Syringomyelia associated with 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.

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Spinal Arachnoid Cyst in Children

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.77 ◽

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.

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Spinal Arachnoid Cyst in Children

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.103 ◽

2018 ◽

Vol 1 (2) ◽

pp. 25

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.

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A sacral arachnoid cyst causing holocord syringomyelia

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.6.peds11219 ◽

2011 ◽

Vol 8 (3) ◽

pp. 299-302 ◽

Cited By ~ 3

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.

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Surgical treatment of laterally ruptured cervical disc

Journal of Neurosurgery ◽

10.3171/jns.1973.38.6.0679 ◽

1973 ◽

Vol 38 (6) ◽

pp. 679-683 ◽

Cited By ~ 92

Author(s):

Francis Murphey ◽

James C. H. Simmons ◽

Bruce Brunson

Keyword(s):

Nerve Root ◽

Cervical Disc ◽

Root Pressure ◽

Content Type ◽

Arm Pain ◽

Follow Up Study ◽

History Of ◽

Neurosurgical Operation ◽

Better Than

✓ From the analysis of 648 patients operated on for ruptured cervical discs between 1939 and March of 1972 and a follow-up study of 380 of these patients, the following conclusions seem justified. Osteophytes or hypertrophic spurs rarely produced the classical clinical picture or deficits. Ninety per cent of the patients awakened in the morning with pain in the neck and rhomboid region. Ten per cent had a history of injury, but there was no characteristic pattern as in lumbar discs. Only one patient had a typical hyperextension injury. Anterior chest pain occurred in one-fifth of the cases. Pain in the neck, rhomboid region, and anterior chest was referred from the discs, while the arm pain was usually the result of nerve root compression; however, in a few cases the degenerating disc caused referred pain to the arm without any nerve root pressure. Since accurate diagnosis can be made on clinical grounds, myelography is not necessary in most cases. In our experience conservative treatment was usually unsuccessful while the surgical results were better than in almost any other neurosurgical operation. The nerve root syndromes associated with extruded lateral cervical discs are outlined and the indications and contraindications for myelography discussed.

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Microvascular Decompression for Patient With Coexistent of Trigeminal Neuralgia, Hemifacial Spasm and Glossopharyngeal Neuralgia- a Case Report

10.21203/rs.3.rs-1064619/v1 ◽

2021 ◽

Author(s):

Tao Sun ◽

Wentao Wang ◽

Longshuang He ◽

Yu Su ◽

Ning Li ◽

...

Keyword(s):

Nervous System ◽

Trigeminal Neuralgia ◽

Hemifacial Spasm ◽

Treatment Strategies ◽

Glossopharyngeal Neuralgia ◽

Case Presentation ◽

Involuntary Contraction ◽

History Of ◽

Primary Trigeminal Neuralgia

Abstract Background: Primary trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GN) are common diseases of nervous system, with similar pathogenesis and treatment strategies. Coexistent of such disease, especially coexistent of TN-HFS-GN simultaneously, is very rare. To date, only nine cases have been reported.Case Presentation: A 70-year-old male with a history of hypertension and diabetes complained of severe involuntary contraction for about 10 years, knife-like and lighting-like pain, which was restricted to the distribution of the second and third branches of trigeminal nerve and pharynx and root of tongue, for about 2 years. Coexistent of TN HFS and GN was diagnosed and MVD was carried out. After MVD, the patient completely free from symptoms and no recurrence and hypoesthesia were recorded in 18 months follow up.Conclusion: Here we report the tenth and oldest male patient with coexistent of TN-HFS-GN. Despite limited reports, MVD is the preferred choice for such diseases which can free patients from spasm and neuralgia.

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Incidental Finding of an Undiagnosed Coarctation of the Aorta Causing Dilated Cardiomyopathy in an Adult

Case Reports in Cardiology ◽

10.1155/2017/6129073 ◽

2017 ◽

Vol 2017 ◽

pp. 1-2

Author(s):

Abdalla Ibrahim ◽

Zahir Satti ◽

Ronan Curtin

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Incidental Finding ◽

Coarctation Of The Aorta ◽

Left Ventricular ◽

Descending Aorta ◽

Arm Pain ◽

Left Ventricular Dilation ◽

History Of

31-year-old male with no past medical history apart from high blood pressure noted by GP one week prior to admission presented with a three-week history of a flu-like illness and symptoms of heart failure with severe global left ventricular dilation and dysfunction on Transthoracic Echocardiography (TTE). Two weeks following admission he complained of left arm pain and CT upper limb confirmed embolic occlusion of the left brachial artery and incidental severe coarctation of the proximal descending aorta after the origin of the left subclavian artery. Follow-up TTE suggested the presence of coarctation of the aorta on a suprasternal view which was not performed at the time of his first TTE. His heart failure and blood pressure responded very well to medical therapy and he has been referred for surgical correction of his aortic coarctation.

