Ependymal Cyst Research Articles

171 Not Just a Matter of Retained Embryonic Spinal Cord: Histopathology of the Filum Terminale in Tethered Cord Syndrome

INTRODUCTION: We present a large consecutive series of patients with tethered cord syndrome who underwent resection of the filum terminale (FT) and the histopathologic findings as analyzed by the neuropathologists. METHODS: FT specimens obtained from a consecutive series of 288 pediatric and adult patients that underwent spinal cord releases performed at a single academic institution from 2013-2021 were analyzed retrospectively (IRB #787945). Hematoxylin and eosin (HE) and immunohistochemistry staining was performed to study the spectrum of cells known to reside in connective tissues. RESULTS: The most common structures included peripheral nerves (97.6%), ependymal cells (70.8%), ganglion cells (38.5%), and neuropil (15.3%). Cases with excess ependymal cells were associated with ependymal canals (5.9%), ependymal cysts (3.1%), and one case with extensive ependymal “proliferation” (0.3%). With regards to the inflammatory cellular findings, eleven specimens (3.8%) contained scattered or accumulated lymphocytes, macrophages, mast cells, macrophage-derived giant cells, and a secondary lymph follicle in one patient. 36 patients (12.5%) had increased vascularity with enlarged capillaries. Nine patients (3.1%) had an associated type of vascular malformation. A group of specimens included dystrophic calcification within the FT (7.6%). CONCLUSIONS: Both vascular and inflammatory changes along with calcifications have been overlooked as possible associated histologic secondary to mechanical stress on the FT. Additionally, vascular anomalies could alter the filum’s mechanical properties due to venous congestion.

Symptomatic infratentorial ependymal cyst arising from the medulla: a case report with review of literature

BackgroundEpendymal cysts (EC) typically present supra-tentorially near the lateral ventricle, juxta ventricular, or temporoparietal regions. Previous cases have also identified infratentorial EC of the brainstem, cerebellum, and subarachnoid spaces. They are mostly asymptomatic. In this paper, we present the first-ever case of a symptomatic medullary ependymal cyst treated with surgery, along with a comprehensive review of the literature on EC of other parts of the brain stem. Case descriptionThis 51-year-old female presented with hearing loss, dizziness, diplopia, and ataxia. Radiographic imaging indicated the presence of a non-enhancing lesion in the medulla with a mass effect on the brainstem. Pathological examination confirmed its characterization as an ependymal cyst. The patient underwent a suboccipital craniotomy for the fenestration of the medullary ependymal cyst under neuro-navigation, Intra-op ultrasound and intra-operative neuro-monitoring. Histopathological examination confirmed the diagnosis of an ependymal cyst. At one month follow-up, her KPS is 90, ECOG PS 1, and her ataxia has improved with complete resolution of diplopia. ConclusionDue to their rarity and potential similarity to other cystic structures, EC may be overlooked or incorrectly diagnosed resulting in mismanagement and surgical disaster. Therefore, a comprehensive understanding and awareness of their distinct characteristics are essential for accurate diagnosis and appropriate management.

Successful Surgical Resection of an Ependymal Cyst in the Fourth Ventricle of a Dog.

Ependymal cysts represent congenital brain malformations rarely described in human medicine, where surgical resection is the treatment of choice. In veterinary medicine, only three cases have been previously reported, with one partially resected with surgery. A 6 yr old entire male American Staffordshire terrier was referred with a 4 mo history of incoordination and collapsing episodes with extensor rigidity. Neurological examination localized the lesion to the left central vestibular system and cerebellum. A brain computed tomography scan showed a hypoattenuating lesion with peripheral contrast enhancement in the fourth ventricle consistent with a cyst and secondary hydrocephalus. Treatment with prednisone was initiated, but despite an initial improvement, neurologic signs recurred and a suboccipital craniectomy to remove the cyst was performed. The cyst was first drained, and the capsule was carefully resected. The histopathological evaluation revealed a simple cubic to cylindrical epithelium with apical cilia and loose surrounding fibrillar tissue consistent with an intraventricular ependymal cyst. Four and a half years after surgery, the dog only shows short episodes of balance loss when turning abruptly but is otherwise neurologically normal. To the authors' knowledge, this is the first reported ependymal cyst in the fourth ventricle of a dog with successful surgical resection.

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome.

