Middle Cranial Fossa Arachnoid Cyst Research Articles

Optic Nerve Edema in Pediatric Middle Cranial Fossa Arachnoid Cysts: Report of 51 Patients From a Single Institution

BackgroundMiddle fossa arachnoid cysts (MFACs) are rare, congenital lesions that may rupture and cause symptoms of elevated intracranial pressure. We sought to describe the presence of and factors associated with optic nerve edema in MFACs, focusing on the utility of ophthalmologic evaluations for guiding cyst management. MethodsWe reviewed clinical and radiographic information for all patients with MFACs with ophthalmologic evaluations at our institution. Headache, cranial nerve palsy, emesis, altered mental status, fatigue, and seizures were considered MFAC-related symptoms. Univariate and multivariable analyses evaluated factors associated with optic edema. ResultsFifty-one patients between 2003 and 2022 were included. Cysts were a median volume of 169.9 cm3 (interquartile range: 70.5, 647.7). Evidence of rupture with subdural hematoma/hygroma occurred in 19 (37.3%) patients. Eighteen (35.3%) patients underwent surgery for their cyst and/or rupture-associated intracranial bleed. Eleven (21.6%) patients had optic edema; all were symptomatic and experienced cyst rupture. Ten of these patients received surgery. Postoperatively, optic edema resolved in 80% of cases. Cyst volume and symptoms were not associated with optic edema; however, patients with ruptured cysts, particularly those with traumatic rupture, were more likely to have optic edema and receive surgery (P < 0.001). ConclusionsWe found optic edema in 21.6% of evaluated MFACs, and this comprised of 57.9% of ruptured cases. Optic edema was not found in unruptured cysts. Cyst fenestration improved optic edema and patient symptoms. In conjunction with clinical history and neuroimaging, optic edema may help guide MFAC management, particularly in patients with cyst rupture.

Nontraumatic symptomatic de novo arachnoid cyst in an adolescent patient treated with cystoperitoneal shunting: illustrative case.

Arachnoid cysts are often congenital, asymptomatic lesions detected in the pediatric population. When seen in adults, they usually occur following trauma. De novo formation of arachnoid cysts is uncommon, with only a few instances cited in the literature and most of which occurred in the pediatric population. Treatment options for these lesions include observation, craniotomy for cyst resection, microsurgical/endoscopic fenestration, or shunting. In this report, the authors describe a female patient with a de novo, symptomatic, enlarging middle cranial fossa arachnoid cyst detected at age 16 years. She was treated with the placement of a cystoperitoneal shunt. After surgery, she experienced clinical and radiological improvement. We illustrate successful shunting of a de novo arachnoid cyst in a symptomatic teen patient. Although arachnoid cysts in certain intracranial locations are more likely to produce symptoms, those in the middle cranial fossa tend to be asymptomatic. To our knowledge, this is the first reported case of a symptomatic de novo arachnoid cyst located in the middle cranial fossa in a postpubertal patient. Although the current presentation is rare, the authors demonstrate an effective surgical treatment of a symptomatic, large, de novo arachnoid cyst in a postpubertal pediatric patient.

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.

