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Krishnan V, Jaganathan S, Baker A, Jayappa S, Murphy J, Glasier C, Choudhary A, Albert G, Ramakrishnaiah R. Arachnoid cyst in the pediatric patient: What the radiologist needs to know. Neuroradiol J 2024:19714009241248746. [PMID: 38649153 DOI: 10.1177/19714009241248746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Arachnoid cysts are the most common incidentally discovered intracranial lesions on imaging and the most common cystic intracranial lesions. They may be developmental or secondary. A relative lack of recent literature and any comprehensive radiological review on arachnoid cysts has led to a general lack of awareness among radiologists of symptomatic or complicated arachnoid cysts. This is particularly concerning in pediatric patients. While arachnoid cysts are asymptomatic in most cases, they can cause clinical symptoms in a minority of cases, especially when they occur in unusual sites. These include intraventricular locations where they may cause hydrocephalus, the basal cisterns where they may compress cranial nerves, the cerebellopontine angle where they have to be differentiated from a number of cystic lesions, the cavum septum pellucidum or cavum velum interpositum, the choroid fissure where they can entrap the temporal horn and compress the hippocampus, the posterior fossa where they need to be differentiated from other posterior fossa cystic lesions, and within the spinal canal where there is a concern for cord or nerve root compression. Larger cysts are more prone to complications such as mass effect, hemorrhage, and rupture. Hemorrhage and rupture often present with acute symptoms. Ruptured cysts lose their characteristic imaging appearance and can mimic several ominous pathologies. It therefore becomes vital to accurately diagnose these cases as complications of pre-existing arachnoid cysts for appropriate management. A detailed review of all diagnostic imaging aspects of arachnoid cysts will help fill in the existing information void on this important entity.
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Affiliation(s)
- Venkatram Krishnan
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Sriram Jaganathan
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Andrew Baker
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Sateesh Jayappa
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Janice Murphy
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Charles Glasier
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Arabinda Choudhary
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Gregory Albert
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
| | - Raghu Ramakrishnaiah
- Department of Pediatric Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, USA
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He Y, Zhang M, Qin X, Huang C, Liu P, Tao Y, Wang Y, Guo L, Bao M, Li H, Mao Z, Li N, He Z, Wu B. Research process, recap, and prediction of Chiari malformation based on bicentennial history of nomenclature and terms misuse. Neurosurg Rev 2023; 46:316. [PMID: 38030943 DOI: 10.1007/s10143-023-02207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Abstract
There is an absent systematic analysis or review that has been conducted to clarify the topic of nomenclature history and terms misuse about Chiari malformations (CMs). We reviewed all reports on terms coined for CMs for rational use and provided their etymology and future development. All literature on the nomenclature of CMs was retrieved and extracted into core terms. Subsequently, keyword analysis, preceding and predicting (2023-2025) compound annual growth rate (CAGR) of each core term, was calculated using a mathematical formula and autoregressive integrated moving average model in Python. Totally 64,527 CM term usage was identified. Of these, 57 original terms were collected and then extracted into 24 core-terms. Seventeen terms have their own featured author keywords, while seven terms are homologous. The preceding CAGR of 24 terms showed significant growth in use for 18 terms, while 13, three, three, and five terms may show sustained growth, remain stable, decline, and rare in usage, respectively, in the future. Previously, owing to intricate nomenclature, Chiari terms were frequently misused, and numerous seemingly novel but worthless even improper terms have emerged. For a very basic neuropathological phenomenon tonsillar herniation by multiple etiology, a mechanism-based nosology seems to be more conducive to future communication than an umbrella eponym. However, a good nomenclature also should encapsulate all characteristics of this condition, but this is lacking in current CM research, as the pathophysiological mechanisms are not elucidated for the majority of CMs.
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Affiliation(s)
- Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., 6 Anrong Road, Chadianzi Street, Jinniu District, Chengdu, 610036, Sichuan, China
| | - Mengjun Zhang
- Department of Neuropsychology, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xiaohong Qin
- Department of Neuropsychology, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Caiquan Huang
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Ping Liu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Lili Guo
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Hongliang Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., 6 Anrong Road, Chadianzi Street, Jinniu District, Chengdu, 610036, Sichuan, China
| | - Zhenzhen Mao
- Emergency Department, Sichuan Taikang Hospital, Chengdu, 610000, Sichuan, China
| | - Nanxiang Li
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Zongze He
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China.
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China.
