A case of symptomatic interhemispheric arachnoid cyst in the elderly]

The incidence of interhemispheric cyst is rare. There have been only 12 cases reported in adults since the advent of CT. We encountered a case of an interhemispheric arachnoid cyst in a 54-year-old patient who had developed paraparesis. Excision of the cystic wall produced a satisfactory result. The CT and MRI scans were not contributory to histological differentiation of the lesions. According to the literature, however, it is highly likely that these patients are suffering from an arachnoid cyst, when the interhemispheric cyst without agenesis of the corpus callosum occurs in adults.     

Epithelial cysts of the central nervous system: report of two cases

Two cases of epithelial cyst are reported. Case 1. A 68-year-old female visited our hospital with a complaint of decreased visual acuity, 0.04 in the left eye, in September 1986. Visual field examination showed bitemporal hemianopsia. CT scan demonstrated nonenhancing cystic lesion involving the suprasellar region. By a right frontotemporal craniotomy, the suprasellar cyst was explored. The wall of the cyst was partially removed to relieve pressure against both optic nerves and chiasma. Histologically, the cyst wall was lined with a single layer of non-ciliated cuboidal epithelium. Electron microscopic study revealed a number of microvilli, continuous basement membrane and desmosomes. Case 2. A 40-year-old female was admitted to our hospital because of sensory disturbance in the left hand for several years. She had an episode of convulsive seizure with a loss of consciousness. Neurological examination revealed hypesthesia of the left hand. CT scan showed non-enhancing right frontoparietal cystic lesion compressing the right lateral ventricle to the left. By a right frontoparietal craniotomy, the cystic lesion was explored. The cyst existed beneath an arachnoid membrane and contained CSF-like clear fluid. The cyst wall was resected, as far as possible, to obtain communication with normal subarachnoid CSF space. Histologically, by light and electron microscopic study, the cyst was considered to be an epithelial cyst. A correct diagnosis is difficult because other cystic lesions such as arachnoid cysts and craniopharyngioma are of similar low density and appear the same on CT scan. It is impossible to diagnose such an epithelial cyst by relying on neuroradiological study alone.(ABSTRACT TRUNCATED AT 250 WORDS)     

Interhemispheric arachnoid cyst in the elderly: case report and review of the literature

BACKGROUND: Preoperative differential diagnosis of interhemispheric cysts is sometimes difficult. CASE DESCRIPTION: We recently experienced a case of symptomatic interhemispheric arachnoid cyst in a 62-year-old woman. We reviewed interhemispheric arachnoid cysts in the elderly and the management of symptomatic interhemispheric arachnoid cysts in elderly patients. Symptomatic interhemispheric arachnoid cysts in the elderly are predominantly located on the right side, have a long history of progressive symptomology, occur predominantly in females, and have no communication with the subarachnoid space. Interhemispheric arachnoid cysts are usually not associated with agenesis of the corpus callosum in elderly patients, whereas interhemispheric nonarachnoid cysts are usually associated with agenesis of the corpus callosum, which will be clearly demonstrated on magnetic resonance imaging. CONCLUSIONS: It is highly possible that an interhemispheric cyst without agenesis of the corpus callosum in an adult is an arachnoid cyst.     

Spinal arachnoid cysts associated with syringomyelia: report of two cases and a review of the literature

We describe two cases of spinal arachnoid cyst associated with syringomyelia and report the clinical results after surgical treatment using excision of the cyst without a shunt operation for the syringomyelia. Case 1 is a 73-year-old woman who presented with a spastic gait and numbness of her bilateral lower extremities. Magnetic resonance imaging (MRI) showed the presence of a spinal arachnoid cyst extending from T3 to T8 and syringomyelia from T8 to T10. The cyst had compressed the spinal cord anteriorly. We excised the cyst without applying a shunt tube for the syringomyelia. Case 2 is a 68-year-old woman who presented with gait disturbance and numbness of her left lower extremity. MRI indicated that the spinal cord had been compressed anteriorly by a spinal arachnoid cyst extending from T10 to T11. Syringomyelia existed just caudal to the cyst at T11. In our surgical treatment, we excised only the cyst. In both cases, neurologic examination after the operation showed amelioration of the condition. Postoperative MRI indicated that the spinal cord had moved to the center, its original position, and the syringomyelia had decreased in size. Conclusively, spinal arachnoid cyst associated with syringomyelia can be treated by simple excision of the cyst without shunting the syrinx if the decompression effect resulting from removal of the cyst is sufficient.     