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

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.2.peds10457 ◽

2011 ◽

Vol 7 (5) ◽

pp. 549-556 ◽

Cited By ~ 7

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.

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Abstract 14134: The Impact of Ablation for Atrial Fibrillation on Dementia Incidence in Patients With and Without Depression

Circulation ◽

10.1161/circ.142.suppl_3.14134 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Heidi T May ◽

Tami L Bair ◽

Stacey Knight ◽

Jeffrey L Anderson ◽

Joseph B Muhlestein ◽

...

Keyword(s):

Atrial Fibrillation ◽

Treatment Strategies ◽

Brain Perfusion ◽

Cardiovascular Comorbidities ◽

Incident Dementia ◽

History Of ◽

The Impact ◽

Mean Time ◽

History Of Depression

Introduction: Studies have previously shown that atrial fibrillation (AF) is associated with dementia. The mechanisms are likely multifactorial, but may involve treatment strategies that include anticoagulation use and rhythm management, particularly when used early. Patients that have earlier-life depression are at risk of dementia. However, depression diagnosis in AF patients may indicate a patient at higher risk of developing dementia and whether treatments ameliorate that risk is unknown. Methods: A total of 132,703 AF patients without a history of dementia were studied. History of depression was determined at the time of AF diagnosis. Patients were deemed as having a follow-up ablation if it occurred prior to a dementia diagnosis. Patients were stratified into 4 groups based on depression history and follow-up ablation status: no depression, ablation (n=5,960); no depression, no ablation (n=106,986); depression, ablation (n=923); and depression, no ablation (n=18,834). Patients were followed for 5-year incidence of dementia. Results: A total of 14.9% (n=19,757) pts had a history of depression at the time of AF diagnosis. The mean time between depression and AF diagnoses was 4.9±4.8 years. Patients with depression were younger (68±15 vs. 71±14 years), more likely to be female (62% vs. 44%), and had more cardiovascular comorbidities. Mean time to ablation was 1.3±1.4 days (median: 7.7 months) from AF diagnosis. Frequencies of 5-year dementia were: no depression, ablation=1.6%; no depression, no ablation=5.2%; depression, ablation=4.7%; and depression, no ablation=9.7%, p<0.0001. Multivariable comparisons between the groups are shown in the Figure. Conclusion: In AF patients with and without depression, ablation was associated with a lower risk of incident dementia. Rhythm control approaches that improve long-term brain perfusion may represent a means to impact cognitive declines in patients at higher risk because of earlier-life depression.

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Salvage craniotomy for treatment-refractory symptomatic cerebral radiation necrosis

Neuro-Oncology Practice ◽

10.1093/nop/npz028 ◽

2019 ◽

Vol 7 (1) ◽

pp. 94-102

Author(s):

Ashish H Shah ◽

Anil K Mahavadi ◽

Alexis Morell ◽

Daniel G Eichberg ◽

Evan Luther ◽

...

Keyword(s):

Radiation Necrosis ◽

Tumor Patients ◽

Future Studies ◽

Neurological Outcomes ◽

Neurological Improvement ◽

Control Brain ◽

Outcome Information ◽

History Of ◽

Treatment Refractory

Abstract Background The incidence of symptomatic radiation necrosis (RN) has risen as radiotherapy is increasingly used to control brain tumor progression. Traditionally managed with steroids, symptomatic RN can remain refractory to medical treatment, requiring surgical intervention for control. The purpose of our study was to assess a single institution’s experience with craniotomy for steroid-refractory pure RN. Methods The medical records of all tumor patients who underwent craniotomies at our institution from 2011 to 2016 were retrospectively reviewed for a history of preoperative radiotherapy or radiosurgery. RN was confirmed histopathologically and patients with active tumor were excluded. Preoperative, intraoperative, and outcome information was collected. Primary outcomes measured were postoperative KPS and time to steroid freedom. Results Twenty-four patients with symptomatic RN were identified. Gross total resection was achieved for all patients. Patients with metastases experienced an increase in KPS (80 vs 100, P < .001) and required a shortened course of dexamethasone vs patients with high-grade gliomas (3.4 vs 22.2 weeks, P = .003). RN control and neurological improvement at 13.3 months’ follow-up were 100% and 66.7%, respectively. Adrenal insufficiency after rapidly tapering dexamethasone was the only morbidity (n = 1). Overall survival was 93.3% (14/15) at 1 year. Conclusion In cases of treatment-refractory symptomatic RN, resection can lead to an overall improvement in postoperative health status and neurological outcomes with minimal RN recurrence. Craniotomy for surgically accessible RN can safely manage symptomatic patients, and future studies assessing the efficacy of resection vs bevacizumab may be warranted.

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