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Elkazaz MK, El-Sayed K. Concomitant spontaneous subdural and intracystic hematoma in arachnoid cyst: a case report and review of the literature. J Med Case Rep 2024; 18:414. [PMID: 39210485 PMCID: PMC11363445 DOI: 10.1186/s13256-024-04570-8] [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: 09/27/2022] [Accepted: 03/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Intracystic hematoma in arachnoid cyst are a very rare pathology that commonly occurs after head trauma, while spontaneous intracystic hematomas in arachnoid cyst associated with subdural hematoma is extremely rare. Currently there are 33 patients of spontaneous intracystic hematomas in arachnoid cyst reported in the literature. In this case report we present an adult patient with concomitant chronic subdural hematoma with intracystic hematoma in arachnoid cyst. CASE PRESENTATION A 19-year-old Egyptian Arabian female patient presented to the outpatient clinic complaining of severe headache of 1-month duration that was progressive in nature. Provisionally, it was thought that it might be an arachnoid cyst with associated chronic subdural hematoma along with intracystic hematoma. Decision to proceed with craniotomy and cyst evacuation was made. CONCLUSION Concomitant intracystic hematoma in arachnoid cyst along with subdural hematoma is a serious condition that might be life-threatening if not well managed.
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Affiliation(s)
- Mohamed K Elkazaz
- Neurosurgery Department, Faculty of Medicine, Suez Canal University Teaching Hospital, Suez Canal University, Ismailia, Egypt.
| | - Khaled El-Sayed
- Neurosurgery Department, Faculty of Medicine, Suez Canal University Teaching Hospital, Suez Canal University, Ismailia, Egypt
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2
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Lam A, Lo WB, Pepper J, Rodrigues D, Gallo P, Solanki GA, Afshari FT. Middle fossa arachnoid cyst fenestration for ruptured cysts associated with subdural collections: paediatric neurosurgery tertiary unit experience. Childs Nerv Syst 2024:10.1007/s00381-024-06581-8. [PMID: 39207526 DOI: 10.1007/s00381-024-06581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Arachnoid cysts are commonly encountered benign cystic structures and often come to attention as incidental findings following cranial imaging. Surgical intervention rates vary in different studies; however, rupture of cyst and subdural collection with mass effect are some of the indications for surgical intervention. In this study, we aimed to evaluate our operated cohort of middle fossa arachnoid cysts to determine the rate of traumatic subdural collection in this cohort and further assess outcomes. METHODS A retrospective review of all consecutive operated middle cranial fossa arachnoid cysts was carried out for the period 2010 to 2024. Demographics including age, sex, Galassi type, surgical technique for fenestration, preceding history of trauma, presence of papilloedema, and complications following surgery were extracted. Indication for surgery included papilloedema and headaches or increasing head circumference or rupture and subdural collections. Arachnoid cysts managed with CSF diversion as primary surgery were excluded. RESULTS Over the study period, 21 fenestrations of the arachnoid cysts were carried out in 19 patients with mean age of 7 years and M:F ratio of 2.2:1 (laterality: 9 right-sided and 10 left-sided). These included seven Galassi 2 and twelve Galassi 3 arachnoid cysts. At presentation, 10 had papilloedema, 5 with no papilloedema, and 4 with no available ophthalmological assessment. Fenestration of cyst included 12 microscopic, 6 endoscopic, and 3 combined approaches. Of the operated cohort, 8 were due to rupture of arachnoid cyst and subdural collections causing mass effect. Of 8 cases of ruptured arachnoid cyst with subdural collections, 75% had clear history of preceding head injury in the context of accidental or sports-related injuries. Two patients required redo-fenestration (10.5%), 1 patient required temporary lumbar drain (5.2%), and 2 patients required cysto-peritoneal shunts (10.5%). CONCLUSION Rupture of arachnoid cysts and subdural collections although rare can be associated with head injury in majority of cases. All operated cases belonged to grade 2 and 3 Galassi.