This study investigated the prevalence of embryonic and connective tissue elements in the filum terminale (FT) of patients with tethered cord syndrome (TCS), examining both typical and pathological histology. The FT specimens from 288 patients who underwent spinal cord detethering from 2013 to 2021 were analyzed. The histopathological examination involved routine hematoxylin and eosin staining and specific immunohistochemistry when needed. The patient details were extracted from electronic medical records. The study found that 97.6% of the FT specimens had peripheral nerves, and 70.8% had regular ependymal cell linings. Other findings included ependymal cysts and canals, ganglion cells, neuropil, and prominent vascular features. Notably, 41% showed fatty infiltration, and 7.6% had dystrophic calcification. Inflammatory infiltrates, an underreported finding, were observed in 3.8% of the specimens. The research highlights peripheral nerves and ganglion cells as natural components of the FT, with ependymal cell overgrowth and other tissues potentially linked to TCS. Enlarged vessels may suggest venous congestion due to altered FT mechanics. The presence of lymphocytic infiltrations and calcifications provides new insights into structural changes and mechanical stress in the FT, contributing to our understanding of TCS pathology.

Dorsal root entry zone fenestration for intramedullary ependymal cyst: illustrative case.

Intramedullary ependymal cysts are rare and difficult to distinguish from syringomyelia and neuroenteric cysts. Almost all cases in the literature have been case reports and have been performed with the traditional posterior median sulcus incision, which is difficult to identify accurately during spinal rotation. Approximately 40% of cases have transient neurological deterioration. The dorsal root entry zone has been proven to be an effective incision area in the treatment of intramedullary lesions, but so far, its utilization in intramedullary ependymal cysts has been rarely reported. This study is the first to report on six cases of intramedullary ependymal cysts treated with an 8-mm incision in the dorsal root entry zone to fully establish the communication between the cyst and the subarachnoid space. Imaging changes and neurological improvement were analyzed in all cases before and after surgery and were followed up for 49.7 months. The utilization of dorsal root entry zone fenestration in intramedullary ependymal cyst has demonstrated feasibility and effectiveness, ensuring the functional integrity of the posterior column.

Ependymal cyst in the caudal cranial fossa of a young Belgian Malinois dog with abnormal cerebrospinal fluid findings

Abstract Fluid-filled cavities within the brain are well-recognized in human and veterinary medicine. Congenital or acquired brain cystic lesions could be isolated or associated with other diseases. Clinical signs related to cysts depend on their size and the mass effect they exert on surrounding neuroanatomical structures. We present a case of a 5-month-old Belgian Malinois dog with cervical pain and right head tilt. The dog had a normal haematochemical profile and negative infectious disease tests. A contrast enhancement Computed Tomography scan revealed the presence of a thin-walled cystic lesion in the caudal cranial fossa at the level of the right pontine-cerebellar junction. A cerebrospinal fluid tap was performed by lumbar puncture, revealing a monocytic pleocytosis. After initial improvement following corticosteroid and antibiotic therapy, clinical signs worsened, and the dog underwent a second clinical evaluation and magnetic resonance imaging examination. After euthanasia a complete postmortem examination was performed. Histological and immunohistochemical findings were suggestive of an ependymal cyst.

Pathogenic/likely pathogenic copy number variations and regions of homozygosity in fetal central nervous system malformations.

To explore pathogenic/likely pathogenic copy number variations (P/LP CNVs) and regions of homozygosity (ROHs) in fetal central nervous system (CNS) malformations. A cohort of 539 fetuses with CNS malformations diagnosed by ultrasound/MRI was retrospectively analyzed between January 2016 and December 2019. All fetuses were analyzed by chromosomal microarray analysis (CMA). Three cases with ROHs detected by CMA were subjected to whole-exome sequencing (WES). The fetuses were divided into two groups according to whether they had other structural abnormalities. The CNS phenotypes of the two groups were further classified as simple (one type) or complicated (≥ 2 types). (1) A total of 35 cases with P/LP CNVs were found. The incidence of P/LP CNVs was higher in the extra-CNS group [18.00% (9/50)] than in the isolated group [5.32% (26/489)] (P < 0.01), while there was no significant difference between the simpletype and complicated-type groups. (2) In the simple-type group, the three most common P/LP CNV phenotypes were holoprosencephaly, Dandy-Walker syndrome, and exencephaly. There were no P/LP CNVs associated with anencephaly, microcephaly, arachnoid cysts, ependymal cysts, or intracranial hemorrhage. (3) Only four cases with ROHs were found, and there were no cases of uniparental disomy or autosomal diseases. The P/LP CNV detection rates varied significantly among the different phenotypes of CNS malformations, although simple CNS abnormalities may also be associated with genetic abnormalities.