Two cases of symptomatic arachnoid cysts in elderly patients--a comparison and analysis with child cases

A symptomatic arachnoid cyst in an elderly patient is rare. We report two cases of symptomatic arachnoid cysts in elderly patients. The first case is that of a 73-year-old woman complaining of headache and speech disturbance. She had an arachnoid cyst in the left interhemispheric fissure. This is rare. Only two interhemispheric arachnoid cysts in the elderly have ever been reported. The other case is that of a 64-year-old woman, having right hemiparesis and dementia and a cyst is shown in her left temporal lobe. Both patients underwent a cystectomy which resulted in the disappearance of their symptoms. Only 56 cases of symptomatic arachnoid cyst over the age of 60 years have ever been reported. We made an analysis of 58 cases, including our two cases, and compared it with child cases. In cases of the elderly, the symptoms are usually headache, hemiparesis, gait disturbance and dementia, which are similar to symptoms of chronic subdural hematoma and normal pressure hydrocephalus. On the other hand, child cases usually reveal signs of intracranial hypertension. Several authors have reported their therapeutic method for child symptomatic arachnoid cysts. However, it is difficult to determine the best method for treating child cases at this time. We think a cystectomy is the first choice of operative procedure for symptomatic arachnoid cyst in the elderly.     

Double-endoscopic approach for management of convexity arachnoid cyst: case report

BACKGROUND: Controversy exists about the best treatment modality for arachnoid cysts. Widely accepted neurosurgical options include craniotomy with open resection of the cyst walls, shunting procedures and stereotactic fenestration of the cyst cavity. Recently, neuroendoscopic approach showed its effectiveness for treatment of these lesions. CASE DESCRIPTION: In the presented case the large convexity arachnoid cyst was diagnosed in a 22-year-old woman with head dullness and local bone bulging. No neurologic signs were found. Surgery was performed by double-neuroendoscopic approach with simultaneous use of two flexible ventriculofiberscopes, which permitted wide resection of the inner cyst wall. Complete resolution of symptoms was noted soon after surgery. CONCLUSION: Double-endoscopic approach might be useful for complex neuroendoscopic procedures that need different simultaneous surgical actions, particularly for cases of large arachnoid cysts.     

骶管内蛛网膜囊肿的MRI表现及诊断价值

目的 探讨骶管内蛛网膜囊肿的MRI特点及其诊断价值.方法 28例骶管内蛛网膜囊肿经手术病理证实.其中其中男19例,女9例,年龄16～70岁,平均41.6岁.所有病例均行MR检查.结果 囊肿位于骶管内,呈卵圆形、不规则形、串珠形.囊肿境界清楚,囊壁薄,囊液信号与脑脊液信号相似,T1WI囊液呈低信号,T2WI囊液呈高信号,其中4例囊肿内可见细条状神经根影,6例增强扫描囊液、囊壁无强化.结论 MRI是最好的影像学诊断方法;骶管内蛛网膜囊肿的发生,主要是先天的硬膜缺陷所致.     

A case of arachnoid cyst in the posterior fossa with lower cranial nerve palsy

We experienced a rare case of arachnoid cyst in the right cerebellomedullary cistern. A 59-year-old female was admitted to our clinic because of lower cranial nerve palsy (deviation of uvula to the left side, swallowing disturbance, curtain sign, hoarseness, atrophy of the right sternocleidomastoid muscle, and deviation of the tongue to the right side). MRI demonstrated a mass lesion compressed towards the medulla oblongata in the right cerebellomedullary cistern. MRI was very helpful as a diagnostic tool, since there is no bone object in the posterior fossa. Although by CT cisternography, the arachnoid cyst was thought to have a communication with the surrounding subarachnoid spaces, the cyst wall was removed because of its compressive symptoms on the lower cranial nerves. After the operation, the cyst shrank, and the clinical symptoms were reduced.     

