A sacral arachnoid cyst causing holocord syringomyelia

2011 ◽  
Vol 8 (3) ◽  
pp. 299-302 ◽  
Author(s):  
Sumit Thakar ◽  
Narayanam Anantha Sai Kiran ◽  
Alangar S. Hegde
Keyword(s):  
Mr Imaging ◽  
Arachnoid Cyst ◽  
Complete Resolution ◽  
Spastic Paraparesis ◽  
Arachnoid Cysts ◽  
Sensory Loss ◽  
Low Back ◽  
Filum Terminale ◽  
Sensory Deficits

Spinal extradural arachnoid cysts (ACs) have an infrequent predilection for the sacrum. As with their counterparts in other regions of the spine, cysts in this location are mostly asymptomatic. Common presentations in symptomatic cases include pain in the low back or perineum, radiculopathy, and sphincteric dysfunction. The authors report a hitherto undescribed presentation in which the predominant symptoms are those related to an associated holocord syrinx. This 15-year-old boy presented with fluctuating, spastic paraparesis and a dissociated sensory loss in the trunk. Admission MR imaging of the spine showed an extradural AC from S-2 to S-4 and a holocord, nonenhancing syrinx. The patient underwent S-2 laminectomy, fenestration of the cyst, and partial excision of its wall. Intradural exploration revealed a normal-looking filum terminale and the absence of any dural communication with the cyst. At a follow-up visit 6 months after surgery, his motor and sensory deficits had resolved. Follow-up MR imaging showed complete resolution of the syrinx in the absence of the sacral AC. This is the first report of a sacral extradural AC causing holocord syringomyelia. Because conventional theories of syrinx formation were not helpful in elucidating this case, a hypothesis is postulated to explain the clinicoradiological oddity.

Management of complex giant spinal arachnoid cysts presenting with myelopathy

2011 ◽  
Vol 15 (1) ◽  
pp. 107-112 ◽  
Author(s):  
Sunil V. Furtado ◽  
Sumit Thakar ◽  
Ganesh K. Murthy ◽  
Ravi Dadlani ◽  
Alangar S. Hegde
Keyword(s):  
Surgical Management ◽  
Arachnoid Cyst ◽  
Spastic Paraparesis ◽  
Arachnoid Cysts ◽  
Complex Nature ◽  
Radical Excision ◽  
Dural Defect ◽  
Spinal Arachnoid Cyst ◽  
Postoperative Instability

A giant spinal arachnoid cyst is an unusual cause of progressive epidural compressive syndrome. The authors describe 4 cases of a “complex” subtype of this lesion and discuss aspects of surgical management. The patients presented with progressive spastic paraparesis and were found to harbor extensive spinal extradural arachnoid cysts with multiple septations and significant paraspinal extensions. Extensive laminotomy and excision of the cyst along with its extensions were performed in all cases. Compared with previously indexed cases of surgically managed extensive spinal extradural arachnoid cysts, the cases reported here are unique because of their complex nature. Curative treatment consists of radical excision inclusive of the paraspinal extensions as well as closure of a dural defect, if found. A laminotomy or laminoplasty should be performed to avoid postoperative instability related to the extensive exposure. Extended follow-up and instrumentation may be required in select cases.

Cyst-ventricle stent as primary or salvage treatment for posterior fossa arachnoid cysts

2011 ◽  
Vol 7 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Daniel H. Fulkerson ◽  
Todd D. Vogel ◽  
Abdul A. Baker ◽  
Neal B. Patel ◽  
Laurie L. Ackerman ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Morbidity Rate ◽  
Initial Symptom ◽  
Salvage Procedure ◽  
The Third ◽  
First Line Therapy ◽  
Posterior Fossa Cyst

