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Di Stadio A, Dipietro L, Messineo D, Ralli M, Ricci G, Greco A, Brenner MJ. Arachnoid Cysts of the Internal Auditory Canal: Multiplanar Magnetic Resonance Imaging With Audio-Vestibular Correlates. Laryngoscope 2021; 131:2323-2331. [PMID: 34152614 PMCID: PMC8518068 DOI: 10.1002/lary.29699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/02/2021] [Accepted: 06/12/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate prevalence, radiological characteristics, and functional correlates of arachnoid cysts (AC) of the internal auditory canal (IAC) region, including associations of nerve compression with auditory/vestibular symptoms and asymmetrical audiogram or vestibular testing. STUDY DESIGN Retrospective study. METHODS T2-weighted magnetic resonance imaging (MRI) studies of IACs were retrospectively analyzed from 1247 patients with asymmetric auditory or vestibular symptoms. Patients with radiological findings of AC of the IAC were identified. Multiplanar analysis was used to analyze cyst position in the IAC and assess nerve displacement or compression. Size, position, and presence of nerve compression were correlated with symptoms. RESULTS Twenty-four patients had a cyst in the middle or fundus in the IAC. Diameter (P = .04) and position (P = .002) of AC were associated with symptoms. Sagittal analyses identified displacement versus compression (P = .003) more reliably than axial imaging. Symptom laterality was associated with the site of radiological abnormality. Vestibular nerve compression was associated with vertigo (P = .0001), and cochlear nerve compression was associated with auditory symptoms (P < .0001). CONCLUSIONS In a retrospective series of patients undergoing MRI of IACs for asymmetric auditory or vestibular impairment, clinical symptom profile correlated with blinded assessment of IAC lesions. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2323-2331, 2021.
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Affiliation(s)
| | - Laura Dipietro
- Engineering DepartmentHighland InstrumentsCambridgeMassachusettsU.S.A.
| | - Daniela Messineo
- Radiology, Oncology, and Anatomopathological DepartmentUniversity La SapienzaRomeItaly
| | - Massimo Ralli
- Organ of Sense DepartmentUniversity La Sapienza of RomeRomeItaly
| | | | - Antonio Greco
- Organ of Sense DepartmentUniversity La Sapienza of RomeRomeItaly
| | - Michael J. Brenner
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganU.S.A.
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A minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal: a step by step description. Braz J Otorhinolaryngol 2019; 87:47-52. [PMID: 31494085 PMCID: PMC9422673 DOI: 10.1016/j.bjorl.2019.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/01/2019] [Accepted: 06/22/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Arachnoid cyst in the internal auditory canal is a quite rare pathology but due to its compressive action on the nerves in this district should be surgically removed. Several surgical techniques have been proposed but no surgeons have used the minimally assisted endoscope retrosigmoid approach for its removal. Objective To investigate the feasibility of using a minimally invasive endoscope assisted retro-sigmoid approach for surgical removal of arachnoid cysts in the internal auditory canal. Methods Minimally invasive endoscope assisted retrosigmoid approach allows to access to the internal auditory canal through a minimally invasive retrosigmoid approach that combines the use of a microscope and an endoscope. It is performed in six steps: soft tissue step, bone step, dura step, cerebellopontine angle step (performed using an endoscope and a microscope), microscope-endoscope assisted arachnoid cysts removal and closure. We tested minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal on two human cadaveric heads (specimens) of subjects affected from audio-vestibular disorders and with arachnoid cysts in the internal auditory canal confirmed by magnetic resonance imaging. Results The mass was completely and successfully removed from the two specimens with no damage to the nerves and/or vessels in the surgical area. Conclusion The results of our study are encouraging and support the feasibility of using minimally invasive endoscope assisted retrosigmoid approach for removal of arachnoid cysts in the internal auditory canal. While further clinical in-vivo studies are needed to confirm the accuracy and safety of using the minimally invasive endoscope assisted retrosigmoid approach for this specific surgery, our group has successfully used the minimally invasive endoscope assisted retrosigmoid approach in the treatment of microvascular compressive syndrome, schwannoma removal and vestibular nerve resection.
