萎缩变性致痫脑组织,如果患者残存颞叶内侧及杏仁核、海马结构,也予以切除,如囊肿周围邻近功能区,则通过体感诱发电位确定中央沟后于功能区行多处软膜下横切术,必要时行脑皮质离断术和胼胝体切开术,12例均行术中皮层脑电图监测.结果 术后37例患者中6例囊肿消失,17例减小,14例无变化,两组相比无显著性差异;囊肿手术组2例无发作,8例改善,15例无效,手术总有效率40%;癫痫手术组7例无发作,3例改善,2例无效,手术总有效率83.3%,两组相比有显著性差异(P＜0.05).结论 IAC伴发癫痫患者术前进行癫痫灶的确认,术中行囊肿壁切除术同时切除癫痫灶,大大提高IAC伴发癫痫的手术疗效.     

Pseudotumor syndrome in treated arachnoid cysts

We report three patients with arachnoid cysts treated by cyst-peritoneal shunting in whom intracranial hypertension occurred during episodes of shunt malfunction. In one case this was associated with re-expansion of the arachnoid cyst, whilst in the other two cases this did not occur. The similarities between these two cases and patients with pseudotumor cerebri suggest a common pathogenic mechanism — specifically, a disturbance of the cerebrospinal fluid circulation.     

Acetazolamide and corticosteroid therapy in complicated arachnoid cyst

Case report We report on the successful conservative treatment of a child harbouring a right-temporal arachnoid cyst associated with bilateral hygroma.Treatment Medical treatment was by corticosteroids for several days and acetazolamide (15 mg/kg/die) for 10 months.Outcome Clinical symptoms and signs disappeared completely with partial resolution of the bilateral hygroma at MRI follow-up.     

Magnetic resonance diagnosis of spinal arachnoid cyst

Magnetic resonance (MR) findings in one case each of extradural and intradural arachnoid cyst are described. Thoracic segments were involved in both cases. The cysts were slightly more intense than cerebrospinal fluid in both cases on T1 weighted images. The nature and extent of the lesions wer better demonstrated on MR images as compared with combined myelography and computed tomography.     

Postinflammatory arachnoid cyst of the quadrigeminal cistern

Arachnoid cysts of the quadrigeminal cistern are rare. Patients with this lesion are usually normal at birth, and signs of increased intracranial pressure (IICP) develop at about 4 to 12 months of age. However, there has been no report about this mechanism. A case of arachnoid cyst of the quadrigeminal cistern is presented. In this case, the process of the cyst growth was observed during the course of follow-up for shunted hydrocephalus. Symptoms coincided with the growth of the cyst. Therefore, the development of the clinical symptoms was thought to be due to IICP caused by cyst expansion. Our case was complicated by inflammation, something that may offer a key to solving the mechanism of cyst fluid accumulation and the relationship between symptoms and development of the cyst.     

Anterior cervical arachnoid cyst presenting with traumatic quadriplegia

Introduction Intradural spinal arachnoid cysts are rare. Rarer still are cysts located anterior to the cervical spinal cord. To date, only 10 such cases have been reported in the English-language literature.Case report Two cases of anterior cervical arachnoid cysts that presented as traumatic quadriplegia are reported.     

Epilepsy associated with a cerebellar arachnoid cyst: seizure control following fenestration of the cyst

Objective The role of the cerebellum in the pathogenesis of seizures remains controversial. Cerebellar origin of seizures, albeit rare, has been described in the literature in association with intrinsic lesions of the cerebellum. We present a unique case of a patient with medically intractable, secondary generalized epilepsy, associated with a superior cerebellar quadrigeminal arachnoid cyst. Clinical presentation A 9-year-old child presented with medically refractory secondary generalized epilepsy associated with recurrent headaches since 6 months of age. The child also had moderate intellectual impairment and autism. On the magnetic resonance imaging (MRI) of the head, he was noticed to have a small superior cerebellar arachnoid cyst in the quadrigeminal area that had increased in size slightly. Interictal electroencephalograph (EEG) was unable to localize the site of the epilepsy. Neurological examination was unremarkable. Intervention A suboccipital craniotomy and supracerebellar infratentorial approach to the cyst was performed at 9 years of age. Intraoperative electrocorticography (ECOG) demonstrated epileptic activity from the cerebellar tissue adjacent to the cyst. The cyst was fenestrated, and the cyst wall was sent for histology. Seizure control improved dramatically after fenestration of the cyst. Conclusion This case provides strong evidence that, albeit rare, the cerebellum may be a source of epileptic activity due to compression by a lesion in the posterior fossa. Hence, in cases with intractable epilepsy of unknown supratentorial source, the differential diagnosis should include a posterior fossa lesion. The finding of a posterior fossa lesion in such cases, even if it is small and appears benign, should precipitate a discussion about the possible relationship between the posterior fossa lesion and the epilepsy.     

CT脑池造影在颅内蛛网膜囊肿诊断及治疗中的应用

目的 探讨CT脑池造影(CTC)在颅内蛛网膜囊肿(IAC)诊断及治疗中的应用价值.方法 南方医科大学南方医院神经外科自2006年10月至2009年10月共收治23例IAC患者.其中非交通性蛛网膜囊肿(NCtAC)患者采用神经内镜造瘘并部分囊壁切除手术治疗,交通性蛛网膜囊肿(CIAC)患者采用保守治疗,通过患者手术前后CT、MRI及CT脑池造影(CTC)检查,分析CTC在鉴别诊断CIAC和NCIAC、评价手术治疗NCIAC的效果中的作用. 结果 CTC证实本组患者中17例为NCIAC即真性囊肿,6例为CIAC即假性囊肿;随访术后NCIAC患者CT或MRI检查显示1例囊肿消失,13例囊肿有不同程度缩小,3例无明显变化.随机抽取8例NCIAC患者行CTC检查显示囊肿与脑池沟通良好. 结论 CTC对颅内囊性病变的诊断,尤其是对CIAC和NCIAC的鉴别诊断中的作用尤为重要,CTC检查为颅内囊性病变是否手术治疗提供明确指征,并且术后CTC检查可初步评价囊肿手术效果.