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Affiliation(s)
- Alexander Lam
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - William B Lo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Joshua Pepper
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Desiderio Rodrigues
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Pasquale Gallo
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Guirish A Solanki
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Fardad T Afshari
- Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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Papadakis JE, Slingerland AL, Rangwala SD, Proctor MR, Shah AS, See AP. Optic Nerve Edema in Pediatric Middle Cranial Fossa Arachnoid Cysts: Report of 51 Patients From a Single Institution. Pediatr Neurol 2024; 156:182-190. [PMID: 38788281 DOI: 10.1016/j.pediatrneurol.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Middle 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. METHODS We 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. RESULTS Fifty-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). CONCLUSIONS We 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.
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Affiliation(s)
- Joanna E Papadakis
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna L Slingerland
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shivani D Rangwala
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Mark R Proctor
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred P See
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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4
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Mamik HK, Kuldeep M, Sinha VD. Spontaneous rupture of arachnoid cyst. J Neurosci Rural Pract 2024; 15:404-406. [PMID: 38746515 PMCID: PMC11090555 DOI: 10.25259/jnrp_554_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Harnoor Kaur Mamik
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital Cum Research Centre, Jaipur, Rajasthan, India
| | - Mahesh Kuldeep
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital Cum Research Centre, Jaipur, Rajasthan, India
| | - Virendra Deo Sinha
- Department of Neurosurgery, Santokba Durlabhji Memorial Hospital Cum Research Centre, Jaipur, Rajasthan, India
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Sgambetterra S, Piatelli G, Pavanello M. Letter to the Editor Regarding: Factors That Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children. World Neurosurg 2023; 176:263. [PMID: 37550937 DOI: 10.1016/j.wneu.2023.04.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Silvia Sgambetterra
- Department of Neuroscience, "Rita Levi Montalcini" Neurosurgery Unit, "City of Health and Science" University Hospital, University of Turin, Turin; and; Division of Pediatric Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Gianluca Piatelli
- Division of Pediatric Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Pavanello
- Division of Pediatric Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Xu J, Wang J, Liu T, Wang Y, Chen F, Yuan L, Zhai F, Ge M, Liang S. Factors that Influence Subdural Hemorrhage Secondary to Intracranial Arachnoid Cysts in Children. World Neurosurg 2023; 175:e73-e80. [PMID: 36907272 DOI: 10.1016/j.wneu.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to investigate factors that influence subdural haemorrhage (SDH) secondary to intracranial arachnoid cysts (IACs) in children. METHODS Data of children with unruptured IACs (IAC group) and those with SDH secondary to IACs (IAC-SDH group) were analyzed. Nine factors, sex, age, birth type (vaginal or caesarean), symptoms, side (left, right, or midline), location (temporal or nontemporal), image type (I, II, or III), volume, and maximal diameter, were selected. IACs were classified as types I, II, and III according to their morphological changes observed on computed tomography images. RESULTS There were 117 boys (74.5%) and 40 girls (25.5%); 144 (91.7%) patients comprised the IAC group and 13 (8.3%) comprised the IAC-SDH group. There were 85 (53.8%) IACs on the left side, 53 (33.5%) on the right side, 20 (12.7%) in the midline region, and 91 (58.0%) in the temporal region. The univariate analysis showed significant differences in age, birth type, symptoms, cyst location, cyst volume, and cyst maximal diameter (P < 0.05) between the 2 groups. Logistic regression using the synthetic minority oversampling technique model showed that image type III and birth type were independent factors that influenced SDH secondary to IACs (β0 = 4.143; β for image type = -3.979; β for birth type = -2.542) and that the representative area under the receiver-operating characteristic curve value was 0.948 (95% confidence interval, 0.898-0.997). CONCLUSIONS IACs are more common in boys than in girls. They can be divided into 3 groups according to their morphological changes on computed tomography images. Image type III and caesarean delivery were independent factors that influenced SDH secondary to IACs.