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Non-schwannomatosis lesions of the internal acoustic meatus-a diagnostic challenge and management: a series report of nine cases. Neurosurg Rev 2015; 38:641-8. [PMID: 25957055 DOI: 10.1007/s10143-015-0638-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/09/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
Vestibular schwannomas (VS) are the most common lesions of cerebellopontine angle (CPA) corresponding to 76-91 % of the cases. Usually, these lesions present typical CT and MRI findings. Non-schwannomatous tumors restricted to the internal auditory meatus (IAM) are rare and their preoperative radiological diagnosis may be difficult. This article describes nine surgically treated intrameatal non-schwannomatous lesions (NSL) and reviews the literature. In the last 16 years, a total of 471 patients with diagnosis of VS were operated on in our department. Preoperatively, 42 patients had diagnosis of intrameatal schwannomas, but surgery revealed in nine cases NSL (3 meningiomas, 3 arachnoiditis/neuritis, 1 cavernoma, 1 vascular loop, and 1 arachnoid cyst). Most frequent symptoms presented by patients with NSL were hearing loss 89 % (8/9) of patients, tinnitus 78 % (7/9), and vertigo 33 % (3/9). Almost all lesions (8/9) presented MRI findings of isointense signal in T1W with contrast enhancement. The only exception was the arachnoid cyst with intracystic bleeding, which was hyperintense in T1W that is not enhanced with contrast. This series shows an occurrence of 21.4 % of non-schwannomatous tumors in 42 cases of lesions restricted to the IAM. Whenever a solely intrameatal enhanced tumor is detected, it is necessary to think about other diagnostic possibilities rather than VS. Therapeutic management may be changed, specially if radiosurgical treatment is considered.
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Arachnoid cysts confined to the internal auditory canal or facial nerve canal. The Journal of Laryngology & Otology 2011; 125:1053-8. [PMID: 21810290 DOI: 10.1017/s0022215111001745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To illustrate the morphological characteristics and pathological significance of arachnoid cysts confined to the internal auditory canal or facial nerve canal. DESIGN Retrospective case series. SUBJECTS Three patients' cases were reviewed, and temporal bone sections examined histologically. RESULTS In this series, three intracanalicular arachnoid cysts were found in the internal auditory canal and one in the facial nerve canal. All lesions consisted of distinct, space-occupying cysts with a sharp boundary with surrounding tissues. They were thin-walled and compressed the surrounding nerve trunks to a variable degree. However, there was no indication that patients suffered meatal nerve dysfunction. CONCLUSION Arachnoid cysts can develop within the internal auditory canal or facial nerve canal. In our series, they were asymptomatic, which is quite different from most intracanalicular arachnoid cysts encountered in clinical practice.
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Francis HW, Nager GT, Holliday MJ, Long DM. Association of heterotopic neuroglial tissue with an arachnoid cyst in the internal auditory canal. Skull Base Surg 2011; 5:37-49. [PMID: 17171156 PMCID: PMC1661786 DOI: 10.1055/s-2008-1058949] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An arachnoid cyst arising within the internal auditory canal, or within the cerebellopontine angle and subsequently extending into the internal meatus and enlarging it, is a rare occurrence. Nevertheless, the neurootologist and the neurosurgeon have an interest in its existence because its clinical manifestations are identical with the ones produced by a schwannoma, involving overwhelmingly the cochleovestibular nerve in that region. An equally rare observation in that location is the presence of ectopic neuroglial tissue. The two can occur independently or in combination. Examples of such lesions are presented, and their possible pathogenesis is discussed.
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Thakar S, Furtado SV, Hegde AS. Arachnoid cyst in the internal auditory canal causing fluctuating facial paresis in a child. Childs Nerv Syst 2011; 27:1177-9. [PMID: 21503755 DOI: 10.1007/s00381-011-1458-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 04/07/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, 560066, India.