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3
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Sahuquillo J, Moncho D, Ferré A, López-Bermeo D, Sahuquillo-Muxi A, Poca MA. A Critical Update of the Classification of Chiari and Chiari-like Malformations. J Clin Med 2023; 12:4626. [PMID: 37510741 PMCID: PMC10380265 DOI: 10.3390/jcm12144626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Chiari malformations are a group of craniovertebral junction anomalies characterized by the herniation of cerebellar tonsils below the foramen magnum, often accompanied by brainstem descent. The existing classification systems for Chiari malformations have expanded from the original four categories to nine, leading to debates about the need for a more descriptive and etiopathogenic terminology. This review aims to examine the various classification approaches employed and proposes a simplified scheme to differentiate between different types of tonsillar herniations. Furthermore, it explores the most appropriate terminology for acquired herniation of cerebellar tonsils and other secondary Chiari-like malformations. Recent advances in magnetic resonance imaging (MRI) have revealed a higher prevalence and incidence of Chiari malformation Type 1 (CM1) and identified similar cerebellar herniations in individuals unrelated to the classic phenotypes described by Chiari. As we reassess the existing classifications, it becomes crucial to establish a terminology that accurately reflects the diverse presentations and underlying causes of these conditions. This paper contributes to the ongoing discussion by offering insights into the evolving understanding of Chiari malformations and proposing a simplified classification and terminology system to enhance diagnosis and management.
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Affiliation(s)
- Juan Sahuquillo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Dulce Moncho
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Clinical Neurophysiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Alex Ferré
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Sleep Unit, Pneumology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Diego López-Bermeo
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Aasma Sahuquillo-Muxi
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Poca
- Department of Neurosurgery, Vall d'Hebron University Hospital, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Park RJ, Unnikrishnan S, Berliner J, Magnussen J, Liu S, Stoodley MA. Cerebellar Tonsillar Descent Mimicking Chiari Malformation. J Clin Med 2023; 12:jcm12082786. [PMID: 37109124 PMCID: PMC10144607 DOI: 10.3390/jcm12082786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
Chiari I malformation has been defined as cerebellar tonsillar descent greater than 5 mm below the foramen magnum. Suboccipital decompression remains the mainstay of treatment for symptomatic patients. Other conditions sometimes have imaging features that mimic Chiari I malformation. These patients are at risk of misdiagnosis and mismanagement, including surgery that may be unnecessary or may even worsen the underlying condition. The aim of this study was to analyse a series of Chiari I malformation mimics and identify differentiating imaging features. The mimics are categorised as post-traumatic cranio-cervical junction arachnoiditis, dural band, spontaneous intracranial hypotension, idiopathic intracranial hypertension, and cysts. Better understanding of these conditions will assist with diagnosis and optimal management, including avoiding unnecessary surgery.
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Affiliation(s)
| | - Sunil Unnikrishnan
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - Joel Berliner
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - John Magnussen
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
| | - Shinuo Liu
- Statewide Neurosurgical Service, Sir Charles Gairdner and Perth Children's Hospitals, Perth, WA 6009, Australia
| | - Marcus A Stoodley
- Macquarie Medical School, Macquarie University, Sydney, NSW 2109, Australia
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Famili HP, Zalewski CK, Ibrahimy A, Mack J, Cantor F, Heiss JD, Brewer CC. Audiovestibular Findings in a Cohort of Patients with Chiari Malformation Type I and Dizziness. J Clin Med 2023; 12:jcm12082767. [PMID: 37109107 PMCID: PMC10142081 DOI: 10.3390/jcm12082767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Chiari Malformation Type I (CM1) is a neurological condition in which the cerebellar tonsils extend past the foramen magnum. While many studies have reported dizziness symptoms in patients with CM1, the prevalence of peripheral labyrinthine lesions is largely unknown. This study aimed to comprehensively describe the audiovestibular phenotype in a cohort of patients with CM1 expressly referred for dizziness. Twenty-four patients with CM1 and a complaint of dizziness/vertigo were evaluated. Hearing and auditory brainstem tract function were essentially normal. While vestibular abnormalities were most prevalent during rotational testing (33%), abnormal functional balance was the most common finding (40%). Patients with CM1 had a greater likelihood of exhibiting an abnormal sensory organization test (SOT) postural stability score for fixed platform conditions, and for the somatosensory analysis score. While no significant associations were identified between tonsillar ectopia extent and any vestibular/balance outcome measure, a significant negative association was identified between neck pain and the somatosensory sensory analysis score. Abnormal functional balance in the somatosensory domain was remarkable, with poorer scores associated with neck pain. An isolated peripheral vestibulopathy was present in only 8% of patients. Despite the low prevalence of vestibulopathy, vestibular/balance assessment is warranted to identify patients who may benefit from referral to specialized medical disciplines.