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Affiliation(s)
- Jinshan Xu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tinghong Liu
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yangshuo Wang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liu Yuan
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Feng Zhai
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Shuli Liang
- Department of Functional Neurosurgery, National Center for Children's Health & Beijing Children's Hospital, Capital Medical University, Beijing, China
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Yokota H, Marutani A, Yamada T. Traumatic Rupture of Arachnoid Cyst into Subdural Space in a Very Elderly Patient. Neurol India 2023; 71:618-619. [PMID: 37322790 DOI: 10.4103/0028-3886.378698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Hiroshi Yokota
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kido-Higashi-Cho, Kawachinagano, Osaka, 586-8521, Japan
| | - Akiko Marutani
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kido-Higashi-Cho, Kawachinagano, Osaka, 586-8521, Japan
| | - Tomonori Yamada
- Department of Neurosurgery, National Hospital Organization Osaka Minami Medical Center, 2-1 Kido-Higashi-Cho, Kawachinagano, Osaka, 586-8521, Japan
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Wangaryattawanich P, Rutman AM, Petcharunpaisan S, Mossa-Basha M. Incidental findings on brain magnetic resonance imaging (MRI) in adults: a review of imaging spectrum, clinical significance, and management. Br J Radiol 2023; 96:20220108. [PMID: 35522780 PMCID: PMC9975529 DOI: 10.1259/bjr.20220108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Utilization of brain MRI has dramatically increased in recent decades due to rapid advancement in imaging technology and improving accessibility. As a result, radiologists increasingly encounter findings incidentally discovered on brain MRIs which are performed for unrelated indications. Some of these findings are clinically significant, necessitating further investigation or treatment and resulting in increased costs to healthcare systems as well as increased patient anxiety. Moreover, management of these incidental findings poses a significant challenge for referring physicians. Therefore, it is important for interpreting radiologists to know the prevalence, clinical consequences, and appropriate management of these findings. There is a wide spectrum of incidental findings on brain MRI such as asymptomatic brain infarct, age-related white matter changes, microhemorrhages, intracranial tumors, intracranial cystic lesions, and anatomic variants. This article provides a narrative review of important incidental findings encountered on brain MRI in adults with a focus on prevalence, clinical implications, and recommendations on management of these findings based on current available data.
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Affiliation(s)
| | | | | | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina, Chapel Hill, NC, United States
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9
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Temporal sylvian fissure arachnoid cyst in children: treatment outcome following microsurgical cyst fenestration with special emphasis on cyst reduction and subdural collection. Childs Nerv Syst 2023; 39:127-139. [PMID: 36348036 PMCID: PMC9968699 DOI: 10.1007/s00381-022-05719-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Controversy remains regarding surgical managements of sylvian fissure arachnoid cyst (SFAC). This review presents our experience in the microsurgical fenestration of pediatric patients with SFAC to define surgical indication, and risks and benefits with special emphasis on postoperative subdural fluid collection (SDFC) and cyst size reduction. METHODS Thirty-four children with SFAC who underwent microsurgical cyst fenestration at a single institution over a 10-year period were retrospectively reviewed for their clinical presentation, neuroimaging findings, and postsurgical course. The SFACs were classified by a novel grading system based on the degree of arachnoid cyst extension from the sylvian fissure to the insular cistern shown on MR images: grade 0 - little or no prominence of sylvian fissure, grade I - SFAC confined to the sylvian fissure, grade II - SFAC partially extending to the insular cistern, grade III - SFAC extending to the entire insular cistern. RESULTS There were 26 males and 8 females. SFAC was present in the left side in 24. Twelve patients presented with cyst rupturing to the subdural space. Cyst grading did not show significant difference compared with rupture status (p > 0.9). All patients underwent microsurgical cyst fenestration. Postoperative SDFC is common but often resolved overtime in two-thirds of the cases with the mean average of 6 months. However, 3 patients had symptomatic postoperative SDFC and needed reoperation shortly after the first operation. Microsurgical cyst fenestrations for SFAC effectively resolved the presenting symptoms and often showed restorations of intracranial structures on follow-up imaging. Cyst resolution or reduction greater than 75% was noted in 61.8% of the patients postoperatively which was noted in a half of the SFAC of children even with age of 11 years or older. During the follow-up, no cyst recurrence or SDFC was noted. Patients with greater surgical reduction of cyst size tended to occur in younger children, and those with lower MR grade. CONCLUSION Our results showed a high reduction rate of SFAC and brain re-expansion after microsurgical fenestration together with symptomatic improvements regardless the patient's age. Considering the developing CNS during childhood, reductions of a large space-occupying lesion followed by restorations of the structural integrity of the developing brain are very desirable. However, a multi-center cooperative prospective longitudinal study on long-term comparative data of those treated and untreated of neuro-psychological outcome and cyst rupture incidence is needed.
