Symptomatic Arachnoid Cysts Research Articles

Experience with Management of Intracranial Arachnoid Cysts.

The aim of this study was to analyze the demographics, clinical presentation, and surgical outcome of intracranial arachnoid cysts and to review the surgical options. This is a retrospective observational study of 56 cases of symptomatic arachnoid cysts among all age groups treated between 2004 and 2020 at the Bombay Hospital, Mumbai. Endoscopic fenestration, microsurgical cyst excision, and shunt insertion were the interventions performed. Clinical presentation, cyst reduction post-intervention, and complications were studied. The follow-up period varied from 1 month to 16 years. Statistical analysis was done for 43 patients with a minimum of 3 years' follow-up. In all, 75% of patients were <18 years of age. Of these, the majority were between the age of 1 and 10 years. There were 14 cases of temporal, 13 cases of retrocerebellar, 10 cases of quadrigeminal cistern, and 7 cases each of interhemispheric and suprasellar arachnoid cysts. The most common clinical presentation was headache and vomiting. Concomitant hydrocephalus was seen on imaging in 24 cases. Endoscopic fenestration of cyst was the most routinely performed procedure (35 cases). Four patients of endoscopic fenestration underwent a redo endoscopic procedure on follow-up. Post-operative reduction in cyst size was found to be significantly better after endoscopic fenestration (p < 0.05). Though the best available treatment for arachnoid cysts remains controversial, surgery has been found to be beneficial in symptomatic cases. Endoscopic fenestration is considered the first-line surgical option and it may be followed by shunt, if necessary. Shunts may be preferred in very young children where there is associated hydrocephalus/macrocephaly.

Intradural symptomatic arachnoid cyst formation following non-instrumented lumbar decompression

Purpose Intradural arachnoid cyst is a rare complication of lumbar puncture, post-trauma or post-intraoperative durotomies. We aim to estimate the incidence of early intradural arachnoid cyst radiologically in non-instrumented posterior lumbar decompression among symptomatic patients, and establish clinical correlation. Materials and methods Patients who underwent lumbar decompression without instrumentation at a tertiary spinal service between December 2014 and January 2018 were identified. When MRI scans were performed post-operatively within 14 days, imaging, medical and operative records were reviewed by two consultant neuroradiologists. Results 488 operations were included. 46 operations were followed by an early MRI scan. 59% were requested to investigate new or ongoing pain. Ten demonstrated an intradural arachnoid cyst – seven had no documented durotomy. Eight were primary operations, three were emergency operations. Statistically, we have not identified durotomy, primary-vs-revision surgery, and elective-vs-emergency surgery as risk factors. Two patients required revision operations, of these, one had a repeat post-operative scan, where the cyst resolved following further decompression at the index level, without intradural exploration. Conclusions Intradural arachnoid cyst may complicate posterior lumbar decompression. To our knowledge, this is the first study to assess its incidence as an early post-operative radiological finding, which is likely to be commoner than we recognise. It may be a cause of persisting post-operative pain.

Compressive myelopathy secondary to posthemorragic arachnoiditis: Case report and literature review

BackgroundSpinal arachnoiditis is an arachnoid inflammatory process frequently caused by infection or spinal surgery; there are different degrees of severity, including arachnoid thickening and severe adhesive lesions that can lead to the development of arachnoid cysts. Non-traumatic subarachnoid haemorrhage (ntSAH) is a relatively uncommon cause of arachnoiditis; further complication with spinal cord compression (SCC) is even more unusual. Methodwe describe a 70-year-old female, with SCC caused by arachnoid cysts. Her medical past history was relevant for an episode of ntSAH after rupture of a posterior communicating artery aneurysm, eight months prior to the onset of symptoms. We also present a literature review of previous published cases. Resultswe selected 23 articles with 24 case reports. A noticeable female predominance (11:1) was observed. It is more common between the fourth and fifth decades. The majority of cases (58 %) were secondary to aneurysmal SAH due to rupture of a posterior circulation aneurysm. The most common location of the cyst is in the cervicothoracic spine. The average time between the initial bleeding and symptom development is 3–6 months. The most frequently described treatment is laminectomy and marsupialization of the cyst, but reports show a high recurrence rate. ConclusionsntSAH is an uncommon aetiology of arachnoiditis and arachnoid cysts. SCC from arachnoid cysts secondary to ntSAH is exceptional. Treatment through laminectomy has a relatively high recurrence rate (33 %). We present different hypotheses to try to explain how the alteration of cerebrospinal fluid (CSF) dynamics after ntSAH can lead to arachnoid cyst development and SCC. Although the small number of cases included in the present series precludes us to draw definite conclusions, ventriculoperitoneal shunt (VPS) placement can be considered as an alternative treatment in the management of known ntSAH patients that present recurrent symptomatic arachnoid cysts.

