Arachnoid Cyst Research Articles

Conservative and Surgical Management Strategies of Intracranial Arachnoid Cysts: A Single Institution Experience of 136 Cases

Aim: Intracranial arachnoid cysts develop from the arachnoid membrane between the membranes called pia mater and dura mater, located on the brain and cerebellum. The aim of this retrospective study is to reveal our clinic's approach to intracranial arachnoidal cysts, which can be seen incidentally in all age groups, in the light of current literature. Materials and Methods: In our study, we retrospectively analyzed the clinical and radiological findings of a total of 136 patients diagnosed with intracranial arachnoid cysts in both genders and all age groups between January 1, 2017 and December 31, 2023. The localization of the arachnoid cyst was examined in the electronic medical records of the patients who had brain tomography and magnetic resonance imaging during the said interval. The gender, age groups, symptoms, treatment approaches and prognoses of the patients were analyzed. Results: The number of patients diagnosed with arachnoid cyst in our radiological examinations was 136. The prevalence was higher in men than in women; 94 patients were male (69.1%) and 42 patients were female (30.1%). 72 patients were 20 years of age or younger (52.9%). Among 136 patients, only 11 patients were found to have more than one arachnoid cyst in terms of localization (8.1%). In terms of localization, the most common locations were the middle fossa, 52 patients (38.2%). Retrocerebellar location was in 43 patients (31.6%), convex location was in 9 patients (6.6%), and anterior fossa location was in 32 patients (23.5%). Only 42 (30.9%) of 136 patients with radiologically detected arachnoid cysts had clinically significant symptoms. Other patients were detected incidentally during neuroradiological examinations performed for trauma or other reasons. During follow-up, an increase in the size of the cyst was observed in only 9 patients (6.6%). The number of patients operated on in our clinic was only 7 (5.1%). During the follow-up period of the remaining patients, only 3 patients had clinical improvement in their symptoms (2.2%). Conclusion: Arachnoid cysts are frequently encountered incidentally in radiological intracranial imaging today, and their incidence increases in the first 20 years of life. While very few patients show clinically significant neurological symptoms, asymptomatic patients do not require surgical treatment. It is recommended that asymptomatic patients be protected from head trauma and periodic neurosurgery outpatient clinic follow-up.

REVERSIBLE AKINETIC CATATONIA DUE TO A LEFT TEMPORAL LOBE ARACHNOID CYST AFTER STEREOTACTIC EVACUATION IN CHILDREN: CASE REPORT

ABSTRACT Background: Catatonia is caused by a variety of psychiatric and organic conditions. Association between temporal lobe arachnoid cyst (ACs) and catatonia was reported and largely debated, in literature. Aim: To report a case of reversible akinetic catatonia after stereotactic removal of left mesiotemporal ACs is reported. Case report: A 16-year-old female admitted for akinetic catatonic is reported. The patient was treated for schizophrenia for one year without any results. One months later, she presented with typic akinetic catatonia. Brain magnetic resonance imaging (MRI) showed an ACs in the mesiotemporal left temporal lobe. She was evacuated by stereotactic evacuation, with good results and amelioration. Conclusion: ACs on the left temporal lobe were reported to be related to psychological and psychiatric disorders. Catatonia can be presented as an acute onset of psychosis in a patient with a left temporal lobe arachnoid cyst in child.

Bilateral middle cranial fossa arachnoid cysts with temporal lobe agenesis. Case report in adult.

Background: The temporal lobe agenesis syndrome is a rare congenital abnormality. Bilateral temporal lobe agenesis along with middle cranial fossa arachnoid cysts is extremely rare, and only very few cases have been reported in the literature. Case report: We present the case of 21-year-old child with bilateral arachnoid cysts and temporal lobe agenesis whose mental examination and neurologic assessment is normal. The Magnetic resonance imaging (MRI) findings revealed bilateral temporal lobe agenesis with bilateral arachnoid cysts. Brain MRI sequence showing bilateral middle cranial fossa arachnoidal cysts, following CSF signal intensity on MRI. Bilateral middle cranial fossa arachnoid cysts with temporal lobe agenesis. The patient was managed conservatively. Conclusion: Bilateral middle cranial fossa arachnoid cysts with temporal lobe agenesis in adult is very rare. The diagnosis is made by brain MRI. Prophylactic surgery in asymptomatic cases is not advisable. These patients must be followed by the practician. The patient and his family must be sensualized and informed of some precautions, especially brain head trauma.