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10
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Beltagy MAE, Enayet AER. Surgical indications in pediatric arachnoid cysts. Childs Nerv Syst 2023; 39:87-92. [PMID: 36284010 DOI: 10.1007/s00381-022-05709-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/13/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Arachnoid cysts are developmental lesions consisting of CSF collections within the subarachnoid space. There are many theories and hypotheses about their pathogenesis and histopathology and this may also explain the diversities seen in clinical behaviors of these cysts, their natural history and consequently their management where there is a great controversy about selecting patients for surgical intervention. The most common location in pediatrics is the Sylvian or middle cranial fossa and this made it gain more concern and greater debate about its management where its diagnosis is often accidently or associated with nonspecific symptoms. AIM Our aim in this article was to review the main surgical indications for pediatric arachnoid cysts in the literature. CONCLUSION We concluded that the decision for surgical intervention for pediatric arachnoid cysts is not a simple one and highly debatable and should be taken cautiously especially with sylvian arachnoid cysts that may reach a large size without symptoms. However, there is a consensus that the occurrence of symptoms definitely correlated to the presence of these cysts or their rupture with consequent subdural hematoma or hygroma are indications for surgical intervention. Large cysts in locations compressing CSF pathways causing hydrocephalus are also candidates for surgical fenestration. The surgical gain from prophylactic surgery is questionable particularly when asymptomatic.
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Affiliation(s)
- Mohamed A El Beltagy
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. .,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Abd El Rhman Enayet
- Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt.,Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
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Massimi L, Bianchi F, Benato A, Frassanito P, Tamburrini G. Ruptured Sylvian arachnoid cysts: an update on a real problem. Childs Nerv Syst 2023; 39:93-119. [PMID: 36169701 PMCID: PMC9968703 DOI: 10.1007/s00381-022-05685-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Sylvian arachnoid cysts (SACs) are the most common type of arachnoid cysts and the most prone to undergo a rupture. This event is considered rare but potentially severe. No definite information is available on its occurrence or management. The goal of the present article is to provide an update on the epidemiological, etiological, and clinical aspects and the management of this peculiar clinical condition. METHODS A comprehensive review of the English literature of the last 40 years on this topic has been realized. Moreover, a personal series of children investigated and treated in the last 20 years is presented. These patients were managed as follows: (1) treatment of the subdural collection; (2) identification of candidates for surgical treatment of the residual cyst (brain MRI, perfusion brain MRI, prolonged invasive ICP monitoring (selected cases), EEG, neuropsychological tests); (3) surgical treatment of the cyst in the patients with pathological perfusion MRI and/or ICP measurement and/or clear neurophysiological and neuropsychological correlations. RESULTS A total of 446 patients (430 from the literature and 16 from the personal series), mainly children, adolescents, and young adults, have been analyzed leading to the following results: (1) SAC rupture is rare but not negligible (yearly risk of rupture: 0.04%; overall risk up to 10% in children affected by SCAs). Prophylactic surgery in asymptomatic cases is not advisable. (2) The mechanism of rupture is not known but an impact of SAC against the sphenoid wing and/or a direct injury on SAC through a thinned temporal bone, with possible laceration of the cyst wall vessels and/or tear of the bridging veins, can be hypothesized. A head injury is often not reported (may be misdiagnosed). (3) Subdural collection (hygroma > chronic hematoma) is the most common finding followed by intracystic bleeding, extradural hematoma, and other types of bleeding. Signs or symptoms of raised intracranial pressure are the most frequent ones. (4) The complication of the rupture is usually treated in emergency or in the acute period by burr hole or craniotomic evacuation of the subdural collection, although a conservative management is possible in some cases. Following the rupture, the majority of SACs are treated (70%), often at the same time of the complication, but no specific investigations are routinely performed to select candidates. According to our protocol, only 43.7% of SACs needed to be treated. CONCLUSIONS The "spontaneous" or posttraumatic rupture of SACs is a rare but potentially significant complication followed by a generally good outcome. The course of the cyst is independent from the outcome of the complication, consequently requiring specific investigations for individuating those lesions interfering with CSF dynamics and/or cerebral blood flow.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy.