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Fleck SK, Baldauf J, Langner S, Vogelgesang S, Siegfried Schroeder HW. Arachnoid Cyst Confined to the Internal Auditory Canal—Endoscope-Assisted Resection: Case Report and Review of the Literature. Neurosurgery 2011; 68:E267-70. [DOI: 10.1227/neu.0b013e3181ff1fb7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
abstract
BACKGROUND AND IMPORTANCE:
An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion.
CLINICAL PRESENTATION:
A slowly progressive hearing loss developed in a 35-year-old woman over 2 years; she reported experiencing tinnitus for 7 years. Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst.
INTERVENTION:
The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The histological examination confirmed the diagnosis of an arachnoid cyst.
CONCLUSION:
The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits.
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Affiliation(s)
| | - Jörg. Baldauf
- Department of Neurosurgery, Ernst Moritz Arndt University, Greifswald, Germany
| | - Soenke. Langner
- Department of Radiology and Neuroradiology, Ernst Moritz Arndt University, Greifswald, Germany
| | - Silke. Vogelgesang
- Department of Neuropathology, Ernst Moritz Arndt University, Greifswald, Germany
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Aubry K, Wassef M, Guichard JP, Herman P, Tran Ba Huy P. Association d’un kyste arachnoïdien et d’une hétérotopie de tissu glial dans le méat auditif interne. ACTA ACUST UNITED AC 2009; 126:133-7. [DOI: 10.1016/j.aorl.2009.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/02/2009] [Indexed: 11/29/2022]
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De Ridder D, Alessi G, Lemmerling M, Fransen H, De Waele L. Hemilingual spasm: a new neurosurgical entity? Case report. J Neurosurg 2002; 97:205-7. [PMID: 12134914 DOI: 10.3171/jns.2002.97.1.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hemilingual spasm is a little-known movement disorder, presenting as intermittent paroxysmal involuntary contractions of half of the tongue muscles. The authors report a case of hemilingual spasm caused by an arachnoid cyst. After marsupialization of the cyst, the patient's symptoms immediately resolved. There has been no recurrence of hemilingual spasm during the follow-up period of more than 40 months.
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Affiliation(s)
- Dirk De Ridder
- Department of Neurosurgery, University Hospital Antwerp, Belgium.
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Brooks ML, Mayer DP, Sataloff RT, Myers DL, Spiegel JR, Ruiz S. Intracanalicular arachnoid cyst mimicking acoustic neuroma: CT and MRI. Comput Med Imaging Graph 1992; 16:283-5. [PMID: 1511401 DOI: 10.1016/0895-6111(92)90031-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A patient with a surgically proven intracanalicular arachnoid cyst was studied using computed tomography, magnetic resonance imaging, and air CT cisternography. The lesion had a similar radiographic appearance to acoustic neuroma and therefore, although rare, must be considered in the differential diagnosis of intracanalicular mass lesions. We report a case in which examination was performed, in evaluating the lesion, utilizing high-resolution air CT cisternography and magnetic resonance imaging (MRI).