Clinical analysis of Terson syndrome in infants

Objective: To observe the clinical features, intervention and outcomes of anatomic and visual functions of Terson syndrome in infants, and to explore the appropriate timing for surgery. Methods: This retrospective study included 23 eyes of 14 infants diagnosed with vitreous hemorrhage related to Terson syndrome between May 2008 and March 2021 in Department of Ophthalmology, Peking University People's Hospital. There were 7 males (11 eyes) and 7 females (12 eyes). The age at the initial visit was (4.59±3.96) months. No obvious abnormality was observed in the anterior segment of both eyes of each patient. Data were collected, including demographics, causes of intracranial hemorrhage, characteristics of intraocular hemorrhage, intervention, outcomes of anatomic and visual functions. Results: The causes were craniocerebral trauma in 3 patients, idiopathic cysts in 8 patients, ependymal cyst rupture in 1 patient and respiratory distress in 2 patients. The chief complaint was behavior change in 9 patients, and hemorrhage was found in 5 patients on fundus examination. The rate of complications related to intraocular bleeding was 12/16 when the duration was less than 3 months and 6/7 when the duration was more than 3 months. Twenty eyes (86.96%) were treated by vitrectomy. The follow-up ranged from 6 to 160 months. Three eyes were atrophied, anatomical success was recorded in 18 eyes, and retinal detachment developed in 2 eyes. The visual acuity was improved in 12 eyes (60%), unchanged in 5 eyes (25%), and deteriorated in 3 eyes (15%), except 3 eyes that did not comply with visual acuity examination. Ten eyes showed an obvious myopic shift. Conclusions: The vitreous hemorrhage related to Terson syndrome can occlude the macula and cause severe structural and functional impairments in infants. Vitrectomy is an effective intervention technique, which can quickly remove blood accumulation and restore the anatomical structure, providing better conditions for the visual development of infants.

Symptomatic Cerebral Ependymal Cyst : A Case Report

Cerebral ependymal cyst is a rare benign neuroepithelial cyst. We report a case of cerebral ependymal cyst in a 62-year-old lady who presented with status epilepticus. She gave history of progressive right occipital headache over a year. Magnetic Resonance Imaging of the brain showed a large occipital cyst. She underwent a right craniotomy, deroofing of the cyst and insertion of Ommaya catheter. The clinicopathological aspects of the cyst are discussed.

Ovarian ependymoma presenting in pregnancy: a case report and literature review

BackgroundOvarian ependymoma is a rare malignancy. Because of the extreme rarity, certain features of the neoplasm, including its clinical behaviour and optimal therapy, are incompletely characterized.Case presentationA 32-year-old pregnant woman at term presented with a left ovarian neoplasm that occurred in the early stage of pregnancy. She underwent left adnexectomy during the caesarean section, and the neoplasm was histologically and immunohistochemically identified to be ovarian ependymoma. Immunohistochemical staining with oestrogen receptors and progesterone receptors showed strong positive staining. According to reports in the literature, the pathological type of ovarian ependymoma in our patient was the extra-axial type. Interestingly, the foetus was also found to have bilateral ependymal cysts during pregnancy. The patient received no further surgical treatment or adjuvant therapy. She and her 14-month-old baby both have no evidence of disease at present. The follow-up of both mother and child is still continuing.ConclusionsThe case presented here illustrates high levels of oestrogen during pregnancy may stimulate viable malignant ependymal cells to proliferate. Hence, young women with extra-axial-type ependymomas may not be suitable for fertility preservation. Moreover, hormone-based therapies can be a potentially effective treatment for women with extra-axial ependymomas.