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Affiliation(s)
- Hannah P Famili
- Audiology Unit, NIDCD, National Institutes of Health, Bethesda, MD 20892, USA
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | | | - Alaaddin Ibrahimy
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jessica Mack
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Fredric Cantor
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - John D Heiss
- Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carmen C Brewer
- Audiology Unit, NIDCD, National Institutes of Health, Bethesda, MD 20892, USA
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6
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How Hong EA, Shalid A, Deepak S, Kounin G. Posterior Cranial Fossa Meningioma Causing Tonsillar Herniation and Giant Cervicothoracic Syringomyelia: Case Report and Review of Literature. Asian J Neurosurg 2022; 17:515-520. [PMCID: PMC9665991 DOI: 10.1055/s-0042-1756634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Syringomyelia is a fluid-filled cyst within the spinal cord and is usually associated with conditions that obstruct the cerebrospinal fluid (CSF) (flow at the foramen magnum or spinal levels such as Chiari malformations, arachnoiditis, and basilar invaginations). Very rarely, posterior cranial fossa tumors can lead to tonsillar herniation and secondary syringomyelia. There are only nine reported cases in the literature. We report a rare case of a 56-year-old female with posterior cranial meningioma and secondary syringomyelia, admitted with headache, nausea, vomiting, and ataxic gait. Magnetic resonance imaging (MRI) demonstrated a large posterior fossa lesion causing early ventriculomegaly and a giant cervicothoracic syrinx within the upper spinal cord extending from the hindbrain inferiorly to the level of T8. She underwent a posterior fossa craniectomy with left C1 hemilaminectomy and complete excision of the tumor. In 6 months following her procedure, an MRI scan showed a significant reduction in the caliber of the syringomyelia throughout its length, and there was a significant improvement in symptoms. Although the pathophysiology of syrinx formation is still poorly understood, the alteration of CSF dynamic flow has been implicated. A common unifying cause appears to be increased transcranial difference in intracranial pressure across the foramen magnum causing tonsillar herniation, irrespective of location in the posterior fossa. With high syrinx pressure, mechanical stress-induced structural change of the spinal cord occurs, allowing the persistence and progression of the syrinx in the spinal cord. Syringomyelia appears to be resolved partially or completely after craniotomy and excision of the posterior fossa lesion.
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Affiliation(s)
- Estelle Anne How Hong
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom,Address for correspondence Estelle Anne How Hong, MBCHB, MRCS ENT Department of Neurosurgery, Hull University Teaching HospitalsAnlaby Road, Hull, HU3 2JZUnited Kingdom
| | - Ahmed Shalid
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Srihari Deepak
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Gueorgui Kounin
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, United Kingdom
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7
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Muthiah N, McDowell MM, Zenonos G, Agarwal N, Snyderman CH, Friedlander RM, Gardner PA. Endoscopic Endonasal Resection of Cranio-Cervical Junction Chordoma and Ventral Chiari Decompression: A Case Report. Oper Neurosurg (Hagerstown) 2021; 21:E421-E426. [PMID: 34392369 DOI: 10.1093/ons/opab285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chiari I malformations secondary to other causes represent a small subset of presenting symptomatic cases. Typically, the primary cause of the malformation is addressed first and results in resolution of the malformation and symptoms. However, in some cases, a patient may present with both a primary Chiari I malformation and another unrelated neurosurgical lesions. OBJECTIVE To present a unique case in which resection of a ventral tumor allowed for spontaneous resolution of a simultaneously noted dorsal Chiari I malformation. METHODS Pertinent data, including presenting symptoms, hospital course, surgical notes, preoperative images, and postoperative images, were collected using the electronic medical record. RESULTS We present a case of a 46-yr-old man with a Chiari I malformation in conjunction with a ventral cranio-cervical junction chordoma. Endoscopic endonasal resection of the chordoma and ventral foramen magnum decompression resulted in radiographic resolution of the Chiari malformation and resolution of his symptoms. Our report represents a rare case of ventral foramen magnum decompression as a treatment for Chiari I malformation. CONCLUSION It is felt that the chordoma mass effect was not the source of the Chiari I malformation. Thus, both ventral and dorsal decompressions of the posterior fossa may be considered for Chiari I decompression in select circumstances.