Cyst formation of meningioma: report of two cases and review of literature

Cystic meningioma is rare and said to account for 1 to 2% of all types of meningioma. Here we report two cases of cystic meningioma. Case 1 is a 25-year-old man. He had suffered from sporadic epileptic seizure for about two years until the first CT was performed. It revealed a large cystic lesion at the right parietal region in touch with the midline structure. A nodular high density area was delineated in the contrast enhanced CT on the medial wall of the cyst. He showed no neurological abnormality at all. Case 2 is a 56-year-old female who had been complaining of memory disturbance, and an episode of sudden dizziness followed by a syncope that lasted for a few minutes. Neurological examination revealed slight right hemiparesis, right homonymous hemianopsia and left papilledema. A large cystic lesion was delineated at the temporal region in the plain CT, and no positively enhanced region could be found in the contrast enhanced CT. After surgical removal of the tumors, both cases were identified as cases of meningioma. They were diagnosed histopathologically as a fibroblastic meningioma and a meningotheliomatous meningioma respectively. The wall of the cyst consisted of the cortical surface per se in both cases. Preoperative diagnosis of such cases and the mechanism by which the cyst is formed were also discussed.     

症状性骶管内囊肿的诊断与治疗

目的：探讨症状性骶管内蛛网膜囊肿的诊断与治疗方法.方法：对12例以骶管内神经受压表现为主,如腰骶部疼痛、下肢痛、会阴部疼痛,鞍区麻木不适,大小便障碍,下肢无力患者,行MRI检查.结合临床症状、体征及MRI表现明确诊断为症状性骶管内囊肿后行手术治疗.手术均在显微镜下操作.对未见明显交通孔的7例中5例行囊壁大部切除后残存囊壁修补缝扎,2例因硬脊膜缺如,无法修补而行囊肿部分切除旷置;5例有交通孔的患者中,2例囊肿大部切除后用肌肉填塞交通孔,2例因交通孔处理困难未作特殊处理,1例囊肿大部切除后,切开交通孔处硬脊膜以扩大交通孔至脑脊液通畅流出,消除交通孔的单向阀门作用.严密缝合切口,术后采取头低臀高俯卧位.结果：骶管内囊肿在MRI上表现为骶管内单发或多发类圆形或椭圆形的软组织影,呈长T1、长T2表现,信号与脑脊液相同.术后2例出现少量皮下积液,加压包扎2～3个月后自行吸收,无1例脑脊液漏.随访3个月～4年6个月,平均18.3个月,症状完全缓解8例,部分缓解3例,1例3个月后症状复发,MRI检查示囊肿较术前轻微扩大,未再次手术.结论：MRI检查是正确诊断骶管内蛛网膜囊肿的有力手段,伴有临床症状、体征者应考虑手术治疗.对囊肿的处理以囊肿大部切除为主,严密缝合切口各层及术后合理体位可以有效防止并发症的发生.     

Spinal extradural meningeal cyst with spinal stenosis

STUDY DESIGN: Case report. OBJECTIVE: To present a rare pathology causing a common disease. SETTING: Spine unit of the orthopaedic surgery department of a university hospital in Berlin/Germany. CASE REPORT: A 39-year-old female with an intraspinal extradural arachnoid cyst of the lumbar spine presented with intermittent radiating lumbar pain. The magnetic resonance imaging (MRI) showed a dorsal spinal extradural arachnoid cyst at L3/4. After wide laminotomy L3, operative cyst resection and stabilisation at L3/4 by posterior lumbar interbody fusion (PLIF), major symptom relief occurred. CONCLUSION: Spinal extradural arachnoid cysts are a rare entity causing low back pain and intermittent radicular syndromes. They can be caused by arachnoid herniation through dural weak spots which are hereditary or occur after trauma. A ball-valve mechanism promotes growth. The main diagnostic tool for spinal extradural cysts is the MRI scan. Additionally, myelography is helpful to demonstrate fluid communication. Complete surgical removal of the cyst should be attempted to reduce risk of recurrence. If extensive decompression is needed for the surgical approach causing segmental instability, interbody fusion is recommended. The outcome depends on age, duration and degree of neurological damage.     

A case of symptomatic arachnoid cyst of the occipital convexity in an adult

Symptomatic arachnoid cyst in an adult patient is rare. We present a case of a 51-year-old female with an arachnoid cyst of the right occipital convexity who developed homonymous hemianopsia. She had complained of numbness in the limbs at the age of 47 and based on MRI was diagnosed with a cystic space-occupying lesion in the right occipital convexity. After being under observation for four and a half years, she complained of headache and visual disturbance, at which time we diagnosed growth of the cyst. On ophthalmologic examination, homonymous hemianopsia was demonstrated. She underwent membranectomy, which resulted in the disappearance of visual disturbance. This case is comparatively rare among previously reported cases of symptomatic arachnoid cyst with regard to both location and symptom. Membranectomy is one of effective methods for treating symptomatic arachnoid cyst in the occipital convexity.     