Retrocerebellar Ependymal Cyst Presenting with Obstructive Hydrocephalus in an Infant

AbstractIntracranial ependymal cysts (ECs) are rare benign lesions. They are frequently asymptomatic and arise in the supratentorial regions. Retrocerebellar ECs is a rare location. We present a case of 3-months-old infant who developed obstructive hydrocephalus, bulging fontanel, and macrocephaly secondary to a retrocerebellar EC. Magnetic resonance imaging (MRI) showed a large retrocerebellar cyst that compressed the cerebellum and the brainstem, producing fourth ventricle outlet obstruction and supratentorial hydrocephalus. Microsurgical fenestration of the cyst to the obex of the fourth ventricle and a cystic wall biopsy were performed. The procedure improved supratentorial hydrocephalus, as well as the patient's clinical condition. A histopathological study confirmed the diagnosis of an EC.As far as we know, after a thorough review of the literature, this is the first reported case of retrocerebellar EC. It is a rare cause of hydrocephalus due to outlet obstruction of the fourth ventricle. Treatment of the cause itself was shown to be effective.

Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series.

The object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions. This is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort. In the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1-137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%-100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma). Endoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done.

Occipital lobe ependymal cyst with unusual presentation

Occipital lobe ependymal cyst with unusual presentation

Occipital lobe ependymal cyst with unusual presentation

Occipital lobe ependymal cyst with unusual presentation

Meningeal cysts complicated with tethered cord syndrome diagnosed by prenatal ultrasonography: a case report

We reported a case diagnosed with meningeal cysts complicated with tethered cord syndrome based on prenatal ultrasound images at 37+5 gestational weeks, which also showed horseshoe kidney and intrahepatic vascular abnormalities (arteriovenous fistula) in the fetus. The gravida had a precipitate delivery at 39+4 gestational weeks. The anus of this newborn was about 1 cm in front of the normal position. Intrahepatic arteriovenous fistula and horseshoe kidney were detected by neonatal ultrasound and CT scan, and spinal cystic occupying lesion was found by lumbar-sacrum MRI. Intraspinal tumors were removed through spinal canal exploration and spinal cord tumor resection and were confirmed as ependymal cysts by pathological analysis, which was consistent with the prenatal diagnosis. Postoperative changes of lumbar spine was reported by CT scan after the operation. The baby received successful anoplasty when five months old and no abnormal growth or development were found when followed up to one year and eight months old. Raising awareness of tethered cord syndrome can help reduce missed diagnosis and misdiagnosis. Key words: Neural tube defects; Ependyma; Cysts; Ultrasonography, prenatal

Awake Surgical Management of Third Ventricular Tumors: A Preliminary Safety, Feasibility, and Clinical Applications Study.

Endoscopic and microneurosurgical approaches to third ventricular lesions are commonly performed under general anesthesia. To report our initial experience with awake transsulcal parafascicular corridor surgery (TPCS) of the third ventricle and its safety, feasibility, and limitations. A total of 12 cases are reviewed: 6 colloid cysts, 2 central neurocytomas, 1 papillary craniopharyngioma, 1 basal ganglia glioblastoma, 1 thalamic glioblastoma, and 1 ependymal cyst. Lesions were approached using TPCS through the superior frontal sulcus. Pre-, intra-, and postoperative neurocognitive (NC) testing were performed on all patients. No cases required conversion to general anesthesia. Awake anesthesia changed intraoperative management in 4/12 cases with intraoperative cognitive changes that required port re-positioning; 3/4 recovered. Average length of stay (LOS) was 6.1 d±6.6. Excluding 3 outliers who had preoperative NC impairment, the average LOS was 2.5 d±1.2. Average operative time was 3.00 h±0.44. Average awake anesthesia time was 5.05 h±0.54. There were no mortalities. This report demonstrated the feasibility and safety of awake third ventricular surgery, and was not limited by pathology, size, or vascularity. The most significant factor impacting LOS was preoperative NC deficit. The most significant risk factor predicting a permanent NC deficit was preoperative 2/3 domain impairment combined with radiologic evidence of invasion of limbic structures - defined as a "NC resilience/reserve" in our surgical algorithm. Larger efficacy studies will be required to demonstrate the validity of the algorithm and impact on long-term cognitive outcomes, as well as generalizability of awake TPCS for third ventricular surgery.