Purely Endoscopic Treatment for Arachnoid Cysts.

Arachnoid cysts are benign, mostly congenital lesions that are asymptomatic in most patients. In some cases, due to their location or sheer size, they produce a mass effect or hydrocephalic obstruction of the cerebrospinal fluid (CSF) flow and thus might warrant surgical treatment. The goal of the surgery is usually to reduce pressure inside the cysts, to reduce the mass effect, or to restore the CSF pathway. Surgical treatment options are resection, fenestration, or shunting of the cyst. Over the past decades, treatment under sheer endoscopic control either through a tube or via craniotomy of arachnoid cysts has been studied thoroughly and replaced open microsurgical cyst surgery in the opinion of many neurosurgeons. Endoscopic treatment has proven to be a safe and feasible technique for both patients and surgeons. In the following chapter, the authors describe their indications for surgery and pre- and postoperative workup, where precautions should be taken, and discuss the different possibilities and techniques of endoscopic cyst fenestration. The aim is to give detailed instructions and present cases for ventriculocystostomy, cystocisternostomy, ventriculocystocisternostomy, and cystoventriculostomy and point out specifics deemed to be important to avoid complications and to ensure the best possible outcome for each patient.

A rare entity of primary hydatid cyst located between the two laiers of the intracranial dura in a child: a case report

Background: Hydatid disease is a parasitic infection caused by the tapeworm Echinococcus granulosus. Intracranial hydatid cysts are rare and account for less than 3% of all cases of hydatid disease. Typically, these cysts are found in the intracerebral spaces. However, this study presents an extremely rare intradural hydatid cyst. Case Presentation: This study presents the case of an 8-year-old boy presented with a 3-month history of headache and vomiting without any neurological deficit. Full radiological investigations were performed, and only brain magnetic resonance imaging showed a large cerebral hydatid cyst located within the dura layers between the periosteal and the endosteal layers. Surgery was performed without cyst rupture, confirming the intracerebral intradural location. Conclusion: Early diagnosis and treatment for intracranial hydatid cysts are crucial to prevent complications such as neurological deficits, seizures, and even death. In this case, the intracerebral intradural location of the cyst is extremely rare.

Isolation of Salmonella enterica Serovar Typhi from Infected Intracranial Dermoid Cyst: A Case Report

Salmonella Typhi is a versatile pathogen that can infect almost all organs of its host. There has been an increase in the number of cases of extraintestinal infection caused by Salmonella species during the past decade. Present case is of a 17-year-old immunocompetent female admitted to the hospital with complaints of a general tonic-clonic seizure and diagnosed with a Suprasellar hypodense lesion with Hydrocephalus (HCP) documented on a Computed Tomography (CT) scan of the head. Magnetic Resonance Imaging (MRI) revealed signs of an intracranial dermoid cyst. Placement of a right Ventriculoperitoneal (VP) Shunt was performed, followed by a right craniotomy with decompression, during which 5 mL of pus was collected from the lesion. The pus was received in the Department of Microbiology and subjected to culture, which grew Salmonella enterica serovar Typhi. The patient had been empirically receiving injection cefoperazone-sulbactam 2g/2g twice daily and injection vancomycin 1g 12 hourly before the isolation of Salmonella Typhi. She had also been receiving injection levetiracetam 500 mg i.v. twice a day and inj. phenytoin 500 mg i.v. thrice a day. Following the positive culture report, injection ceftriaxone 2 g daily was started. The patient was discharged on the fifth postoperative day while on injection ceftriaxone, oral levetiracetam 500 mg, and phenytoin 100 mg and was asked to report to the neurosurgery department after seven days for follow-up. On follow-up, she showed improvement, and there were no complaints of fever, seizure, or loss of consciousness. In conclusion, proper clinical, radiological, and microbiological evaluation is very much necessary, and clinicians should be aware of the relatively rare manifestations of Salmonella Typhi infections.