- Catholic University of the Sacred Heart, Rome, Italy.
| | - F Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - A Benato
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario, A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Zhao H, Xie W, Cao L, Ni Z, Wang B, Ma J. Predictors for the clinical prognosis of sylvian arachnoid cysts in children. Front Pediatr 2023; 11:1075087. [PMID: 36937976 PMCID: PMC10014871 DOI: 10.3389/fped.2023.1075087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives To investigate the potential factors affecting the clinical prognosis of intracranial sylvian arachnoid cysts(IAC) in children. Methods All patients with IAC admitted to our department from January, 1, 2015 to December, 31, 2016, were retrospectively reviewed. Patients were grouped based on surgical treatment (surgery cohort vs non-surgery cohort). The clinical and image outcome of the patients were followed routinely. The clinical characteristics and the prognosis of the patients were compared in different cohorts. Binary logistic regression analysis was applied to analyze the potential factors which may post an influence on the prognosis of the patients. Results Of 500 patients admitted to our department for IAC, 424 patients had good prognosis and 76 had poor prognosis, with no deaths occurred during the follow-ups. 68 patients had IAC related complications and 91 patients developed new symptoms during the follow-ups. There were significant differences (P < 0.05) between the 2 cohorts in below aspects: age, gender, Galassi subtype, whether the mother was a unipara, the maximum diameter of the cysts at the first visit and the last follow-up, headache, head circumference, temporal bulge, new symptoms, cysts rupture and hemorrhage, subdural effusion, and IAC disappearance. The mean changes in the maximum diameter of the IAC for the patients were marginally higher for the surgery cohort than for the non-surgery cohort (P < 0.01). Binary logistic regression analysis suggested that the number of symptom, no new symptoms during follow-up, surgical treatment, age, maximum diameter of cysts at first diagnosis were independent risk factors affecting the prognosis of patients (P < 0.05). Conclusions Patients older than 22.5 months, with the maximum diameter of IAC greater than 5.75 cm, who have multiple symptoms, born prematurely, develope new symptoms during the follow-ups and obvious symptoms after trauma need to conduct necessary surgical treatment in time. Patients with complications such as cysts rupture with hemorrhage and subdural effusion will acquire good prognosis after timely surgical treatment. IAC complete disappearance warrants no such important attention for the good prognosis.
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Affiliation(s)
| | | | | | | | | | - Jie Ma
- Correspondence: Baocheng Wang Jie Ma
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13
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Gong W, Wang XD, Liu YT, Sun Z, Deng YG, Wu SM, Wang L, Tian CL. Intracranial drainage versus extracranial shunt in the treatment of intracranial arachnoid cysts: a meta-analysis. Childs Nerv Syst 2022; 38:1955-1963. [PMID: 35723726 DOI: 10.1007/s00381-022-05585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review the literature and analyze the efficacy and safety of two surgery procedures, intracranial drainage and extracranial shunt, for intracranial arachnoid cysts. METHODS We searched the online Medlars, PubMed, and Cochrane Central electronic databases and collected studies of patients with intracranial arachnoid cysts treated with two surgical methods. RESULTS The meta-analysis results shows that there were not statistically significant in clinical symptoms improvement, cyst reduction, the improvement of epilepsy, epidural hematoma, cerebrospinal fluid leak, and recurrence rate (P > 0.05, with RR values are 0.99, 0.94, 1.00, 0.94, 1.21, and 0.75 respectively). There was statistically significant in the occurrence rate of intracranial infection (P = 0.0004, RR = 0.28). The intracranial drainage group was lower than extracranial shunt group. CONCLUSION The results indicated that the efficacy and safety of two surgery procedures are similar in the treatment of intracranial arachnoid cysts, but the intracranial drainage was better than extracranial shunt in reducing the risk of intracranial infection.
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Affiliation(s)
- Wei Gong
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Xiao-Dan Wang
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Yan-Ting Liu
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Zheng Sun
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Yuan-Guo Deng
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Sheng-Mei Wu
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Lei Wang
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China
| | - Chun-Lei Tian
- Department of Neurosurgery, The First College of Clinical Medical Science, China Three Gorges University & Institute of Neurology, Yichang Central People's Hospital, China Three Gorges University, Yichang, 443003, China.