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Affiliation(s)
- Nallammai Muthiah
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Georgios Zenonos
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Friedlander
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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8
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Aono T, Ono H, Tanishima T, Tamura A, Saito I. T11/T12 ossification of the yellow ligament contributing to thoracic myelopathy in patient with posterior fossa arachnoid cyst and acquired incidental Chiari I malformation/syrinx. Surg Neurol Int 2021; 12:246. [PMID: 34221577 PMCID: PMC8247752 DOI: 10.25259/sni_404_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Thoracic ossification of the yellow ligament (OYL) may contribute to myelopathy. In the case presented, the patient additionally had a chronic posterior fossa arachnoid cyst with an acquired Chiari I malformation and cervicothoracic syrinx. Case Description: A 40-year-old female with a posterior fossa arachnoid cyst found 17 years ago, and newly acquired Chiari I malformation (tonsils down 5 mm) with a C7-T5 syrnix, presented with the new onset of lower extremity myelopathy. The MR documented marked dorsolateral cord compression due to T11/T12 OYL. Six months following a laminectomy for resection of OYL, the patient was asymptomatic. Conclusion: In patients presenting with the new onset of lower extremity myelopathy, evaluation of the complete neuraxis may be warranted. Here, the patient has an unchanged posterior fossa arachnoid cyst with an acquired Chiari I malformation/C7-T5 syrinx. However, the patient’s symptoms were fully attributed to the MR-documented T11/T12 OYL that was successfully resected.
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Affiliation(s)
- Toshiya Aono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
| | - Hideaki Ono
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
| | - Takeo Tanishima
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
| | - Akira Tamura
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
| | - Isamu Saito
- Department of Neurosurgery, Fuji Brain Institute and Hospital, Fujinomiya-shi, Shizuoka, Japan
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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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Yoshida K, Toda M, Yamada Y, Yamada M, Yokoyama Y, Fujiwara H, Kosugi K, Sasaki H, Jinzaki M. Orthostatic Enlargement of a Supracerebellar Arachnoid Cyst With Cerebellar Descent Visualized by Upright Computed Tomography. World Neurosurg 2020; 145:256-259. [PMID: 32992060 DOI: 10.1016/j.wneu.2020.09.132] [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: 07/30/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Posterior fossa arachnoid cysts are often asymptomatic, but can rarely cause postural headache, the mechanism of which remains unknown. CASE DESCRIPTION We present a 40-year-old woman with an asymptomatic supracerebellar arachnoid cyst. Upright computed tomography (CT) showed enlargement of the arachnoid cyst and caudal descent of the cerebellum compared with supine CT with narrowing of the craniocervical junction cerebrospinal fluid space. CONCLUSIONS This finding aids in understanding the association of posterior fossa arachnoid cysts with orthostatic headache. Clinicians should be aware of possible posture-related changes in intracranial structures.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan.
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoichi Yokoyama
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hirokazu Fujiwara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenzo Kosugi
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Hajtovic S, Placantonakis DG. Resolution of Tonsillar Herniation and Syringomyelia Following Resection of a Large Anterior Frontal Parasagittal Meningioma. Cureus 2020; 12:e7636. [PMID: 32399368 PMCID: PMC7213766 DOI: 10.7759/cureus.7636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Chiari I malformation is the herniation of cerebellar tonsils below the level of the foramen magnum due to congenital or acquired pathologies. Acquired Chiari I malformation (ACM) may occur secondary to space-occupying lesions (SOLs), such as intracranial tumors due to elevated intracranial pressure (ICP), and can be accompanied by syringomyelia. ACM and syringomyelia have been shown to resolve after resection of the SOL, without the need for adjuvant posterior fossa decompression. The vast majority of SOLs leading to ACM have been reported in the posterior fossa, thus exerting a direct mass effect on the cerebellum. Supratentorial SOLs leading to ACM are much less frequent but, when present, are most commonly parieto-occipital. We report a rare case of a large anterior left frontal, parasagittal meningioma causing ACM and syringomyelia. These findings resolved following the resection of the meningioma, with no further surgical intervention. Our case demonstrates that ACM can occur secondary to an anterior supratentorial mass and further supports the idea that decompression of the posterior fossa is not required for the resolution of intracranial tumor-associated ACM and syringomyelia.