Object The optimal treatment of symptomatic posterior fossa arachnoid cysts is controversial. Current options include open or endoscopic resection, fenestration, or cyst-peritoneal shunt placement. There are potential drawbacks with all options. Previous authors have described stenting a cyst into the ventricular system for supratentorial lesions. The current authors have used a similar strategy for posterior fossa cysts. Methods The authors performed a retrospective review of 79 consecutive patients (1993–2010) with surgically treated intracranial arachnoid cysts. Results The authors identified 3 patients who underwent placement of a stent from a posterior fossa arachnoid cyst to a supratentorial ventricle. In 2 patients the stent construct consisted of a catheter placed into a posterior fossa arachnoid cyst and connecting to a lateral ventricle catheter. Both patients underwent stent placement as a salvage procedure after failure of open surgical fenestration. In the third patient a single-catheter cyst-ventricle stent was stereotactically placed. All 3 patients improved clinically. Two patients remained asymptomatic, with radiographic stability in a follow-up period of 1 and 5 years, respectively. The third patient experienced initial symptom resolution with a demonstrable reduction of intracystic pressure. However, he developed recurrent headaches after 2 years. Conclusions Posterior fossa cyst–ventricle stenting offers the benefits of ease of surgical technique and a low morbidity rate. It may also potentially reduce the incidence of shunt-related headaches by equalizing the pressure between the posterior fossa and the supratentorial compartments. While fenestration is considered the first-line therapy for most symptomatic arachnoid cysts, the authors consider cyst-ventricle stenting to be a valuable additional strategy in treating these rare and often difficult lesions.

Syringomyelia associated with intradural arachnoid cysts

2006 ◽  
Vol 5 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Langston T. Holly ◽  
Ulrich Batzdorf
Keyword(s):  
Arachnoid Cyst ◽  
Treatment Strategies ◽  
Tethered Cord ◽  
Arachnoid Cysts ◽  
Cavity Size ◽  
Neurological Improvement ◽  
Arm Pain ◽  
History Of ◽  
Intradural Arachnoid Cysts

Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.

scholarly journals Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 256-259 ◽  
Author(s):  
Saleh Baeesa ◽  
Abdalrahman Aljameely
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Benign Lesions ◽  
Clinical And Radiological Results

AbstractIntramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up.Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

Microsurgical Keyhole Approach for Middle Fossa Arachnoid Cyst Fenestration

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1138-1145 ◽  
Author(s):  
Michael L. Levy ◽  
Michael Wang ◽  
Henry E. Aryan ◽  
Kevin Yoo ◽  
Hal Meltzer
Keyword(s):  
Arachnoid Cyst ◽  
Arachnoid Cysts ◽  
Treatment Modalities ◽  
Middle Fossa ◽  
Imaging Studies ◽  
Cyst Size ◽  
Serial Imaging ◽  
Keyhole Approach ◽  
Cyst Fenestration

Abstract OBJECTIVE The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to provide a baseline for comparisons of the efficacies of other treatment modalities. METHODS A retrospective review of data for 50 children who underwent keyhole craniotomy for fenestration of temporal arachnoid cysts between 1994 and 2001 was performed after institutional review board approval. During that period, the first-line treatment for all symptomatic middle fossa arachnoid cysts was microcraniotomy for fenestration. Microsurgical dissection to create communications between the cyst cavity and basal cisterns was the goal. All patient records were reviewed and numerous variables related to presentation, cyst size and classification, treatment, cyst resolution, symptom resolution, follow-up periods, and cyst outcomes were recorded. RESULTS Fifty temporal arachnoid cysts in 50 treated patients were identified. The average age at the time of surgery was 68 ± 57.2 months. The follow-up periods averaged 36 months. There were 34 male and 16 female patients in the series. Twenty-six cysts were on the left side. Indications for surgery included intractable headaches (45%), increasing cyst size (21%), seizures (25%), and hemiparesis (8%). The symptoms most likely to improve were hemiparesis (100%) and abducens nerve palsies. Headaches (67%) and seizure disorders (50%) were less likely to improve. Nine patients exhibited progressive increases in cyst size in serial imaging studies. Those patients were monitored for a mean of 40 ± 23 months before intervention. In the entire series, 82% of patients demonstrated decreases in cyst size in serial imaging studies. Of those patients, 18% demonstrated complete cyst effacement. Overall, 83% of patients with Grade II cysts and 75% of patients with Grade III cysts exhibited evidence of decreases in cyst size in long-term monitoring. Two patients required shunting after craniotomy (4%). Hospital stays averaged 3.4 days. Total surgical times averaged 115 minutes. No significant blood loss occurred (5–50 ml). Complications included spontaneously resolving pseudomeningocele (10%), transient Cranial Nerve III palsy (6%), cerebrospinal fluid leak (6%), subdural hematoma (4%), and wound infection (2%). CONCLUSION A microsurgical keyhole approach to arachnoid cyst fenestration is a safe effective method for treating middle fossa cysts. This procedure can be performed with minimal morbidity via a minicraniotomy. Compared with an endoscopic approach, better control of hemostasis can be obtained, because of the ability to use bipolar forceps and other standard instruments. The operative time and length of hospital stay were not excessively increased.