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Shimizu S, Ito S, Higuchi K. Multiple etiologies of secondary headaches associated with arachnoid cyst, cerebrospinal fluid hypovolemia, and nontraumatic chronic subdural hematoma in an adolescent: A case report. Surg Neurol Int 2022; 13:386. [PMID: 36128159 PMCID: PMC9479647 DOI: 10.25259/sni_327_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Diagnosing the cause of headaches can be challenging. Even if intracranial lesions are found in a patient, careful assessment is essential for diagnosis, and treatment strategies will differ for each etiology. Case Description: A 16-year-old boy presented with sudden-onset headache which had lasted for 2 days. His headache was aggravated in the orthostatic position. The patient denied recent head trauma. He had been diagnosed with an arachnoid cyst (AC) in his right middle cranial fossa. Computed tomography (CT) revealed bilateral subdural effusions and slit-like lateral ventricles with no significant changes to the AC. After intravenous hydration followed by 2 days bed rest, his symptoms abated. He was diagnosed as having suffered spontaneous cerebrospinal fluid (CSF) hypovolemia. One month later, the patient experienced recurrent gradual onset headache and vomiting. CT revealed chronic right side subdural hematoma (SDH) with intracystic hemorrhage, which resulted in the elevation of intracranial pressure. An urgent hematoma evacuation was performed. He became symptom-free immediately after surgery. Postoperative follow-up CT showed no change in the AC and no recurrence of SDH. The lateral ventricles and subdural space were normal in size. Conclusion: We report a case presenting multiple types of secondary headaches, which were caused by intracranial hypotension or hypertension, with different etiologies. These were spontaneous CSF hypovolemia, nontraumatic intracystic hemorrhage form of AC, and nontraumatic chronic SDH. Although lesions seen at the time of initial diagnosis did not need surgical treatment, careful observation and repetitive imaging assessments might be useful for discovering unsuspected additional etiologies requiring surgical intervention.
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Affiliation(s)
- Sae Shimizu
- Department of Residency, Japanese Red Cross Nagahama Hospital, Nagahama, Japan
| | - Sayaka Ito
- Department of Neurosurgery, Kohka Public Hospital, Kohka, Japan
| | - Kazushi Higuchi
- Department of Neurosurgery, Japanese Red Cross Nagahama Hospital, Nagahama, Japan
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Watson I, McDonald PJ, Steinbok P, Graeber B, Singhal A. Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21462. [PMID: 36303495 PMCID: PMC9379718 DOI: 10.3171/case21462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arachnoid 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. OBSERVATIONS The 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. LESSONS Acetazolamide 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.
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Affiliation(s)
- Isabella Watson
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Patrick J. McDonald
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Section of Neurosurgery, University of Manitoba, Manitoba, Canada
| | - Paul Steinbok
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Brendon Graeber
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
- Department of Radiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Ashutosh Singhal
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
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16
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Vinchon M, Noulé N, Karnoub MA. The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news. Childs Nerv Syst 2022; 38:133-145. [PMID: 34564748 DOI: 10.1007/s00381-021-05357-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. MATERIAL AND METHODS In the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. RESULTS We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. CONCLUSION It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.
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Affiliation(s)
- Matthieu Vinchon
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France.
| | - Nathalie Noulé
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France
| | - Melodie-Anne Karnoub
- Department of Pediatric Neurosurgery, Service de Neurochirurgie Pédiatrique, CHRU de Lille, Lille University Hospital, 59 037, Lille, France
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17
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De Marco R, Secci F, Piatelli G. Letter to Editor Regarding "Endoscope-Controlled Microsurgery of a Ruptured Middle Fossa Arachnoid Cyst". World Neurosurg 2021; 151:296. [PMID: 34243639 DOI: 10.1016/j.wneu.2021.03.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Raffaele De Marco
- Department of Neuroscience, "Rita Levi Montalcini" Neurosurgery Unit, "City of Health and Science" University Hospital, University of Turin, Turin, Italy; Department of Neurosurgery, Giannina Gaslini Institute Children's Hospital, Genova, Italy.