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Affiliation(s)
- Sabastian Hajtovic
- Neurosurgery, City University of New York (CUNY) School of Medicine, Sophie Davis Biomedical Education Program, New York, USA
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12
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Fiaschi P, Morana G, Anania P, Rossi A, Consales A, Piatelli G, Cama A, Pavanello M. Tonsillar herniation spectrum: more than just Chiari I. Update and controversies on classification and management. Neurosurg Rev 2019; 43:1473-1492. [DOI: 10.1007/s10143-019-01198-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023]
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Onyia CU, Akinniranye O, Olaitan A, Agoha C. Short Report on a Rare Presentation of Temporal Arachnoid Cyst and Lessons Learned. World Neurosurg 2019; 126:310-313. [PMID: 30885870 DOI: 10.1016/j.wneu.2019.02.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. CASE DESCRIPTION We report a recent experience on this association. CONCLUSIONS In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.
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Affiliation(s)
- Chiazor U Onyia
- Department of Surgery, Lagoon Hospitals Group, Lagos, Nigeria.
| | | | - Adebayo Olaitan
- Department of Anaesthesia, Lagoon Hospitals Group, Lagos, Nigeria
| | - Chimezie Agoha
- Department of Surgery, Lagoon Hospital, Apapa, Lagos, Nigeria
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Marques de Almeida Holanda M, Costa do Nascimento JJ, Batista LL, Pinto Kitamura MA, Cavalcanti Neto BF, Valença MM. Cerebellar Tonsillar Cysts Associated with Chiari Malformation in Adults: A Short Series. World Neurosurg 2018; 120:205-210. [PMID: 30176398 DOI: 10.1016/j.wneu.2018.08.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Authors analyzed surgical patients with Chiari malformation (CM) associated with cerebellar tonsillar cyst. This association is quite rarely encountered in the literature. CASE DESCRIPTION We retrospectively reviewed 60 surgical adult patients with MRI evaluation who underwent posterior fossa decompression for treatment of CM type I. All surgeries were performed between January 1995 and July 2015. From 60 patients with CM, four cases presented cerebellar tonsillar cysts (male=2). Basilar invagination (BI) (n=4) and syringomyelia (n=1) were associated. There were pyramidal signs (n=4) and low cranial nerves dysfunction (n=1). Radiological evaluation showed T1-hypointense and T2-hyperintense image on the cystic tissue (n=4). The surgical technique was suboccipital craniectomy, C1-C2 laminectomy (if needed), y-shaped durotomy, total resection and coagulation/aspiration of tonsils. CONCLUSIONS In the present series, we were able to identify 7% of tonsillar cysts among 60 patients with CM. MRI with Flair and Diffusion sequences should be pre-operatively used for evaluation of tissue characteristics as differential diagnosis of cystic lesion and gliosis. The clinical presentation endorses surgical indication, with a good chance of clinical improvement. This was the first time that the frequency of tonsillar cysts has been evaluated in a series of adult patients.
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Affiliation(s)
| | | | - Laécio Leitão Batista
- Department of Radiology, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Marcelo Moraes Valença
- Post-graduation in Neuropsychiatry, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Neurosurgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Mori T, Nishino E, Jitsukawa T, Hoshino E, Hirakawa S, Kuroiwa Y, Fuse S, Yoto Y, Tsutsumi H. Chiari type 1 malformation associated with central sleep apnea after high dose growth hormone (GH) therapy in a 12-year-old boy: A case report. Clin Pediatr Endocrinol 2018; 27:45-51. [PMID: 29403156 PMCID: PMC5792821 DOI: 10.1297/cpe.27.45] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
We describe the case of a short-statured 12-yr-old boy who developed a Chiari type 1
malformation associated with central sleep apnea after administration of high-dose GH
therapy, which he had been receiving since the age of 10 yr and 4 mo. He responded well to
GH therapy, and his height increased by 18.8 cm in 2 yr. At 12 yr and 4 mo of age, his
mother reported that he had developed sleep apnea during the previous year and it had
worsened over a month prior to presentation at our hospital. Otolaryngological examination
did not reveal tonsillar or adenoidal hypertrophy. Polysomnography demonstrated severe
central sleep apnea with an apnea-hypopnea index of 46.5/h. Sagittal T1-weighted magnetic
resonance imaging (MRI) demonstrated herniation of the cerebellar tonsils 15 mm below the
foramen magnum into the cervical spinal cord. Continuous positive airway pressure therapy
initiated prior to performing neurosurgery was ineffective. Following uncomplicated
foramen magnum decompression, his breathing pattern during sleep returned to normal.