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

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

Volume change of cranial arachnoid cysts after successful endoscopic fenestration in symptomatic children

Endoscopic fenestration remains a first-line treatment option for symptomatic arachnoid cysts. After fenestration, the cyst does not collapse but reaches an equilibrium state. The aim of this study was to evaluate the change in cyst volume following successful fenestration and symptomatic improvement. Cyst volume was measured on serial MR scans of 4 children (1 female, 3 males) with symptomatic arachnoid cysts (middle fossa n = 2, choroidal fissure n = 1 and posterior fossa n = 1), who experienced symptom resolution after endoscopic fenestration. Average follow-up was 20.5months (range 3-48). Significant cyst volume reduction was seen in all four patients. In patient 1, preoperative cyst volume was 336cm3 and decreased to 194cm3 at 7months (42% reduction). In patient 2, preoperative volume was 12.64cm3 and reduced to 1.51cm3 at 3months (88% reduction). In patient 3, preoperative volume was 105cm3 and reduced to 72cm3 in 2months (30% reduction). In patient 4, preoperative volume was 125cm3 and reduced to 54cm3 at 7months (56% reduction). All remained stable after 7months and there has been no late increase in volume. Significant reduction in arachnoid cyst volume at the order of 30-40% is seen after successful endoscopic fenestration. The cyst volume appears to decrease gradually in the first 3-7months and reaches a plateau after that. Complete resolution of symptoms in the presence of residual volume may indicate that cyst volume below a threshold may not correlate directly with clinical status.

Navigated neuroendoscopy combined with intraoperative magnetic resonance cysternography for treatment of arachnoid cysts

Endoscopic cystocysternostomy or cystoventriculostomy is the treatment of choice in patients with symptomatic intracranial arachnoid cysts. There are no objective diagnostic tests for reliable intraoperative evaluation of the effectiveness of performed stomies. The aim of this prospective open-label study is to demonstrate for the first time the usefulness of intraoperative cysternography performed with the low-field 0.15-T magnetic resonance imager Polestar N20 during endoscopic cysternostomies. The study was performed in patients operated for middle fossa arachnoid cysts (n = 10), suprasellar cysts (n = 4), paraventricular or intraventricular cysts (n = 6), and a pineal cyst (n = 1). The operations were performed with use of a navigated neuroendoscope. Intraoperative magnetic resonance (iMR) cysternography was performed before and after the cystostomy. In each case, iMR cysternography was safe and could show clearly the cyst morphology and the effectiveness of performed endoscopic cystostomies. In six cases, iMR cysternography had a significant influence of the surgical decision (p = 0.027). The rate of inconsistency between the intraoperative observations and iMR imaging–based findings was 29%. A good contrast flow through the fenestrated cyst walls correlated with a good long-term clinical outcome (ρ = 0.54, p < 0.05) and good long-term radiological outcome (ρ = 0.72, p < 0.05). Intraoperative low-field MR cysternography is a safe and reliable method for assessment of the efficacy of performed endoscopic cystostomies and has significant influence on the surgical decision. It may be reliably used for prediction of the long-term clinical and radiological outcome.

Microsurgical, endoscopic, and shunt management of pediatric temporosylvian arachnoid cysts: a comparative study.