| | - Francesca Secci
- Department of Neurosurgery, Giannina Gaslini Institute Children's Hospital, Genova, Italy
| | - Gianluca Piatelli
- Department of Neurosurgery, Giannina Gaslini Institute Children's Hospital, Genova, Italy
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18
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Schulz M, Oezkan Y, Schaumann A, Sieg M, Tietze A, Thomale UW. Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome. J Neurosurg Pediatr 2021; 28:102-112. [PMID: 33930866 DOI: 10.3171/2020.10.peds20839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated. METHODS A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007-2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed. RESULTS A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%-50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months. CONCLUSIONS The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.
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Affiliation(s)
- Matthias Schulz
- 1Pediatric Neurosurgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Yasin Oezkan
- 1Pediatric Neurosurgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Andreas Schaumann
- 1Pediatric Neurosurgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Miriam Sieg
- 2QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin; and
| | - Anna Tietze
- 3Department of Neuroradiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- 1Pediatric Neurosurgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
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19
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Pavanello M, Piatelli G. Letter to the Editor Regarding "Communicating Syringomyelia". World Neurosurg 2021; 147:228-229. [PMID: 33685007 DOI: 10.1016/j.wneu.2020.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Marco Pavanello
- Department of Neurosurgery, Giannina Gaslini Hospital, Genoa, Italy.
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Fiaschi P, Piatelli G, Pavanello M. Letter to the Editor Regarding "'Two-Birds-One-Stone' Approach for Treating an Infant with Chiari I Malformation and Hydrocephalus: Is Cerebrospinal Fluid Diversion as Sole Treatment Enough?". World Neurosurg 2021; 145:526-527. [PMID: 33348501 DOI: 10.1016/j.wneu.2020.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Pietro Fiaschi
- Department of Neurosurgery, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy; Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Università di Genova, Genova, Italy.
| | - Gianluca Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Pavanello
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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21
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Ceraudo M, Prior A. Subduro-peritoneal shunts in the management of subdural collection related to ruptured intracranial arachnoid cysts. Childs Nerv Syst 2021; 37:1417-1418. [PMID: 33141319 DOI: 10.1007/s00381-020-04959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Marco Ceraudo
- Department of Neurosurgery, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
| | - Alessandro Prior
- Department of Neurosurgery, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Largo Rosanna Benzi 10, 16132, Genoa, Italy
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22
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Spontaneous subdural and intracavitary hemorrhage of temporal arachnoid cyst in an adult patient. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Bryden A, Majors N, Puri V, Moriarty T. A Rare Case of Spontaneous Arachnoid Cyst Rupture Presenting as Right Hemiplegia and Expressive Aphasia in a Pediatric Patient. CHILDREN-BASEL 2021; 8:children8020078. [PMID: 33498812 PMCID: PMC7911169 DOI: 10.3390/children8020078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
This study examines an 11-year-old boy with a known history of a large previously asymptomatic arachnoid cyst (AC) presenting with acute onset of right facial droop, hemiplegia, and expressive aphasia. Shortly after arrival to the emergency department, the patient exhibited complete resolution of right-sided hemiplegia but developed headache and had persistent word-finding difficulties. Prior to symptom onset while in class at school, there was an absence of reported jerking movements, headache, photophobia, fever, or trauma. At the time of neurology consultation, the physical exam showed mildly delayed cognitive processing but was otherwise unremarkable. The patient underwent MRI scanning of the brain, which revealed left convexity subdural hematohygroma and perirolandic cortex edema resulting from ruptured left frontoparietal AC. He was evaluated by neurosurgery and managed expectantly. He recovered uneventfully and was discharged two days after presentation remaining asymptomatic on subsequent outpatient visits. The family express concerns regarding increased anxiety and mild memory loss since hospitalization.