Clinical study on intracranial arachnoid cyst: with reference to the middle cranial fossa

Thirty-two cases of congenital arachnoid cyst (AC), 26 cases of supratentorial, and 6 cases of infratentorial cyst are reported. They were encountered over a period of 9 years. The 26 supratentorial cysts consisted of 21 cases located in the middle fossa, 2 in the frontal, and 3 in the suprasellar. Patients' ages ranged from 7 months to 67 years (mean: 19.3 years), with a male to female ratio of 23:9. The most common symptoms were headache, epileptic seizure, and cranial enlargement. Based on observations between neuroradiological examinations including analysis of the cyst content, and operation, typical AC might be defined as "duplicated arachnoid and its splitting", and it may be said that "there is continuous existence of cerebral structure such as cortex and white matter lying adjacent to AC on MRI". Out of 32 cases, 15 received surgical treatment because of mass effect of AC itself, abnormal dynamics of the AC fluid, and/or increasing sign of ICP. 13 cases had resection of AC outer membrane with craniotomy, and the remaining two had cystoperitoneal shunt. One of the shunting cases complicated subdural hematoma. Surgical treatment was discussed and radical craniotomy rather than a shunt procedure was preferred. Prognosis of all cases was favorable and uneventful.     

Usefulness of constructive interference in steady state (CISS) imaging for the diagnosis and treatment of a large extradural spinal arachnoid cyst.

We present a rare case of a symptomatic large extradural arachnoid cyst extending from the lower thoracic to sacral region in a 12-year-old boy, who presented with the signs and symptoms of spinal cord compression over 4 years. Since the pedicle of the cyst could not be delineated using conventional magnetic resonance imaging (MRI), cine-mode MRI, and computed tomography scan, partial resection of the cyst was initially performed, which significantly improved motor function. After the first operation, a single pedicle was clearly demonstrated by 3D constructive interference in steady state (CISS) MRI. Thus, additional surgery aimed at closing the dural defect was performed to prevent future enlargement of the cyst. The operative findings were consistent with those of 3D CISS imaging. Clinical and radiological features of this lesion are discussed, focusing on the usefulness of 3D CISS MRI for preoperative evaluation, and especially for delineating the pedicle in cases of large extradural spinal arachnoid cysts.     

Huge thoracolumbar extradural arachnoid cyst excised by recapping T-saw laminoplasty

Background context

Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Total removal of the cyst and repair of the dural defect is the primary treatment for symptomatic spinal extradural arachnoid cysts.

Purpose

To report the usefulness of recapping T-saw laminoplasty in treating huge extradural arachnoid cyst.

Study design

Case report.

Methods

We report the case of a 43-year-old man who presented with a 2-year history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) showed a huge extradural arachnoid cyst at the T12–L3 level extending into bilateral neural foramina and severe posterior compression of the spinal cord and cauda equina.

Results

The patient underwent total resection of the cyst and closure of the communication. En bloc recapping T-saw laminoplasty of T12–L2 including the T12–L1 and L1–L2 facet joints was performed to obtain extensive exposure and preserve posterior stability. Postoperatively, the patient achieved complete recovery of neurologic functions. Follow-up MRI demonstrated no recurrence of the cyst. Bone union after laminoplasty was obtained within 6 months.

Conclusion

Total resection of the cyst and closure of the communication is curative for this rare lesion. Recapping T-saw laminoplasty provides extensive exposure for removal of a large cyst while allowing complete preservation of the posterior spinal elements.     

Entirely suprasellar symptomatic Rathke's cleft cyst

Two rare cases of entirely suprasellar Rathke's cleft cyst were reported. Case 1. A 62-year-old man was admitted to our hospital on the 14th of January, 1988, complaining of headache and diplopia. A plain skull x-ray showed the sella turcica was normal. CT scan and MRI demonstrated a lesion mass located entirely in the suprasellar cistern. Right frontotemporal craniotomy was performed, and the cyst wall was resected subtotally. Microscopic sections of cyst wall showed ciliated single layer with focal stratified epithelium. Case 2. A 51-year-old man was hospitalized complaining of visual impairment in the left eye. Endocrinological examination showed no abnormalities. CT and MRI demonstrated a lesion mass located entirely in the suprasellar region. Right frontotemporal craniotomy was performed. The mass was opened and a large amount of yellowish fluid was released. Histologically, the specimens were simple ciliated cuboidal epithelium. Postoperative courses of these patients were uneventful. The findings on CT and MRI of the cases located entirely in the suprasellar region were varied. The histopathogenesis and embryological pathogenesis of Rathke's cleft cyst in the literature, particularly the entirely suprasellar type, were discussed.     