Efficacy of shunt surgery in pediatric middle cranial fossa arachnoid cysts

Amaç: Araknoid kistlerin yarıdan fazlası orta fossa yerleşimlidir. Literatürde tedavi zamanlaması ve şekli konusunda tam bir görüş birliği bulunmamaktadır. Biz kliniğimizde orta kraniyal fossa araknoid kistlerde şant cerrahisi uyguladığımız hastaların sonuçlarını sunarak bu hastaların tedavileri konusuna katkıda bulunmayı amaçladık.&#x0D; &#x0D; Yöntemler: 2015 ve 2021 yılları arasında kliniğimizde orta kranial fossada tip 3 araknoid kist nedeniyle kistoperitoneal şant cerrahisi uyguladığımız 6 hastayı retrospektif olarak inceledik. Tüm hastaların operasyon öncesi ve sonrası klinik ve radyoljik durumları incelenerek not edildi. Operasyon sonrası 1. yıl klinik ve radyolojik kontrolleri de mevcut olan hastalar çalışmaya dâhil edildi.&#x0D; &#x0D; Bulgular: Tüm hastaların araknoid kist yerleşim yeri kranial orta fossa idi ve tüm hastalar kistoperitoneal şant ile tedavi edildiler. 2 yaş altı tüm hastalarda tespit edilmiş şikayet veya bulgu hareket ve tepkilerde azalma ve fontonel gerginliği iken 2 yaş üstünde şiddetli baş ağrısıydı. Tüm hastaların araknoid kistleri sınıflandırmada tip 3’tü ve radyolojik incelemelerde bası bulguları vardı. Hastaların tümünün cerrahi sonrası semptom ve şikayetleri azaldı. Bir hastada slit kist sendromunu düşündürecek klinik bulgular oluştu. Bu hasta dışında hiçbir hastada kontrol süresince herhangi bir komplikasyon görülmedi.&#x0D; &#x0D; Sonuç: Çalışmamız pediatrik orta kraniyal fossa tip 3 araknoid kistli hastalarda kistoperitoneal şant cerrahisinin, ilk tedavi yöntemi olarak da uygulanabilecek etkili ve güvenli tedavi yöntemi olduğu görüşünü desteklemektedir.

The unique features of middle cranial fossa and Sylvian fissure arachnoid cysts in children: MRI evaluation.

The purpose of the study is to evaluate MRI findings of middle fossa arachnoid cysts in children according to Galassi classification and determine the differences between types and to assess the morphological changes in cysts during follow-up imaging. MR images of 266 middle fossa arachnoid cysts of 255 pediatric patients were evaluated by two experienced radiologists retrospectively. MRI features including the sidedness of the cyst, Galassi type, parenchymal compression findings (cortical flattening and white matter compression), bone remodeling, and midline shift were evaluated on axial T2- and T1-weighted images. Follow-up MRI and available CSF flow MR imaging data were evaluated for change in cyst size and cisternal connections, respectively. The most common type was type 1 according to Galassi classification. The accompanying bone remodeling and white matter compression had a higher incidence in Galassi type 2 and 3 groups than Galassi type 1. Mean age of patients with bone remodeling and white matter compression was significantly higher in patients with Galassi type 1. All patients with cyst enlargement were younger than 2years of age, and all of them were Galassi type 1. Cisternal connection was demonstrated in 7 patients. While parenchymal compression and bone remodeling are expected findings in Galassi type 2 and 3 cysts, these features can also be seen in smaller Galassi type 1 cysts, regardless of size. Most of the middle fossa arachnoid cysts remain stable on follow-up imaging, and the increase in size is not an expected finding, especially in older children.

Endoscopic Fenestration for Treating Galassi Type III Middle Cranial Fossa Arachnoid Cysts: Single- and Multiple-stoma have the Same Curative Effect.

For endoscopic fenestration of middle cranial fossa arachnoid cysts (MCFACs), the decisions on the location and number of stomas are key issues. However, research on this particular topic has been limited. Thus, this study aimed to compare single- versus multiple-stoma endoscopic fenestration for treating Galassi type III MCFACs. This retrospective study included 86 patients with Galassi type III MCFACs treated with endoscopic fenestration. Single-stoma fenestration to the basal cistern was performed in 37 cases, whereas multiple-stoma fenestration to the basal cistern and the carotid cistern was performed in 49 cases. Clinicoradiologic profiles and follow-up data were analyzed. The rate of symptom relief was 83.7% (72/86), and the rate of cyst shrinkage was 96.5% (83/86). Postoperative ipsilateral subdural effusion, which was significant (p = 0.042), and noninfectious fever were the two most common complications in the single- and multiple-stoma groups. No significant differences in intraoperative nerve injury, vascular injury, proportion of cases with cyst reduction, and symptom remission rate were observed between the two groups. The rates of cyst recurrence and secondary surgery in the single-stoma group were higher than those in the multiple-stoma group, although the difference was not significant. Endoscopic fenestration is an effective and minimally invasive approach for treating Galassi type III MCFACs. Single- and multiple-stoma endoscopic fenestrations have the same curative effect.

Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases.

BACKGROUNDArachnoid cysts are benign, often asymptomatic intracranial mass lesions that, when ruptured, may cause seizures, raised intracranial pressure, hemorrhage, and/or loss of consciousness. There is no widely agreed upon treatment, and there is debate as to whether a nonoperative or surgical approach is the best course of action. The carbonic anhydrase inhibitor acetazolamide may be an effective nonoperative approach in treating ruptured arachnoid cysts.OBSERVATIONSThe Pediatric Neurosurgery Clinical Database at BC Children’s Hospital from 2000 to 2020 was queried, and four pediatric patients who were treated with acetazolamide after presentation with a ruptured middle cranial fossa arachnoid cyst were identified. All patients showed some degree of symptom improvement. Three of the patients showed complete reabsorption of their subdural collections in the ensuing 6 months. One patient had an inadequate response to acetazolamide and required surgical management.LESSONSAcetazolamide is a safe and reasonable primary treatment option in pediatric patients with ruptured middle cranial fossa arachnoid cysts, and it may help avoid the need for surgery.

Intracranial Arachnoid Cysts Presenting with First-Episode Mania and Subsequent Hyperammonemic Encephalopathy: A Case Report

Abstract Intracranial arachnoid cysts are often an incidental discovery in the course of neuroimaging for other conditions. While often asymptomatic, cysts which enlarge can cause mass or pressure effects on adjacent structures. We report a 33-year-old male patient who presented with first episode of manic symptoms. Following treatment with sodium valproate patient developed altered sensorium and was subsequently diagnosed with middle cranial fossa arachnoid cysts and valproic acid-induced hyperammonemic encephalopathy that was successfully treated with enteric lactulose. There are several case reports of arachnoid cysts presenting in patients with psychiatric disorders and debating whether these cysts are a cause or co-occurrence. In 16 reported patients, who had arachnoid cysts with psychiatric symptoms, 9 had cysts exerting mass/pressure effects. Three patients had surgical intervention and showed significant improvement following surgery. So did 1 patient who was treated with mannitol infusion. Intracranial arachnoid cysts may also present with atypical psychiatric symptoms or complicate the treatment process by way of poor response or treatment emergent adverse effects. There is an important role for thorough neurological examination, neuroimaging, and vigilant use of psychotropics in such patients.

An infant with TBIRD after subdural hematoma/hygroma caused by a ruptured middle cranial fossa arachnoid cyst

An infant with TBIRD after subdural hematoma/hygroma caused by a ruptured middle cranial fossa arachnoid cyst

Non-Operative Management of a Pediatric Patient With Bilateral Subdural Hematomas in the Setting of Ruptured Arachnoid Cyst

Pediatric subdural hematomas (SDH) are associated with arachnoid cysts (AC), particularly in the middle cranial fossa (MCF). Operative management of these hemorrhages is a mainstay of treatment. Conservative management may be an option if there is minimal mass effect and the patient is mildly symptomatic. A 14-year-old male presented with right frontal headaches that worsened with activity. He was found to have a large right MCF AC. Scheduled routine outpatient follow-up CT of the head demonstrated bilateral SDH. There was no history of significant head trauma. He was admitted for close observation and his inpatient scans remained stable. Outpatient follow-up imaging over the course of three and a half years demonstrated resolution of SDH and decreased AC size. He denied headaches and continued doing well in school. ACs are a risk factor for the development of SDH in young male patients after minor trauma. Development of intracranial hypotension secondary to AC rupture may have contributed to the development of bilateral SDH in our patient. We demonstrate here that close clinical follow up with serial imaging may be considered a management strategy in these patients.