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Affiliation(s)
- Anne Bryden
- Department of Neurology and Pediatrics, University of Louisville SOM, Louisville, KY 40202, USA
- Correspondence: ; Tel.: +1-(570)-951-2998
| | - Natalie Majors
- Department of Neurology and Pediatrics, Vanderbilt University, Nashville, TN 37420, USA;
| | - Vinay Puri
- Department of Neurology and Pediatrics, University of Louisville, Louisville, KY 40202, USA;
| | - Thomas Moriarty
- Department of Neurological Surgery and Pediatrics, University of Louisville, Louisville, KY 40202, USA;
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24
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Di Perna G, Piatelli G, Rossi A, Consales A, Fiaschi P, Castaldo M, Pavanello M. Coexisting Retrocerebellar Arachnoid Cyst and Chiari Type 1 Malformation: 3 Pediatric Cases of Surgical Management Tailored to the Pathogenic Mechanism and Systematic Review of the Literature. World Neurosurg 2020; 148:44-53. [PMID: 33385608 DOI: 10.1016/j.wneu.2020.12.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Arachnoid cysts are benign cerebrospinal fluid collection within a duplication of arachnoid membrane and, when found in the retrocerebellar site, they may be associated with tonsils herniation. This rare situation of coexisting retrocerebellar arachnoid cyst (AC) and Chiari malformation type 1 (CM-1) have been previously reported in few cases (10 patients) with syringomyelia and hydrocephalus described to be the most relevant issues. The aim of this paper is to describe 3 pediatric cases of this condition with a systematic review of the literature, underlining the importance of surgical management tailored to the pathogenic mechanism. METHODS A restrospective analysis of patients treated for coexisting CM-1 and ACs at the authors' institution has been carried out. RESULTS A case of a 10-month-old baby with coexisting AC and CM-1 with tri-ventricular hydrocephalus treated with endoscopic third ventriculostomy, a case of a 1-year-old child with a huge retrocerebellar AC and CM-1 treated with a cysto-peritoneal shunt, and a case of a 15-year-old child with retrocerebellar AC causing symptomatic CM-1 treated with C0-C2 decompression, AC fenestration and duraplasty are described. A long-term follow-up is reported. CONCLUSIONS Surgical management of coexisting ACs and CM-1 should not aim at the complete resolution of the cyst or of tonsil herniation, especially when pediatric patients are treated. Rather, the purpose of the neurosurgeon should be to understand the underlying pathogenic mechanism, and then restoring both the cerebrospinal fluid flow in the posterior fossa and the dynamic equilibrium between ventricles, cyst, and subarachnoid space.
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Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy; Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy.
| | - Gianluca Piatelli
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | | | - Pietro Fiaschi
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili (DINOGMI), Universitá; di Genova, Genova, Italy
| | - Margherita Castaldo
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Turin, Turin, Italy
| | - Marco Pavanello
- Division of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Singh G, Zuback A, Gattu R, Kilimnik G, Vaysberg A. Subdural hygroma after spontaneous rupture of an arachnoid cyst in a pediatric patient: A case report. Radiol Case Rep 2020; 16:309-311. [PMID: 33304441 PMCID: PMC7714662 DOI: 10.1016/j.radcr.2020.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 11/05/2022] Open
Abstract
Arachnoid cysts are benign masses that represent a relatively small percentage of intracranial lesions. Spontaneous rupture of an arachnoid cyst resulting in a subdural hygroma is a very rare event. We report a case of a pediatric patient with a history of an arachnoid cyst and chronic headaches presenting with bilateral papilledema, worsening headaches, and no history of head trauma. Magnetic resonance imaging of the brain revealed an extra-axial cystic lesion in the right middle cranial fossa, similar to an arachnoid cyst seen on previous imaging. A new right subdural collection similar to the cerebral spinal fluid signal causing mass effect on brain parenchyma was determined to represent a subdural hygroma. Craniotomy was performed to evacuate the subdural hygroma as well as cyst fenestration. We report this case to emphasize the importance of considering spontaneous rupture of an arachnoid cyst as a differential diagnosis despite absence of head trauma.
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26
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Ceraudo M, Prior A. Letter to the Editor Regarding, "Shunt Valve Rupture: An Interesting Case Report of Ventriculoperitoneal Shunt Failure". World Neurosurg 2020; 144:335-336. [PMID: 33227876 PMCID: PMC9976946 DOI: 10.1016/j.wneu.2020.09.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Marco Ceraudo
- Department of Neurosurgery, Ospedale Policlinico San Martino, IRCCS for Oncology and Neuroscience, Genoa, Italy.
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