Trigeminal neuralgia revealing an epidermoid cyst impinging on the Vth cranial nerve: A case report

Intracranial epidermoid cysts, also referred to as intracranial primary cholesteatomas, are uncommon, benign tumors characterized by slow, linear growth patterns akin to normal epidermal tissue. They typically become symptomatic around age 43, with a slight female predominance, and are most frequently located in the cerebellopontine angle. This summary presents the case of a 62-year-old woman suffering from paroxysmal excruciating pain of the right hemiface, indicative of trigeminal neuralgia, linked to an intracranial epidermoid cyst in the cerebellopontine angle. Radiological assessment, through magnetic resonance imaging, was instrumental in identifying the cyst. Total surgery resection is the most effective treatment, but it can be challenging due to tumor adherence to important neurovascular structures, therefore responsible for an incomplete removal of the proliferative capsule causing a higher risk of recurrence. The case also raises questions about treatment options, as the patient opted against surgical intervention. Managing intracranial epidermoid cysts requires a careful weighing of potential benefits against associated risks.

A rare entity of primary hydatid cyst located between the two laiers of the intracranial dura in a child: a case report

Background: Hydatid disease is a parasitic infection caused by the tapeworm Echinococcus granulosus. Intracranial hydatid cysts are rare and account for less than 3% of all cases of hydatid disease. Typically, these cysts are found in the intracerebral spaces. However, this study presents an extremely rare intradural hydatid cyst. Case Presentation: This study presents the case of an 8-year-old boy presented with a 3-month history of headache and vomiting without any neurological deficit. Full radiological investigations were performed, and only brain magnetic resonance imaging showed a large cerebral hydatid cyst located within the dura layers between the periosteal and the endosteal layers. Surgery was performed without cyst rupture, confirming the intracerebral intradural location. Conclusion: Early diagnosis and treatment for intracranial hydatid cysts are crucial to prevent complications such as neurological deficits, seizures, and even death. In this case, the intracerebral intradural location of the cyst is extremely rare.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Symptomatic Long-segment Extradural Arachnoid Cyst: An Interesting Case Report with Literature Review

Abstract Extradural spinal arachnoid cysts are rare lesions which when become symptomatic lead to progressive neurological signs and symptoms. The spectrum of presentation is myriad and surgical intervention is reserved for symptomatic patients. A 17-year-old boy presented with features of progressive spastic paraparesis for the last 5 months. Initial radiological work-up was suggestive of thoracolumbar extradural cystic lesion. Computed tomography myelography was not able to detect the dural defect. He underwent surgical excision of the cyst under intraoperative neuromonitoring. The lesion was excised in single piece and the intradural communication was noticed along an exiting nerve root. The dural defect at the mid-length of the lesion was identified and closed watertight. Significant improvement in the sensory-motor complaints was noted in the postoperative period. The identification of the dural defect and ensuring its closure along with the complete removal of the cyst is the key to avoid recurrence and is the standard procedure of choice.

Disseminated Intracranial and Spinal Neurenteric Cysts: A Case Report and Literature Review

