Management of subdural hygromas associated with arachnoid cysts

2013 ◽  
Vol 12 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Cormac O. Maher ◽  
Hugh J. L. Garton ◽  
Wajd N. Al-Holou ◽  
Jonathan D. Trobe ◽  
Karin M. Muraszko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arachnoid Cyst ◽  
Medical Records ◽  
Complete Resolution ◽  
Expectant Management ◽  
Signs And Symptoms ◽  
Arachnoid Cysts ◽  
Subdural Hygroma ◽  
History Of ◽  
Indication For Surgical Treatment

Object Arachnoid cysts may occasionally be associated with subdural hygromas. The management of these concurrent findings is controversial. Methods The authors reviewed their experience with arachnoid cysts and identified 8 patients with intracranial arachnoid cysts and an associated subdural hygroma. The medical records and images for these patients were also examined. Results In total, 8 patients presented with concurrent subdural hygroma and arachnoid cyst. Of these 8 patients, 6 presented with headaches and 4 had nausea and vomiting. Six patients had a history of trauma. One patient was treated surgically at the time of initial presentation, and 7 patients were managed without surgery. All patients experienced complete resolution of their presenting signs and symptoms. Conclusions Subdural hygroma may lead to symptomatic presentation for otherwise asymptomatic arachnoid cysts. The natural course of cyst-associated subdural hygromas, even when symptomatic, is generally benign, and symptom resolution can be expected in most cases. The authors suggest that symptomatic hygroma is not an absolute indication for surgical treatment and that expectant management can result in good outcomes in many cases.

Recovery of sensorineural hearing loss following operative management of a posterior fossa arachnoid cyst

2009 ◽  
Vol 4 (2) ◽  
pp. 121-124 ◽  
Author(s):  
Mayur Jayarao ◽  
Anand K. Devaiah ◽  
Lawrence S. Chin
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Complete Resolution ◽  
Signs And Symptoms ◽  
Operative Management ◽  
Sensorineural Hearing ◽  
Arachnoid Cysts ◽  
Rare Presentation

Arachnoid cysts are benign, intraarachnoid cysts filled with cerebrospinal fluid that are usually encountered in the middle cranial fossa. If present in the posterior fossa, they usually produce nonspecific signs and symptoms such as headaches, dizziness and vertigo. We report the rare presentation of a young girl with right-sided sensorineural hearing loss and tinnitus secondary to a right cerebellopontomedullary arachnoid cyst. The patient underwent a suboccipital retrosigmoid (retromastoid) craniectomy with fenestration of the arachnoid cyst. Subsequently, the patient experienced improvement in hearing with near-complete resolution of sensorineural hearing loss. To the authors' knowledge, postoperative near-complete resolution of hearing loss secondary to posterior fossa arachnoid cysts in a pediatric patient has not been previously reported. The authors also review the literature with respect to posterior fossa arachnoid cysts and discuss their clinical features, diagnosis, and management.

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.

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.

Arachnoid cyst slit valves: the mechanism for arachnoid cyst enlargement

2013 ◽  
Vol 12 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Sameer H. Halani ◽  
Mina G. Safain ◽  
Carl B. Heilman
Keyword(s):  
Arachnoid Cyst ◽  
Basilar Artery ◽  
Cardiac Cycle ◽  
Mass Effect ◽  
Middle Cranial Fossa ◽  
Arachnoid Cysts ◽  
Csf Flow ◽  
Subdural Hygroma ◽  
Cranial Fossa ◽  
Mass Lesions

Arachnoid cysts are common, accounting for approximately 1% of intracranial mass lesions. Most are congenital, clinically silent, and remain static in size. Occasionally, they increase in size and produce symptoms due to mass effect or obstruction. The mechanism of enlargement of arachnoid cysts is controversial. One-way slit valves are often hypothesized as the mechanism for enlargement. The authors present 4 cases of suprasellar prepontine arachnoid cysts in which a slit valve was identified. The patients presented with hydrocephalus due to enlargement of the cyst. The valve was located in the arachnoid wall of the cyst directly over the basilar artery. The authors believe this slit valve was responsible for the net influx of CSF into the cyst and for its enlargement. They also present 1 case of an arachnoid cyst in the middle cranial fossa that had a small circular opening but lacked a slit valve. This cyst did not enlarge but surgery was required because of rupture and the development of a subdural hygroma. One-way slit valves exist and are a possible mechanism of enlargement of suprasellar prepontine arachnoid cysts. The valve was located directly over the basilar artery in each of these cases. Caudad-to-cephalad CSF flow during the cardiac cycle increased the opening of the valve, whereas cephalad-to-caudad CSF flow during the remainder of the cardiac cycle pushed the slit opening against the basilar artery and decreased the size of the opening. Arachnoid cysts that communicate CSF via circular, nonslit valves are probably more likely to remain stable.