Intraventricular arachnoid cyst appearing with attacks of orbital pain: case report and review of the literature

While there have been 5 cases of intraventricular arachnoid cyst published in the literature, the occurrence in the anterior horn of the lateral ventricle has not been reported. We report a case of intraventricular arachnoid cyst of the anterior horn causing attacks of orbital pain. A 30-year-old man was admitted with frequent attacks of orbital pain on his right side. Neurological examination revealed no abnormality. Plain CT showed a cystic dilatation of the anterior horn of the right lateral ventricle, and enhanced CT showed a deviation of the septal veins to the left side. T1-weighted MRI demonstrated a low-intensity mass in the anterior horn of the right lateral ventricle, and T2-weighted image demonstrated the mass as having high intensity. PEG in the sitting position showed no filling of air into the right lateral ventricle due to obstruction of the right foramen of Monro. The patient underwent an operation under a diagnosis of intraventricular benign cyst. The cyst wall was subtotally removed and the right foramen of Monro was opened. Histological examination of the specimen showed an arachnoid membrane with prolific collagen fibers. From an embryological point of view, the arachnoid membrane is derived from the arachnoid cell. We think intraventricular arachnoid cysts to originate from the remnants of the arachnoid cell on the tela choroidea or on the choroid plexus like intraventricular meningiomas.     

内镜下经鼻蝶入路单纯肌肉填塞法治疗鞍内蛛网膜囊肿的临床效果

目的探讨经鼻蝶入路单纯肌肉填塞法治疗鞍内蛛网膜囊肿的临床效果。方法回顾性分析2014年1月至2020年2月于郑州大学第一附属医院神经外科行经鼻蝶入路单纯肌肉填塞法治疗的11例鞍内蛛网膜囊肿患者的临床资料。男性5例, 女性6例, 中位年龄48岁(范围:23～75岁)。临床表现包括头痛6例, 头晕4例, 性欲减退1例, 意识障碍1例, 视力障碍7例和混合性垂体功能障碍5例。患者术前MRI图像均可见鞍窝扩大, MRI增强图像显示鞍内蛛网膜囊肿囊壁未见强化, CT图像可见鞍底受压变薄。9例患者囊肿向鞍上扩展, 鞍隔受压呈"弓形", 7例囊肿向上压迫视交叉。患者均于神经内镜下经鼻蝶入路切开囊肿壁, 充分引流并填塞肌肉。观察患者术后症状、垂体内分泌功能改善情况及复发情况。结果所有患者术后鞍区MRI图像可见囊肿明显减小或消失。发生颅内感染1例, 电解质紊乱2例, 给予对症治疗后均缓解。术后未发生脑脊液鼻漏。患者术后临床症状完全缓解6例, 部分缓解5例;垂体内分泌功能完全恢复2例, 明显改善者4例。患者术后均获得随访, 随访时间10～40个月。1例患者术后3个月发现囊肿部分复发, 因未出现新发症状, ...     

骶管内蛛网膜囊肿的外科治疗

目的 :探讨骶管内蛛网膜囊肿的诊断及治疗方法。方法 :2 3例骶管内蛛网膜囊肿病人行椎板减压后 ,对囊肿的处理有 3种方法 :13例行囊肿大部分切除后 ,重新缝合残余的囊肿以包绕囊内神经根 ;8例囊肿大部分切除后用肌肉填塞交通孔 ;2例囊肿切开旷置。平均随访 3 0 2个月 ,观察疗效。并对其临床表现 ,手术中的病理特点 ,手术后的并发症 ,以及X线片 ,CT ,CTM ,MRI等影像学资料进行分析。结果 :MRI可清楚显示囊肿呈长T1及T2信号 ,信号强度与脑脊液一致。临床症状以骶管内神经受压表现为主 ,囊肿与硬膜囊一般有交通孔。囊肿切除后重新缝合包绕神经组与囊肿切除肌肉填塞组优良率并无统计学差异。术后并发症有皮肤糜烂和颅内感染。结论 :MRI是最好的影像学诊断方法 ;骶管内蛛网膜囊肿的发生是由于先天的硬膜缺隐所致。对囊肿的处理以囊肿切除 ,肌肉填塞封堵交通孔最为合理。术后不宜放引流及平卧。