Arachnoid cysts (ACs) are most frequently located in the middle cranial fossa. Some patients are asymptomatic whereas others exhibit signs of increased intracranial pressure, seizures, or cognitive and behavioral symptoms. When ACs do require treatment, the optimal surgical technique remains controversial. This study was conducted to assess the most effective surgical treatment for these cysts. The authors retrospectively reviewed 240 temporal intracranial ACs managed over a 25-year period in their pediatric neurosurgical unit. Pre- and posttreatment results were clinically and radiologically assessed. A majority of male patients (74.6%) with an overall median age of 6.9 years were included. The mean cyst size was 107 cm3; the Galassi classification showed 99 (41.3%) type I, 77 (32.1%) type II, and 64 (26.7%) type III cysts. Forty-four ACs (18.3%) were diagnosed after rupture. Surgical management was performed by microsurgery (28.3%), endoscopic cyst fenestration (14.6%), cystoperitoneal shunting (CPS; 16.2%), or subdural shunting (10%). Furthermore, 74 children (30.8%) did not undergo operations. After a mean follow-up of 4.1 years, the mean percentage decrease in cyst volume and the overall rate of clinical improvement did not significantly differ. The endoscopy group had earlier complications and a shorter event-free survival (EFS) time (EFS at 3 years = 67.7%, vs 71.5% and 90.5% for CPS and microsurgery, respectively; p < 0.007) and presented with more subdural hematomas compared to the microsurgery group (p < 0.005). The microsurgery group also showed a tendency for longer cystocisternostomy permeability than the endoscopy group. Concerning the management of unruptured symptomatic temporal ACs, microsurgery appears to be the most effective treatment, with longer EFS and fewer complications compared to shunting or endoscopy.

Adult Posterior Cranial Fossa Arachnoid Cyst: A Case Report

Adult posterior fossa arachnoid cysts are rare lesions that are considered to be mostly congenital in origin. We present 49-year-old man admitted with a chief complaint of tremor and balance problems for the past 2 months. He had ataxia on examination. Magnetic resonance imaging revealed a well circumscribed midline cystic lesion of the posterior fossa sharing the same signal characteristics as cerebrospinal fluid and non-communicating to the fourth ventricle. He underwent surgical treatment for his symptomatic posterior fossa arachnoid cyst with a good outcome at 2 years follow up.

Unusual Cause of Trigeminal Neuralgia: Arachnoid Cyst of Petrous Apex

Arachnoid cyst of petrous apex is an uncommon cyst lesion that herniates from the posterolateral portion of the Meckel’s cave into the petrous apex. It can be unilateral or bilateral, usually observed in female population. Its etiopathogenesis is still uncertain and many theories were reported in the literature. The characteristic imaging appearance, topography and benign behavior of the lesion allow to differentiate arachnoid cyst from other cyst-like lesions of petrous apex and prevent abusive surgery or unnecessary investigations. The purpose of this study is to illustrate through this observation the role of sectional imaging in the diagnosis of symptomatic arachnoid cyst of petrous apex.

Arachnoid cysts of the internal auditory canal: An underappreciated entity?

To describe the histopathologic findings and clinical presentation of arachnoid cysts (ACs) within the human temporal bone. Retrospective cohort analysis. An analysis of all medical records of patients diagnosed with an AC was performed. Temporal bones underwent standard processing for histologic examination. The slides were examined by light microscopy. The histologic findings were compared to premortem clinical data. Twenty-seven ACs were identified in 22 patients. Twenty ears (74%) had no identified risk factor for AC development. The median volume was 12.8 mm3 . The most prevalent location of the ACs was at the fundus (16 ACs) followed by the middle portion of the internal auditory canal (IAC) (six ACs). Nine ACs were asymptomatic. Among the 18 symptomatic ACs, the most common presentation was sensorineural hearing loss (SNHL) (94%), followed by tinnitus (22%). The most affected structure was the cochlear nerve (59%), followed by the vestibular nerve (41%). The average hearing threshold was of moderately severe SNHL and speech discrimination was in the range of 50% on monosyllabic word tests. The median time interval from initial presentation to death was 12 years. No correlation was found between duration of symptoms and AC volume. AC of the IAC is not uncommon. Its presentation is variable, ranging from asymptomatic to SNHL, with poor speech discrimination, tinnitus, and vertigo. This diagnosis should be kept in the differential diagnosis of retrocochlear pathologies. 4 Laryngoscope, 129:1667-1674, 2019.