Neurenteric cysts (NECs) are rare congenital, benign lesions of the central nervous system (CNS), predominantly located within the spinal cord. However, they may also occur less frequently within the brainstem, fourth ventricle, or cerebellopontine angle (CPA). Originating from anomalous interactions between embryonic layers, NECs are recognized for their potential to compress adjacent structures. We report a unique case of disseminated NECs exhibiting few to absent symptoms, which represents an unusual presentation of this disease, with only six similar reports in the literature. A 22‐year‐old female presented to our institute with chronic headaches resistant to nonsteroidal anti‐inflammatory drugs (NSAIDs). Initially treated for intracranial hypertension (ICH) secondary to a cyst in the quadrigeminal cistern at the age of 17 via neuroendoscopic surgery and subsequent ventriculoperitoneal shunting, she experienced transient relief. However, follow‐up at 22 years of age revealed multiple cysts in the basal and spinal cisterns, with MRI findings suggestive of neurocysticercosis. Despite treatment with albendazole and corticosteroids, subsequent MRIs showed no change in the size or number of the cysts. Six years later, symptoms had worsened, previously identified cysts had grown, and the detection of new cysts prompted surgical intervention. Histopathological examination confirmed the presence of NECs. This case highlights the diagnostic challenges posed by NECs, especially in regions endemic for neurocysticercosis, where clinical and radiological findings may initially suggest this condition. It underscores the importance of considering NECs in the differential diagnosis of cystic lesions in the CNS, even in the absence of typical symptoms of spinal cord compression. The recurrence and spread of NECs post‐treatment demand a comprehensive management approach, encompassing surgical intervention and close monitoring.

Management of Pediatric Sylvian Arachnoid Cysts. A Single Center Experience

Management of Pediatric Sylvian Arachnoid Cysts. A Single Center Experience

Surgical management of syringomyelia associated with spinal arachnoid cyst: clinical and radiological outcomes

Surgical management of syringomyelia associated with spinal arachnoid cyst: clinical and radiological outcomes

Endoscopic treatment methods of Suprasellar Arachnoid Cysts in Children: A Systematic Review and Meta-Analysis

Endoscopic treatment methods of Suprasellar Arachnoid Cysts in Children: A Systematic Review and Meta-Analysis

Clinical, radiological, neurocognitive, and patient reported outcomes following surgical treatment of arachnoid cysts in adults

Clinical, radiological, neurocognitive, and patient reported outcomes following surgical treatment of arachnoid cysts in adults

Purely Endoscopic Supracerebellar Infratentorial Approach to the Pineal Region in Pediatric Population.

Pineal lesions represent less than 1% of all brain tumors (Villani et al., Clin Neurol Neurosurg 109:1-6, 2007). The abysmal location and critical neurovascular structures remain a surgical challenge, despite the advent of microneurosurgery. The classical wide surgical suboccipital craniotomy with the supracerebellar infratentorial approach, described by Sir Victor Horsley (Victor, Proc R Soc Med 3:77-78, 1910), is infamous for its considerable surgical morbidity and mortality. This was later upgraded microneurosurgically by Stein to improve surgical outcomes (Stein, J Neurosurg 35:197-202, 1971).Ruge et al. reported the first purely endoscopic fenestration of quadrigeminal arachnoid cysts via this corridor (Ruge et al., Neurosurgery 38:830-7, 1996). A cadaver-based anatomical study by Cardia et al. demonstrated the viability for endoscope-assisted techniques (Cardia et al., J Neurosurg 2006;104(6 Suppl):409-14). However, the first purely endoscopic supracerebellar infratentorial (eSCIT) approach to a pineal cyst was performed in 2008 by Gore et al. (Gore PA et al., Neurosurgery 62:108-9, 2008).Unlike transventricular endoscopy, eSCIT approach poses no mechanical risk to the fornices and can be utilized irrespective of ventricular size. More vascular control and resultant reduction in uncontrolled hemorrhage improve the feasibility of attaining complete resection, especially around corners (Zaidi et al,, World Neurosurg 84, 2015). Gravity-dependent positioning and cerebrospinal fluid (CSF) diversion aid cerebellar relaxation, creating the ideal anatomical pathway. Also, angle of the straight sinus, tentorium, and tectal adherence can often influence the choice of approach; thus direct endoscopic visualization not only counteracts access to the engorged Galenic complex but also encourages sharp dissection of the arachnoid (Cardia et al., J Neurosurg 104:409-14, 2006). These tactics help provide excellent illumination with magnification, making it less fatiguing for the surgeon (Broggi et al., Neurosurgery 67:159-65, 2010).The purely endoscopic approach thwarts the dreaded risk of air embolisms, via simple copious irrigation from a small burr hole (Shahinian and Ra, J Neurol Surg B Skull Base 74:114-7, 2013). The tiny opening and closure are rapid to create, and the smaller wound decreases postoperative pain and morbidity. Recent literature supports its numerous advantages and favorable outcomes, making it a tough contender to traditional open methods.

Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases.

Arachnoid cysts (ACs) are congenital abnormalities that can be located anywhere within the subarachnoid space along the cerebrospinal axis, although they are most often found on the left side in the temporal fossa and sylvian fissure. ACs comprise approximately 1% of all intracranial space-occupying lesions and are considered potential risk factors for subdural hematoma (SDH) in individuals of all age groups who have experienced traumatic brain injury. Although it is uncommon for an intracystic hemorrhage of an AC to occur without evidence of head trauma, it may be more common among children and young adults. Here, the authors present three cases of spontaneous AC intracystic hemorrhage with chronic SDH. Additionally, they provide a thorough review of the existing literature. All three patients with AC were adolescent males. In all cases, AC was identified using the Galassi classification (type II or III) and associated with spontaneous intracystic hemorrhage and chronic SDH as seen on imaging. Spontaneous intracystic hemorrhage is a rare complication and occurs most commonly on the left side. Surgery is the definitive treatment, requiring either craniotomy or burr hole for hematoma evacuation and microsurgical fenestration to drain the cyst into the subarachnoid cisterns.

Corrigendum: Quadrigeminal plate arachnoid cyst presenting with eye movement related migraine: a rare case report

[This corrects the article DOI: 10.13181/mji.cr.236858]

Large intradiploic arachnoid cyst of the skull in child—a case report and new terminology proposition

We present a rare finding of the arachnoid matter invaginating into the base of middle cranial fossa and creating an abnormal space. Presented entity was incidentally found in head CT scan of 12-year-old male. Based on the radiological characteristics in CT scans and MR images, the diagnosis of intradiploic arachnoid cyst (AC) was suggested. After surgical intervention and histopathological analysis of the specimen, the diagnosis was confirmed. We assume this is the first description of large intrasphenoid AC without any traumatic or iatrogenic cause. The literature provides many different terms for the phenomenon. We are proposing the term intradiploic arachnoid diverticulum as the more accurate for capturing the essence of the phenomenon. It provides clear differentiation of the entities from classical arachnoid cysts since they are of different anatomical localization (intradural vs. extradural) and etiopathogenesis. Management with arachnoid diverticulum is not yet established, but observation with serial imaging studies should be recommended as primary management in case of asymptomatic cyst. When cyst is symptomatic, surgical treatment may be required.

Case Report: Novel biallelic moderately damaging variants in RTTN in a patient with cerebellar dysplasia.

Rotatin, encoded by the RTTN gene, is a centrosomal protein with multiple, emerging functions, including left-right specification, ciliogenesis, and neuronal migration. Recessive variants in RTTN are associated with a neurodevelopmental disorder with microcephaly and malformations of cortical development known as "Microcephaly, short stature, and polymicrogyria with seizures" (MSSP, MIM #614833). Affected individuals show a wide spectrum of clinical manifestations like intellectual disability, poor/absent speech, short stature, microcephaly, and congenital malformations. Here, we report a subject showing a distinctive neuroradiological phenotype and harboring novel biallelic variants in RTTN: the c.5500A>G, p.(Asn1834Asp), (dbSNP: rs200169343, ClinVar ID:1438510) and c.19A>G, p.(Ile7Val), (dbSNP: rs201165599, ClinVar ID:1905275) variants. In particular brain magnetic resonance imaging (MRI) showed a peculiar pattern, with cerebellar hypo-dysplasia, and multiple arachnoid cysts in the lateral cerebello-medullary cisterns, in addition to left Meckel cave. Thus, we compare his phenotypic features with current literature, speculating a possible role of newly identified RTTN variants in his clinical picture, and supporting a relevant variability in this emerging condition.