Intracranial ependymal cyst with unusual presentation: Case report and review of literature

Abstract Background Ependymal cysts remain a very rare cause of neurological symptoms among intracranial cystic lesions. It differs from an arachnoid cyst, as it does not communicate with subarachnoid space. Case description A 33-year-old woman was admitted in our neurosurgery department with history of headache, vomiting and right unilateral blindness. Neuroimaging studies showed an intraparenchymal cystic lesion in the right frontal lobe with radiologic characteristic as seen in the ependymal cyst or hydatic cyst. She underwent the neurosurgical procedure of marsupialization and was discharged on day 6 post op. At one month follow up, the patient presented with a decrease vision acuity on the left eye, and head CT scan showed a recurrence of the cyst hence, we performed a second surgery with shunt procedure. Histological examination of the resected tissue demonstrated that, it was an ependymal cyst. Conclusion Since there is often times a clinico-radiological discordance they are generally incidental findings in majority of cases. While complete surgical excision is the treatment of choice for the symptomatic cysts, cystic fluid diversion presents a better compromise nevertheless in cases where this may not be achieved.

Endoscopic treatment of intraventricular ependymal cysts in children: personal experience and review of literature.

Intracranial ependymal cysts are rare neuroepithelial cysts that occur less frequently than arachnoid cysts. The cysts are most often intraparenchymal, but they are rarely reported to be intraventricular. This study evaluates the role of endoscopy in the treatment of intraventricular ependymal cysts (IVECs). Twelve pediatric patients (mean age 4.3years) with symptomatic IVECs were the subject of this study. The cyst was located inside the lateral ventricle in all cases (100%), it was present in trigone (10 patients, 83.3%), and in temporal horn (2 patients, 16.7%). Concomitant hydrocephalus was present in two patients (16.7%). All patients underwent operations through a purely endoscopic procedure. Communication of the cyst with the subarachnoid space was performed in six patients (50%); endoscopic cystocisternostomy was performed in four patients (33.3%), and endoscopic cystoventriculostomy in two patients (16.7%). Postoperative clinical improvement associated with postoperative reduction in cyst size was encountered in ten patients (83.3%). Improvement of hydrocephalus occurred in both patients who had hydrocephalus (100%). There were no deaths or permanent morbidity. Among the follow-up period (mean 44.3months), none of the patients required a repeat endoscopic procedure due to recurrence of symptoms or increase in cyst size. Intraventricular ependymal cysts can be effectively treated by endoscopy. Endoscopic fenestration of the cyst wall into subarachnoid space, basal cisterns, or ventricular system can be used in the treatment of these patients with postoperative symptomatic improvement and reduction of cyst size. The procedure is simple, effective, minimally invasive, and associated with low morbidity and mortality rates.