Symptomatic Arachnoid Cyst After Cervical Manipulation

Symptomatic Arachnoid Cyst After Cervical Manipulation

Endoscopic Surgical Management of Intracranial Symptomatic Arachnoid Cyst

Endoscopic Surgical Management of Intracranial Symptomatic Arachnoid Cyst

Cisto Aracnoide Intrasselar Tratado por via Endoscópica Endonasal

Introdução: Cistos Aracnoides (CA) representam 1% das lesões expansivas intracranianas e a localização intrasselar ocorre em apenas 3% desses cistos. Por tratar-se de uma patologia rara, com diagnósticos diferenciais mais comuns (adenoma hipofisário, craniofaringioma, cisto da bolsa de Rathke) seu manejo ainda gera dúvidas. Caso Clínico: Paciente de 53 anos com queixas de escotomas visuais, cefaleia holocraniana, vertigens e alucinações visuais e auditivas. A ressonância magnética (RM) de encéfalo evidenciou lesão cística em topografia de sela túrcica com compressão das vias ópticas. A paciente foi submetida a cirurgia endoscópica transesfenoidal. Após fenestração do cisto, foi observada comunicação com o espaço subaracnoide suprasselar e optado por obliteração do cisto com gordura e confecção de flap naso-septal. A paciente não apresentou fístula liquórica no pós-operatório. Houve melhora importante da cefaleia e das alterações visuais. A RM de controle mostrou regressão da compressão sobre as vias ópticas. Discussão: Os CA intrasselares sintomáticos requerem manejo cirúrgico. As vias transcraniana e transesfenoidal oferecem opções de tratamento. O acesso endoscópico endonasal é o mais utilizado atualmente. Ainda há discussão sobre a melhor forma de abordar essas lesões. A remoção de todo o cisto é possível, mas aumenta a manipulação da glândula hipofisária e o risco de disfunção hormonal. A abertura do cisto e obliteração com gordura reduz a manipulação da hipófise e evita recoleta liquórica. Apresentamos um caso tratado com obliteração do cisto com evolução satisfatória.

Surgical treatment of a large arachnoid cyst with multiple complications

Introduction. Arachnoid cysts are common among the general population. Best treatment option is still the subject of much debate. Surgical options include open-craniotomy or endoscopic cyst fenestration, cysto-peritoneal shunt insertion, or marsupialization via craniotomy. The aim of this article was to present a patient with an extremely large arachnoid cyst which occupied almost the entire left hemisphere. Case outline. The patient with a large symptomatic arachnoid cyst was treated by craniotomy and open fenestration. The patient suffered multiple postoperative complications, such as imidiate intracerebral hemorrhage due to hypertension, obstructive hydrocephalus, and a fresh ulcer in the bulbus duodeni. All the complications were successfully treated. Conclusion. Since the best treatment option is still the subject of much debate, we think that personalized medical approach is the best one, taking into account patient symptoms, localization and size of the cyst, patient?s general condition, and surgeon?s familiarity with the procedure.

Results of surgical treatment of symptomatic cysts of lateral fissure in children

&lt;p&gt;&lt;strong&gt;Aim.&lt;/strong&gt; The study aims to analyze the clinical and radiological results of treating arachnoid cysts of lateral fissure, which present a frequent pathology accounting for 30-50% of all brain arachnoid cysts. At present, the strategy of surgical treatment is controversial. For a long time, treatment included both microsurgical and shunt operations, however, in modern neurosurgery many authors prefer endoscopic techniques or endoscopic-assisted microsurgery. Determining the indications for intervention also remains disputable. Some authors tend to believe that "preventive" surgery of asymptomatic arachnoid cysts of lateral fissure with minimal clinical manifestations is also debatable.&lt;br /&gt;&lt;strong&gt;Methods.&lt;/strong&gt; 22 pediatric patients underwent surgery at Novosibirsk Center of Neurosurgery from 2013 to 2015. Successful interventions by using mostly an endoscopic approach were carried out in 18 (81.8%) patients resulting in regression of clinical symptoms. A positive effect was not achieved in 4 (18.1%) patients with primary endoscopic cysto-cisternostomy who required additional operations. &lt;br /&gt;&lt;strong&gt;Conclusion.&lt;/strong&gt; Endoscopic fenestration in our series is a safe, effective and minimally invasive procedure of the first stage of treatment in patients with a symptomatic arachnoid cyst of lateral fissure.&lt;/p&gt;&lt;p&gt;Received 5 May 2016. Accepted 14 September 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Funding:&lt;/strong&gt; The study had no sponsorship.&lt;br /&gt;&lt;strong&gt;Conflict of interest:&lt;/strong&gt; The authors declare no conflict of interest.&lt;/p&gt;

Petrous Apex Arachnoid Cyst Fenestration via an Endoscopic Transsphenoidal Approach: A Case Report and Review of the Literature

Objectives: To describe a rare case of symptomatic arachnoid cyst in the petrous apex and discuss the diagnostic and management options for this pathology.