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Affiliation(s)
- M L Brooks
- Graduate Hospital Imaging Center, Philadelphia, PA 19146
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12
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Pascual-Castroviejo I, Roche MC, Martínez Bermejo A, Arcas J, García Blázquez M. Primary intracranial arachnoidal cysts. A study of 67 childhood cases. Childs Nerv Syst 1991; 7:257-63. [PMID: 1933926 DOI: 10.1007/bf00299008] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sixty-seven cases (41 males and 26 females) of arachnoidal cysts in children under 11 years are reported. About 53% of cases were diagnosed before 1 year of life. Thirty-one (42.2%) were supratentorial (interhemispheric 9, temporal fossa 10, convexity 5, sylvian fissure 3, supra- and/or retrosellar 4); 31 (46.2%) infratentorial (supra- and/or retrocerebellar 22, foramen of Magendie 3, quadrigeminal cistern 5, pontocerebellar 1); 5 (7.5%) supra- and infratentorial. Macrocephaly was the presenting symptom in 48 cases (71.5%). Associated features were frequent: cranial asymmetry in 24; aqueductal stenosis in 10; agenesis of corpus callosum in 8; deficient cerebellar lobullation in 4; Chiari I malformation in 2; neurofibromatosis type 1 with dysgenetic zones of the brain in 1; arteriovenous malformation in 1. Diagnosis was made at autopsy in six cases in the days before computed tomography and magnetic resonance: three patients had a cyst in the supra- and retrocerebellar midline; two had a cyst in the quadrigeminal cistern and the sixth was a rare case with the cyst passing from the posterior fossa to the left lateral ventricle through a hole in the basal surface of the brain. Small and some middle-sized cysts were not treated. Big and some middle-sized cysts were usually treated by cysto- and/or ventriculoperitoneal shunts. Arachnoidal cysts of the quadrigeminal cistern usually present with aqueductal stenosis and have to be treated with ventriculoperitoneal shunt. Craniotomy and fenestration of the cysts were performed in some cases with good results. The average mental level of these children is usually moderately low.
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Cartwright MJ, Eisenberg MB, Page LK. Posterior fossa arachnoid cyst presenting with an isolated twelfth nerve paresis. Case report and review of the literature. Clin Neurol Neurosurg 1991; 93:69-72. [PMID: 1651196 DOI: 10.1016/0303-8467(91)90013-f] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An unusual case of a posterior fossa arachnoid cyst containing atypical fluid is described in a patient presenting with an isolated ipsilateral twelfth nerve paresis. Despite the chronicity of symptoms, surgical decompression resulted in a satisfactory functional recovery.
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Affiliation(s)
- M J Cartwright
- Department of Neurological Surgery, University of Miami School of Medicine, FL 33101
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Bornemann H, Galanski M, Vogelsang H. Cochleomeatal scintigraphy--a new tool in modern neuroradiological diagnosis of acoustic neuroma. Neuroradiology 1984; 26:107-11. [PMID: 6371578 DOI: 10.1007/bf00339857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cochleomeatal scintigraphy (CMS) and CT or air CT cisternography are today the methods of choice for the detection or exclusion of a neuro-otologically suspect acoustic neuroma. Whereas CT as a morphological method of investigation provides better preoperative information, CMS is likely to be superior to CT as a functional investigation technique in relapse diagnosis.
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Abstract
An arachnoid cyst of the internal auditory canal causing compression atrophy of nerve trunks was found in each of three human temporal bones. Arachnoid cysts are found in about 0.5% of operations for suspected neoplasm of the internal auditory canal. There is no current method for differentiating intracanalicular neoplasm from arachnoid cysts.
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Parnes SM, Nelson LR. Subarachnoid cyst simulating an intracanalicular acoustic neuroma. Otolaryngol Head Neck Surg 1981; 89:1019-20. [PMID: 6801581 DOI: 10.1177/019459988108900627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
The clinical symptoms and signs of four patients with arachnoid cysts in the posterior fossa are discussed. In three patients, the cyst was in the internal auditory canal; one patient had an acoustic neuroma and two large cysts in the cerebellum. Whereas the conventional diagnostic tests for acoustic neuroma cannot differentiate between neuromas and arachnoid cysts, the newer thin section body scanners can show a lesion with no enhancement in the case of the cyst. Surgical approaches for removal of this lesion must take into consideration the preservation of hearing in the involved ear.
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Fischer AJ, Marres EH, Thijssen HO. A tumour in the cerebellopontine angle region: an unusual case. Clin Neurol Neurosurg 1978; 80:189-94. [PMID: 218765 DOI: 10.1016/s0303-8467(78)80040-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper describes a nearly 60-year old patient with unilateral hearing loss, developed in one year, and complaints of tinnitus and dizziness. Additional findings were unilateral peripheral facial paresis and a diminished corneal reflex. The cause was found to be a metastasis of an anaplastic carcinoma, localized at the site of the internal acoustic porus.
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