Endoscopic Treatment of Middle Cranial Fossa Arachnoid Cysts in Children: Surgical Results of 65 Cases

Congenital arachnoid cysts in the middle fossa accounts for 50% of all intracranial arachnoid cysts. Several management options have been described; however, no single technique has been universally adopted. We describe a series of pediatric patients with middle cranial fossa arachnoid cyst that were treated through an innovative minimally invasive endoscopic technique, along with their clinical aspects and surgical outcomes. Data from 65 patients operated between 2012 and 2018 were retrospectively analyzed. Follow-up ranged from 12 to 96 months. Clinical presentation and surgical outcomes were collected. Endoscopic cystocisternostomy was performed in all patients using a mini endoscope. There were 41 male and 24 female patients, with a mean age of 5.3 years at the time of treatment. Except for 4 patients, all presented with 1 or more symptoms, and the most frequent were intracranial hypertension signs. All patients were treated with the same surgical technique, with an efficacy of 81.5%. Using a mini endoscope allow us to perform multiple fenestrations along the arachnoid and deeply inspect the basal cisterns, achieving a much wider communication between the cyst and subarachnoid space with a high success rate and minimal invasiveness.

Ruptured middle cranial fossa arachnoid cysts after minor trauma in adolescent boys presenting with subdural hygroma: two case reports

BackgroundIntracranial arachnoid cysts are common, cerebrospinal fluid-filled, innocent lesions that are usually detected incidentally on brain imaging. They may rupture and complicate due to subdural hematoma or hygroma after minor trauma.Case summaryAuthors present two cases of ruptured middle cranial fossa arachnoid cysts in adolescent (12-year-old and 15-year-old) Afghan boys presenting with subdural hygroma after minor trauma.ConclusionImaging work-up is necessary for symptomatic patients following minor head trauma as incidentally detected ruptured intracranial arachnoid cysts can be responsible for the symptoms.

Pneumosinus Dilatans: An exploration into the association between Arachnoid Cyst, Meningioma and the pathogenesis of Pneumosinus Dilatans

ObjectivesTo investigate the association between certain intracranial masses (meningioma and arachnoid cyst) and the incidence of Pneumosinus Dilatans (PSD) – including whether the size of the mass correlates with severity of the condition. Patients and methodsA review of the available case reports on PSD was performed. Clinical data was extracted from 111 case reports for analysis. A further case-control study was performed using CT Head datasets to investigate the aetiological relationship between intracranial masses and PSD. Cases included patients with confirmed arachnoid cyst or meningioma. Controls included patients with no intracranial masses. ResultsPSD is most common in the frontal (48%) and sphenoid sinuses (43%). Men are twice as likely to be affected as women. 58% of cases occur in patients aged 35 or under. The most common symptoms reported are facial deformities (39%), headache (24%) and visual loss (15%). Unexplained visual changes (e.g. diplopia, reduced visual acuity) are strongly correlated with sphenoid sinus involvement. PSD is more common in patients with skull-base meningioma (OR 5.67) and middle cranial fossa arachnoid cysts (OR 10.00). Mean sinus volume in patients with PSD can increase by up to 4 times. ConclusionWe present the first direct investigation into the relationship between meningioma, arachnoid cyst and Pneumosinus Dilatans. There is a statistical correlation between skull-base meningioma and middle cranial fossa arachnoid cysts and the incidence of PSD. This specific anatomical relation suggests that local factors contribute to the pathogenesis of the condition. Alterations in intracranial pressure due to mass effect or vascular occlusion, in addition to the localised release of bone growth factors (IGF-1, IGF-2, PDGF), are possible mechanisms for this. The first peak in incidence of PSD coincides with the completion of normal sinus pneumatisation, which raises the further possibility that predisposing genetic factors also contribute.

Psychosis and iddle cranial fossa arachnoid cyst: Case report and literature review

Controversies emerged in linking middle cranial fossa-arachnoid cyst to psychosis. Despite the anatomical association between such cyst and psychosocial behaviour, still several features of the cyst itself hamper causation. I report a case of a young female labeled refractory schizophrenia who presented with antipsychotic toxicity overlooking an arachnoid cyst in the middle cranial fossa. Due to the paucity of information in the literature on such association here I discuss further implications from a first medical encounter, from a patientÂ’s perspective and from a disposition perspective as well.