Prevalence and natural history of arachnoid cysts in children

2010 ◽  
Vol 5 (6) ◽  
pp. 578-585 ◽  
Author(s):  
Wajd N. Al-Holou ◽  
Andrew Y. Yew ◽  
Zackary E. Boomsaad ◽  
Hugh J. L. Garton ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Natural History ◽  
Mr Imaging ◽  
Incidental Finding ◽  
Arachnoid Cysts ◽  
Consecutive Series ◽  
Imaging Characteristics ◽  
History Analysis ◽  
History Of ◽  
Over Time

Object Arachnoid cysts are a frequent finding on intracranial imaging in children. The prevalence and natural history of these cysts are not well defined. The authors studied a large consecutive series of children undergoing MR imaging to better define both the MR imaging–demonstrated prevalence and behavior of these lesions over time. Methods The authors reviewed a consecutive series of 11,738 patients who were 18 years of age or younger and had undergone brain MR imaging at a single institution during an 11-year period. In the patients in whom intracranial arachnoid cysts were identified, clinical and demographic information was recorded and imaging characteristics, such as cyst size and location, were evaluated. Prevalence data were analyzed using univariate and multivariate logistic regression, linear regression, and ANOVA. All patients with sufficient data (repeat MR imaging studies as well as repeated clinical evaluation over at least 5 months) for a natural history analysis were identified. This group was assessed for any change in symptoms or imaging appearance during the follow-up interval. Results Three hundred nine arachnoid cysts (2.6% prevalence rate) were identified. There was an increased prevalence of arachnoid cysts in males (p < 0.000001). One hundred eleven patients met all criteria for inclusion in the natural history analysis. After a mean follow-up of 3.5 years, 11 arachnoid cysts increased in size, 13 decreased, and 87 remained stable. A younger age at presentation was significantly associated with cyst enlargement (p = 0.001) and the need for surgery (p = 0.05). No patient older than 4 years of age at the time of initial diagnosis had cyst enlargement, demonstrated new symptoms, or underwent surgical treatment. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in pediatric patients. An older age at the time of presentation is associated with a lack of clinical or imaging changes over time.

scholarly journals Long-term Follow-up of a Multiloculated Arachnoid Cyst of the Middle Cranial Fossa

2007 ◽  
Vol 86 (6) ◽  
pp. 338-341 ◽  
Author(s):  
Marc A. Cohen ◽  
Noam A. Cohen ◽  
Gul Moonis ◽  
David W. Kennedy
Keyword(s):  
Arachnoid Cyst ◽  
Radiographic Progression ◽  
Middle Cranial Fossa ◽  
Arachnoid Cysts ◽  
Close Observation ◽  
Long Term Follow Up ◽  
Intracranial Lesions ◽  
Cranial Fossa

Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.

Active spontaneous decompression of a suprasellar-prepontine arachnoid cyst detected with routine magnetic resonance imaging

2009 ◽  
Vol 3 (1) ◽  
pp. 70-72 ◽  
Author(s):  
Bradley P. Thomas ◽  
Matthew M. Pearson ◽  
Curtis A. Wushensky
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Arachnoid Cyst ◽  
Male Infant ◽  
Ventricular System ◽  
Arachnoid Cysts ◽  
Resonance Imaging ◽  
Csf Flow ◽  
Routine Magnetic Resonance Imaging