scholarly journals Clinical Factors Affecting Recovery Periods of Vascular and Idiopathic Acquired Paralytic Strabismus

2021 ◽  
Vol 62 (8) ◽  
pp. 1123-1128
Author(s):  
Su-Min Yoon ◽  
Suk-Gyu Ha ◽  
Yeong-Woo Seo ◽  
Seung-Hyun Kim
Keyword(s):  
Medical Records ◽  
Odds Ratio ◽  
Complete Resolution ◽  
Recovery Period ◽  
Age At Onset ◽  
Clinical Factors ◽  
Factors Affecting ◽  
History Of ◽  
Angle Of Deviation ◽  
Paralytic Strabismus

Purpose: Clinical factors affecting the recovery period in patients with vascular or idiopathic paralytic strabismus were evaluated.Methods: This study involved a retrospective review of medical records of patients diagnosed with vascular and idiopathic acquired paralytic strabismus. Vascular paralysis was defined in cases of hypertension, diabetes mellitus, or cardiovascular disease. The angle of deviation and limitation of extraocular movement were evaluated at each visit. Recovery was defined as the absence of diplopia and complete resolution of limitation of extraocular movement. Factors affecting recovery success and recovery period were analyzed.Results: We retrospectively reviewed data of 145 patients consisting of 87 with vascular paralytic strabismus (cranial nerve [CN] III: 21, CN IV: 28, CN VI: 38) and 58 with idiopathic paralytic strabismus (CN IV: 20, CN VI: 24, CN III: 14). The recovery rate did not significantly differ between vascular (60.9%) and idiopathic (63.8%) groups (p = 0.15). The recovery period was longer in the vascular group (130.1 ± 145.1 days) than in the idiopathic group (92.6 ± 76.6) (p = 0.02). Age at onset was significantly associated with the recovery period in both vascular and idiopathic groups. In the vascular group, the recovery periods were 107.4 ± 74.8 days in CN III palsy, 97.2 ± 51.9 days in CN IV palsy, and 159.3 ± 194.1 days in CN VI palsy. The recovery period was significantly longer in patients with CN VI palsy (p = 0.03). Hypertension was significantly influencing the recovery period in patients with vascular CN VI palsy (odds ratio = 2.54, p = 0.01).Conclusions: The recovery period was longer in patients with vascular paralytic strabismus than in patients with idiopathic paralytic strabismus. Recovery rates were not significantly different between groups. In patients with vascular CN VI palsy, a history of hypertension was significantly associated with the recovery period.

scholarly journals Giant Intracranial Arachnoid Cyst Mimicking Benign Paroxysmal Vertigo of Childhood: Case Report with Review of Literature

2014 ◽  
Vol 6 (4) ◽  
pp. 6-9
Author(s):  
Amit Kumar Tyagi ◽  
Gaurav Ashish ◽  
Anjali Lepcha ◽  
Achamma Balraj
Keyword(s):  
Case Report ◽  
Arachnoid Cyst ◽  
Signs And Symptoms ◽  
Arachnoid Cysts ◽  
Review Of Literature ◽  
Intracranial Arachnoid Cyst ◽  
Peripheral Vertigo

ABSTRACT Arachnoid cysts constitute 1% of all intracranial space-occupying lesions. These typically produce vague and nonspecific symptoms. However, a subset of these lesions can produce constellation of signs and symptoms indistinguishable from those causing peripheral vertigo. We discuss the presentation of a giant arachnoid cyst which presented with dizziness and mimicked benign paroxysmal vertigo of childhood (BPVC).

scholarly journals Case Report: A Case of Acquired Symptomatic Arachnoid Cyst in an Elderly Patient