Unique presentation of a ruptured arachnoid cyst with subdural hygroma formation and midline shift in a 10-year-old girl

Objective: The majority of intracranial arachnoid cysts are asymptomatic and are detected incidentally. They are benign congenital cavities arising in the subarachnoid space. Rupture may result in symptomatic presentation, the most common symptom being headache. Raised intracranial pressure is a rare complication requiring surgical treatment. Methods: Information was collected from the patient, parents, notes and hospital databases. Results: A 10-year-old girl presented to a district general hospital with a 2-month history of a strange sensation in her head during any physical activity. A week prior to admission she heard a “pop” in her head while performing a cartwheel, developed nausea and headache that was eased when standing up or tilting her head to the right. On examination, the patient was neurologically intact with no signs of raised intracranial pressure. However, MRI brain showed a ruptured 3.8 × 2.9 x 2.3 cm left middle cranial fossa arachnoid cyst with extensive subdural hygroma and mass effect (Image 1, 2). She was managed with burr hole drainage. Conclusion: It is essential to pay attention to the history, which may appear to be trivial on presentation (a sensation of “pop” while doing cartwheel) to avoid missing burst arachnoid cysts that may have disastrous consequences.

Bilateral Subdural Hygroma in a Case with Sylvian Arachnoid Cyst

Arachnoid cysts are congenital lesions developing from arachnoid membrane. The incidence of arachnoid cysts in the general population is around 0.1% and their most common place is middle fossa. Arachnoid cysts usually present during childhood and are identified incidentally. When symptomatic, the most common presentation includes headache and seizure. The popular treatment for this lesion is surgery. In this case report, we describe a 12-year-old boy with a middle cranial fossa arachnoid cyst presenting with progressive headache, and bilateral subdural hygroma following a trivial trauma.

Management of Symptomatic Middle Cranial Fossa (Sylvian) Arachnoid Cyst

Management of Symptomatic Middle Cranial Fossa (Sylvian) Arachnoid Cyst

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children.

OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.

P122 – 2666: Neuropsychological evaluation of children with middle cranial fossa arachnoid cysts, before and after decompression of the cyst through neurosurgical fenestration

Objective To evaluate cognitive outcome in children after surgical decompression of arachnoid cysts of the middle cranial fossa. An additional objective was to assess the children as one part of the decision whether to perform a surgical intervention or not. Arachnoid cysts are often considered asymptomatic incidental findings of MRI or CT. In this project the aim was to assess prevalence of cognitive symptoms correlated to the cyst and possible postsurgical improvement. Methods Neuropsychological assessment at the department of child neurology at Karolinska University Hospital, Stockholm. The assessment of intellectual ability was done using WISC-IV. Assessment of specific cognitive functions was done using NEPSY-II, Rey Oesterrieth Complex Figure test, BNT-II and FAS (test of verbal fluency). A follow-up with the same psychometric tests 4–5 months after surgery. Results To this date 6 children has gone through presurgical assessment. Four of six children showed cognitive symptoms in the assessment. Symptoms that was correlated to the location of the cyst and the neurosurgeon decided on fenestration of the cyst. Two of six children had no cognitive symptoms and the neurosurgeon decided on no surgical intervention. Two of the four children with symptoms have been evaluated 5 months after decompression of the cyst. Both clinical and psychometric results points towards reduction of cognitive symptoms in these two patients. Conclusion Neuropsychological assessment might be used as a help in decisions regarding surgery. Pre- and post-op assessment might be a way of evaluating the possible benefits of decompression of arachnoid cysts of the middle cranial fossa in children.

Progressive post traumatic tearing of an arachnoid cyst membrane resulting in intracystic and subdural haemorrhage

We report the case of a 43-year-old man with a middle cranial fossa arachnoid cyst who presented post trauma with neurological symptoms. The initial CT scan of the brain did not detect acute changes in the arachnoid cyst but subsequent imaging revealed abnormalities which progressed over time. Arachnoid cysts are usually a benign and incidental finding. Rare complications such as intracystic haemorrhage and subdural haemorrhage can occur. It is important to be aware of these complications so that patients with arachnoid cysts are appropriately investigated when presenting with neurological symptoms.