Fourth ventricle lesion: Answer

Choroid plexus cyst. The patient underwent a suboccipital craniotomy and removal of the dorsal arch of C1 in the prone position. The cyst, which was presenting at the foramen of Magendie, was opened and deflated. The wall was separated from the surrounding structures with blunt dissection and completely removed. There was some vascular attachment to the choroid plexus on the roof of the fourth ventricle that was transected to separate the cyst and remove it. The macroscopic appearance of the cyst was smooth, mobile and tan-pink in colour. Histopathological analysis of the cyst is shown in Fig. 2. The choroidal origin of the epithelium was confirmed by showing focal immunohistochemical positivity for transthyretin and cytokeratin AE1/AE3, and no immunoreactivity to S100 or glial fibrillary acidic protein (GFAP). The pathological diagnosis of the lesion was benign Choroid Plexus Cyst (CPC). Choroidal cysts of the ventricular system are usually small-sized asymptomatic lesions that are incidentally encountered at autopsy and their size does not usually extend beyond 15–20 mm in diameter [1Choi J.H. et al.A symptomatic choroid plexus cyst in the lateral ventricle: case report.J Korean Neurosurg Soc. 1998; 27: 1283-1287Google Scholar, 2Netsky M. Shuangshoti S. Origin of choroid plexus and ependyma. The choroid plexus in health and disease. University Press of Virgina, Charlottesville1975: 3-18Google Scholar]. They are most frequently found in children and account for approximately 3% of all paediatric cerebral pathological entities [3Baka J. Sanders W. MRI of hemorrhagic choroid plexus cyst.Neuroradiology. 1993; 35: 428-430Crossref PubMed Scopus (7) Google Scholar, 4Odake G. Tenjin H. Murakami N. Cyst of the choroid plexus in the lateral ventricle: case report and review of the literature.Neurosurgery. 1990; 27: 470-476Crossref PubMed Scopus (33) Google Scholar]. They may be single or multiple and generally located around the trigone of the lateral ventricles [[5]Giorgi C. Symptomatic cyst of the choroid plexus of the lateral ventricle.Neurosurgery. 1979; 5: 53-56Crossref PubMed Scopus (13) Google Scholar]. These congenital cysts are thought to arise from entanglement of villi from the rapidly growing choroid plexus that traps CSF and cellular debris to take on the appearance of a cyst [[6]Kennedy KA, Carey JC. Choroid plexus cysts: significance and current management practices. In: Seminars in ultrasound, CT and MRI, Elsevier: 1993.Google Scholar]. They are commonly found during the second trimester of normal fetuses, and appear to be more common in aneuploidy, particularly trisomy 18 [[7]McLennan M. Radiology rounds choroid plexus cysts.Can Fam Phys. 1997; 43: 1357PubMed Google Scholar]. The occurrence of symptomatic CPCs within the fourth ventricle are evidently extremely rare, more so in adults as most of the foetal cysts regress [[8]New P. Davis K. Intraventricular noncolloid neuroepithelial cysts.Am J Neuroradiol. 1981; 2: 569-576PubMed Google Scholar]. On CT imaging, cystic lesions usually appear as a well-defined mass of similar low density to CSF. MR brain imaging demonstrates the precise location of the cyst within the ventricular system, along with its thin wall often closely applied to the ventricular lining. The cystic contents have a signal on both T1- and T2- weighted MR images, corresponding to CSF [[9]Czervionke L. et al.Neuroepithelial cysts of the lateral ventricles: MR appearance.Am J Neuroradiol. 1987; 8: 609-613PubMed Google Scholar]. The differential diagnoses include ependymal cyst, parasitic cysts as found in neurocysticercosis and hydatidosis, and epidermoid cysts. Ependymal cysts tend to be intracerebral with a tendency to displace rather than expand the ventricle and show immunopositivity to GFAP [[3]Baka J. Sanders W. MRI of hemorrhagic choroid plexus cyst.Neuroradiology. 1993; 35: 428-430Crossref PubMed Scopus (7) Google Scholar]. The parasitic cysts are commonly accompanied by surrounding cysts, with or without peripheral enhancement and calcification, and may contain a mural nodule representing the scolex [[8]New P. Davis K. Intraventricular noncolloid neuroepithelial cysts.Am J Neuroradiol. 1981; 2: 569-576PubMed Google Scholar]. Epidermoid cysts can potentially mimic a choroid plexus cyst because they occur largely within the fourth ventricle and their contents have the same density as CSF. However, their MRI appearance varies depending on the lipid and keratin content [3Baka J. Sanders W. MRI of hemorrhagic choroid plexus cyst.Neuroradiology. 1993; 35: 428-430Crossref PubMed Scopus (7) Google Scholar, 10Martínez-Lage J.F. et al.Congenital arachnoid cyst of the lateral ventricles in children.Child's Nervous Syst. 1992; 8: 203-206Crossref Scopus (42) Google Scholar]. The patient recovered uneventfully with improvement of his gait. Postoperative MR scan showed no residual cyst and CT brain scan 4 weeks postoperatively showed no hydrocephalus. Fourth ventricle lesion: QuestionJournal of Clinical NeuroscienceVol. 45PreviewA 61 year-old man presented with a one-year history of progressive gait disturbance, dizziness, episodes of blurred vision and mild headache. There was no associated ataxia, focal neurological deficits or papilloedema. He had a history of hypertension, which was well controlled. Full-Text PDF

Symptomatic Surgically Treated Non-neoplastic Cysts of the Central Nervous System: A Clinicopathological Study From Pakistan.

To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). Case series. The Aga Khan University Hospital, Karachi, from 2003 to 2012. All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ±13.2 years), 32 arachnoid cysts (mean age 24.8 ±20.2 years), 6 dermoid cysts, 3 enterogenous cysts and Rathke's cleft cysts each and 1 ependymal cyst. All cyst types mainly presented in young adults in both genders with signs and symptoms of a mass lesion. Non-neoplastic cyst mainly presented like a CNS mass lesion in young adults. Epidermoids were the most common type of these cysts in the present series followed by the colloid and the arachnoid cysts.