2019 ◽  
pp. 1-3
Author(s):  
Ryosuke Sawaya ◽  
Daisuke Shimbo ◽  
Katsuyuki Asaoka ◽  
Kazuki Uchida ◽  
Koji Itamoto ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Arachnoid Cyst ◽  
Subarachnoid Space ◽  
The Elderly ◽  
Arachnoid Cysts ◽  
Subdural Hygroma ◽  
Cyst Excision ◽  
Cyst Recurrence

Arachnoid cysts comprise approximately 1% of all intracranial space-occupying lesions and etiologies of its formation are believed to be both congenital and acquired. However, very few cases of symptomatic acquired arachnoid cyst have been reported so far in the elderly. Here we report a case of acquired symptomatic arachnoid cyst in an elderly patient. We present here a case of 75 years-old male presenting with seizure-like episode. He was diagnosed bilateral subdural hygroma and left-sided arachnoid cyst by CT. However, he was performed CT 12 years ago, which showed no arachnoid cyst then. We performed microsurgical cyst excision and fenestration to the subarachnoid space. Postoperatively his condition has been excellent so far, with no cyst recurrence.

scholarly journals Syringomyelia associated with intradural arachnoid cysts

2007 ◽  
Vol 22 (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.

Spinal Arachnoid Cyst in Children

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Wihasto Suryaningtyas
Keyword(s):  
Arachnoid Cyst ◽  
Nerve Root ◽  
Financial Burden ◽  
Trauma Surgery ◽  
Arachnoid Cysts ◽  
History Of ◽  
Spinal Arachnoid Cyst ◽  
Intradural Arachnoid Cysts ◽  
Nerve Root Involvement

Spinal arachnoid cyst is rarely seen in children. The presenting features can be mistakenly assumed as myelitis or Guillan-Barre syndrome. Intermittent weaknesses of the leg, progressive ascending weakness of the leg, sensory disturbance, and altered physiological reflexes are the hallmark of the disease. Nabors classified the pathology of the spinal arachnoid cyst into three types: extradural without nerve root involvement; extradural with nerve root; and intradural. It is mostly located in mid- to lower thoracic. The causes and natural history of pediatric arachnoid cysts are unclear. They usually are associated with trauma, surgery, arachnoiditis, and neural tube defects. MRI is a useful diagnostic tool. We present two cases of extradural and intradural arachnoid cysts in children. The follow-up and surgical results are reviewed. The surgical therapy itself is straightforward. However, the wrong conclusion might cause a financial burden and may cause preventable sequel.

Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome

2010 ◽  
Vol 5 (6) ◽  
pp. 554-561 ◽  
Author(s):  
Gregory W. Albert ◽  
Arnold H. Menezes ◽  
Daniel R. Hansen ◽  
Jeremy D. W. Greenlee ◽  
Stuart L. Weinstein
Keyword(s):  
Surgical Treatment ◽  
Medical Records ◽  
Chiari Malformation ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Dramatic Improvement ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Initial Symptoms ◽  
Oropharyngeal Dysfunction

Object The authors conducted a study to evaluate the unique presenting signs and symptoms of Chiari malformation Type I (CM-I) in children younger than 6 years of age and highlight the benefits of early surgical treatment in this patient population. Methods The authors reviewed the medical records of patients who presented to the neurosurgery department before their 6th birthday and subsequently underwent surgery for CM-I. They identified 39 patients who had been evaluated between 1984 and 2007 and examined the medical records for presentation, surgical intervention, and outcome. Results Children aged 0–2 years commonly presented with oropharyngeal dysfunction (77.8%). Children aged 3–5 years more frequently presented with syringomyelia (85.7%), scoliosis (38.1%), and/or headache (57.1%). All patients underwent posterior fossa craniectomy. Additionally, in many patients cervical laminectomy and/or duraplasty was performed. A few patients required transoral decompression and occipitocervical fusion. In most cases, surgery led to resolution or dramatic improvement of initial symptoms. Conclusions Early recognition and surgical treatment of CM-I in young children leads to good outcomes in the majority of patients. Additional therapies for oropharyngeal dysfunction, syringomyelia, and scoliosis can frequently be avoided.

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