Symptomatic intraventricular arachnoid cyst in an elderly man

Incidental findings on cranial imaging in nonagenarians

Object

The aim of this article was to report on the nature and prevalence of incidental imaging findings in a consecutive series of patients older than 90 years of age who underwent intracranial imaging for any reason.

Methods

The authors retrospectively reviewed the electronic medical and imaging records of consecutive patients who underwent brain MR imaging at a single institution over a 153-month interval and were at least 90 but less than 100 years of age at the time of the imaging study. The prevalence of lesions by type in this consecutive series of MR imaging evaluations was calculated for all patients. The authors reviewed the medical record to evaluate whether a change in management was recommended based on MR imaging findings. They evaluated patient age at the time of death and the time interval between MR imaging and death.

Results

The authors identified 177 patients who met the study criteria. The group included 119 women (67%) and 58 (33%) men. Their mean age was 92.3 ± 1.8 years. Evidence of acute ischemic changes or cerebrovascular accident (CVA) was found in 36 patients (20%). Fifteen patients (8%) had an intracranial tumor. Intracranial aneurysms were incidentally identified in 6 patients (3%). Chronic subdural hematomas were found in 3 patients (2%). Overall, 25 patients (14%) had some change in medical management as a result of the MR imaging findings. The most common MR imaging finding that resulted in a change in medical management was an acute CVA (p < 0.0001). The mean time to death from date of MR imaging was 2.5 ± 2.3 years.

Conclusions

Intracranial imaging is rarely performed in patients older than 90 years. In cases of suspected stroke, MR imaging findings may influence treatment decisions. Brain MR imaging studies ordered for other indications in this age group rarely influence treatment decisions. Incidentally discovered lesions in this age group are generally not treated.

Posttraumatic intraventricular arachnoid cyst accompanied by pseudomeningoencephalocele in a child

Growing skull fracture (GSF) is a rare complication of head trauma. A posttraumatic intraventricular arachnoid cyst (AC), neither isolated nor accompanied by a GSF has not been reported previously. A seven-year-old girl was admitted after a severe head injury with a separated right parieto-occipital fracture and contusion. She responded well to conservative therapy. Seven weeks after discharge, she was re-admitted with a large parieto-occipital pseudomeningoencephalocele due to herniation of cerebrospinal fluid and neural tissue to the subgaleal space through the widened fracture defect, an extra-axial cyst at the posterior interhemispheric space and an intraventricular cystic mass. She underwent open surgery, and the intraventricular cystic mass was totally removed. The histological findings were consistent with an AC. One week after dural repair, hydrocephalus developed, and a ventriculo-peritoneal shunt was inserted. She did well during two-year follow-up. The present case is unique as an intraventricular AC following head trauma. When an intraventricular cystic lesion is encountered after severe head trauma, the possibility of an AC should be considered; especially with neighboring contused neural tissue and leptomeningeal cyst formation.

A large arachnoid cyst of the lateral ventricle extending from the supracerebellar cistern--case report

BACKGROUND

The pathogenetic mechanism of intraventricular arachnoid cyst development is still controversial, but is believed to originate from the vascular mesenchyme or as an extension of the arachnoid cyst in the subarachnoid space into the ventricle through the choroidal fissure. We report a case supporting the extension hypothesis and suggest differential points between an intraventricular arachnoid cyst that extended from the supracerebellar space and a lateral ventricular diverticulum that extended into the supracerebellar cistern.

CASE DESCRIPTION

A 12-month-old girl presented with macrocephaly and developmental delay. Her magnetic resonance imaging showed an arachnoid cyst that had developed from the supracerebellar space in the posterior fossa, and which extended into the left lateral ventricle resulting in expansion of the left lateral ventricle and displacing the choroids plexus anteriorly and laterally and the midline to the right. We treated an intraventricular arachnoid cyst by endoscopic fenestration resulting in dramatic reduction of the intraventricular arachnoid cyst with large bilateral subdural fluid collection. We performed a subduroperitoneal shunt for subdural fluid collection and subsequent cystoperitoneal shunt for the remnant cyst.

CONCLUSION

We suggest that this case supports the extension hypothesis from the subarachnoid space through the choroidal fissure into the lateral ventricle. We also suggest that one of the radiological differential points between an intraventricular arachnoid cyst and a ventricular diverticulum is displacement and compression of the choroid plexus of the lateral ventricle.

[Intracranial arachnoid cyst. Report of 9 operated cases]

Analysis of nine patients with intracranial arachnoid cysts surgically treated from 1974 to 1995. The treatment consisted of cystoperitoneal shunt in seven patients and craniotomy with excision of cyst membrane in the other two cases. After surgery, bacterial meningitis and failure shunt device were observed in three cases. Both the infectious process and the shunt device were respectively treated and corrected at once. It has been observed total clinical improvement in all nine cases. A review of the literature has been made and some pathophysiological, diagnostic and therapeutic aspects are discussed.