Solitary Symptomatic Spinal Extradural Arachnoid Cyst Needing Surgical Treatment: A Series of Three Cases

Extradural arachnoid cysts are rare lesions which may produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions but asymptomatic patients can be managed conservatively. We present three cases of symptomatic extradural arachnoid cysts managed at our institute. Magnetic resonance imaging (MRI) done in all cases showed an extradural arachnoid cyst at Dorsal (2 cases) and cervical (1 case) level. All patients were operated with successful result. The pathophysiology, symptomatology, investigations and treatment options of this rare condition are described in relation to our cases. Key messages: Extradural arachnoid cysts are rare lesions which may produce symptoms by compressing the spinal cord or nerve roots. Surgery is the treatment of choice in such lesions but asymptomatic patients can be managed conservatively. Symptomatic patients have good results with surgical excision of the cyst.

Clinical and radiological outcomes of surgical treatment for symptomatic arachnoid cysts in adults

We retrospectively analyzed 63 patients (31 males and 32 females) with arachnoid cysts managed over a 15year period at our institution. Surgical indications and modalities for the treatment of intracranial arachnoid cysts are controversial, although endoscopic fenestration is often recommended as a standard procedure. In our cohort, clinical postoperative results and radiological assessments based on the presenting symptoms, cyst location, cyst volume and surgical modalities were recorded. The most common symptoms included headaches (66.7%), dizziness (46%) and seizures (36.5%). Cyst wall excision with microsurgical craniotomy was carried out in 28 patients (44.4%), cyst fenestration in 16 (25.4%), cystoperitoneal or ventriculoperitoneal shunting in 15 (23.8%) and endoscopic fenestration in four patients (6.3%). A satisfactory clinical outcome was achieved in 51 patients (80.9%) and cyst reduction was achieved in 49 (77.8%), at the last follow-up. Clinical improvement correlated significantly with volume reduction in patients with suprasellar and infratentorial cysts (r=0.495; p=0.022) while a similar result was not found after surgery in patients with frontal and temporal cysts. Surgical complications were not correlated with surgical modalities, occurring in only seven patients (11.1%). The various surgical modalities did not influence outcomes. Patients with nonspecific symptoms such as headache may obtain favourable outcomes from surgical treatment with no severe complications, although, intracranial hypertension and neurological deficits are more definite surgical indications for arachnoid cysts.

Microsurgical treatment of intracraneal arachnoid cysts

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations.

Characteristics and management of arachnoid cyst in the pediatric headache clinic setting.

Arachnoid cysts are generally identified incidentally on brain imaging, although they occasionally cause symptoms because of expansion or bleeding. This study aims to describe patients in whom an arachnoid cyst was identified on magnetic resonance imaging (MRI) study performed for the evaluation of headache in a pediatric headache clinic and to highlight the clinical dilemma posed by this finding. A retrospective descriptive study design was used. The electronic database of a tertiary pediatric headache clinic was searched for all newly admitted patients with headache who underwent MRI evaluation in 2008-2013. The indications for imaging were based on clinical practice parameters recommended by the Subcommittee of the American Academy of Neurology. Clinical and imaging parameters were collected from the files. Findings were compared between patients with and without an arachnoid cyst. Of the 250 (31%) of 800 patients who met the inclusion criteria, 11 (4.4%) had an arachnoid cyst. Two patients had a ruptured cyst with midline shifting and a large subdural collection. Both presented with headache, vomiting, phonophobia, and photophobia. In the other 9 asymptomtic patients with an arachnoid cyst, imaging showed only a mild mass effect without midline shifting; their symptoms were considered unrelated to the cyst. The patients with a symptomatic arachnoid cyst were referred for surgery, with good outcome. Arachnoid cysts are found in a small percentage of brain scans performed for evaluation of headache in the setting of a hospital-based pediatric headache clinic. For the long run in these clinical settings, most of the cysts are asymptomatic. Precise anamnesis, neurologic examination, and imaging performed according to accepted practice guidelines may help clinicians determine if the headache and symptoms are caused by the cyst or if they should seek primary headache diagnosis with overlapping symptoms. The clinical distinction between symptomatic and asymptomatic patients (symptoms that are directly related to the arachnoid cyst) may be difficult. Family history of migraine may help in the diagnosis of asymptomatic patients.