Arachnoid cysts are congenital CSF collections that arise adjacent to arachnoid cisterns. These lesions can be incidental neuroimaging findings but may also cause symptoms and necessitate treatment, particularly in children. The authors present their experience with a male infant harboring a large suprasellar-prepontine arachnoid cyst who underwent spontaneous decompression into the ventricular system, as evidenced by a visualized CSF flow jet observed on routine MR imaging.

scholarly journals Dynamic and three-dimensional transcranial sonography studies of an asymptomatic, cerebral convexity arachnoid cyst

1999 ◽  
Vol 7 (6) ◽  
pp. E12
Author(s):  
Felix Schlachetzki ◽  
Thilo Hölscher ◽  
O.W. Ullrich ◽  
M.D. Sabine Kübber ◽  
Wendelin Blersch ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arachnoid Cyst ◽  
Three Dimensional ◽  
Imaging Study ◽  
Transcranial Sonography ◽  
Dynamic Imaging ◽  
Noninvasive Methods ◽  
Benign Condition ◽  
Csf Circulation

Dynamic and three-dimensional transcranial sonography (dTCS and 3D-TCCS) examinations are complementary, noninvasive methods used in the assessment and follow up of patients with cerebrospinal fluid (CSF) circulation disorders. A 16-year-old female patient who presented with a space-occupying, cerebral convexity arachnoid cyst and recurrent tension-type headache underwent examination for raised intracranial pressure (ICP) by using a standard color-coded duplex sonography system attached to a personal computer–based system for 3D data acquisition. Conventional TCS identified the outer arachnoid membrane of the cyst, which undulated freely after short rotation of the head (“headshake maneuver”). The undulation was documented as a QuickTime movie that is included with this article. A 3D dataset was acquired and, by using a multiplanar reformatting reconstruction algorithm, the authors obtained images with excellent resolution that corresponded to an initial magnetic resonance (MR) imaging study. No differences on dTCS and 3D-TCS were detectable at follow up 9 months later, indicating normal ICP and a stable, benign condition. The use of 3D-TCCS and dTCS ultrasonography may complement other diagnostic procedures such as MR imaging and, thus, can improve management and therapeutic strategies for patients with CSF circulation disorders. In this report the authors present evidence of the excellent fine resolution and exact reproducibility of reconstructed ultrasound image planes derived from 3D datasets and the additional biomedical information from dynamic imaging.

Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment

2009 ◽  
Vol 110 (6) ◽  
pp. 1250-1255 ◽  
Author(s):  
Maurizio Domenicucci ◽  
Natale Russo ◽  
Elisabetta Giugni ◽  
Alberto Pierallini
Keyword(s):  
Arachnoid Cyst ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Ct Scanning ◽  
Arachnoid Cysts ◽  
Trauma Treatment ◽  
Cranial Trauma ◽  
Subdural Bleeding ◽  
Mass Lesions

Object Arachnoid cysts are relatively common congenital intracranial mass lesions that arise during the development of the meninges. They can be complicated by the formation of an ipsilateral chronic subdural hematoma (CSDH) after minor cranial trauma. Treatment of these coexisting conditions remains controversial. In this study the authors describe the anatomical, clinical, and neuroradiological features and outcome in a series of patients whose CSDH associated with arachnoid cysts were managed surgically by draining the hematoma alone and leaving the cyst intact. The authors based this surgical management on histological and neuroradiological observations concerning these associated medical conditions. Methods A series of 8 patients with CSDHs associated with arachnoid cysts underwent surgery to drain the hematoma though a bur hole. The arachnoid cyst was left intact. Postoperative follow-up included CT scanning and T1- and T2-weighted MR imaging. Results Clinical, anatomical, and radiological observations suggest that because separate membranes cover arachnoid cysts and the related hematoma, arachnoid cysts remain unaffected by the subdural bleeding. In the present study, these observations received support from the neuroimaging appearances, suggesting that arachnoid cysts related to hematoma contained only blood breakdown products from the hematoma that had filtered through the reciprocal dividing membranes. Conclusions Arachnoid cysts associated with SDH are anatomically separate conditions whose neurological symptoms respond to surgical drainage of the CSDH alone.

Sign in / Sign up

Export Citation Format

Share Document