Sagittal MRI examination should be considered in patients who develop sleep apnea
during/following administration of GH therapy.
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Affiliation(s)
- Toshihiko Mori
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Eri Nishino
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Tomomi Jitsukawa
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Emiko Hoshino
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Satoshi Hirakawa
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Yuki Kuroiwa
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Shigeto Fuse
- Department of Pediatrics, NTT East Sapporo Hospital, Hokkaido, Japan
| | - Yuko Yoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, Hokkaido, Japan
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Syringomyelia without tonsillar herniation-cisterna magna herniation a cause? Childs Nerv Syst 2017; 33:1243-1245. [PMID: 28676979 DOI: 10.1007/s00381-017-3513-z] [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: 06/14/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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Wang J, Alotaibi NM, Samuel N, Ibrahim GM, Fallah A, Cusimano MD. Acquired Chiari Malformation and Syringomyelia Secondary to Space-Occupying Lesions: A Systematic Review. World Neurosurg 2017; 98:800-808.e2. [DOI: 10.1016/j.wneu.2016.11.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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Ros López B, Martín Gallego Á, Iglesias Moroño S. Quistes aracnoideos del sistema nervioso central. Algoritmos y recomendaciones generales de manejo. Neurocirugia (Astur) 2016; 27:67-74. [DOI: 10.1016/j.neucir.2015.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/07/2015] [Indexed: 12/14/2022]
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Martinez-Perez R, Hinojosa J, Pascual B, Panaderos T, Welter D, Muñoz MJ. [Rare location of arachnoid cysts. Extratemporal cysts]. Neurocirugia (Astur) 2016; 27:121-8. [PMID: 26725189 DOI: 10.1016/j.neucir.2015.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/20/2015] [Accepted: 10/24/2015] [Indexed: 11/28/2022]
Abstract
The therapeutic management of arachnoid cysts depends largely on its location. Almost 50% of arachnoid cysts are located in the temporal fossa-Sylvian fissure, whereas the other half is distributed in different locations, sometimes exceptional. Under the name of infrequent location arachnoid cysts, a description is presented of those composed of 2 sheets of arachnoid membrane, which are not located in the temporal fossa, and are primary or congenital.
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Affiliation(s)
| | - José Hinojosa
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Beatriz Pascual
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España
| | - Teresa Panaderos
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España
| | - Diego Welter
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España
| | - María J Muñoz
- Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, España
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Sun L, Emich S, Fu W, Chen Z, Hao W, Ling F, Jian F. Retrocerebellar arachnoid cyst resulting in syringomyelia in a patient without tonsillar herniation: successful surgical treatment with reconstruction of CSF flow in the foramen magnum region. Neurosurg Rev 2016; 39:341-6; discussion 347. [DOI: 10.1007/s10143-015-0680-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/01/2015] [Accepted: 08/09/2015] [Indexed: 12/15/2022]
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Hue SB, Seong HY, Kwon SC, Lyo IU, Sim HB. Syringomyelia Associated with a Huge Retrocerebellar Arachnoid Cyst: A Case Report. KOREAN JOURNAL OF SPINE 2015; 12:156-9. [PMID: 26512273 PMCID: PMC4623173 DOI: 10.14245/kjs.2015.12.3.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 11/19/2022]
Abstract
Occasionally, a posterior fossa arachnoid cyst can induce compression of the spinal cord and cause syringomyelia. Here, we report the case of a 29-year-old man with both progressive shoulder pain and gait disturbance, who was found to have a huge retrocerebellar arachnoid cyst associated with syringomyelia. Accordingly, posterior fossa decompression and arachnoid cyst excision were performed. Post-operative MRI showed a marked reduction in the size of the arachnoid cyst and syringomyelia. The patient's symptoms were clearly improved compared to before surgery. In our view, treatment in such patients should focus on decompressing the foramen magnum and include the removal of the coexistent arachnoid cyst walls, which appear to be the crucial factor in development of syringomyelia. In this report, we discuss the pathogenic mechanisms underlying syringomyelia-associated retrocerebellar arachnoid cyst and review the current literature on this topic.
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Affiliation(s)
- Sung Baek Hue
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Han Yu Seong
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Soon Chan Kwon
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Uk Lyo
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hong Bo Sim
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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22
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Srinivasan US, Lawrence R. Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series. Asian J Neurosurg 2015; 10:47. [PMID: 25767579 PMCID: PMC4352631 DOI: 10.4103/1793-5482.151512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction and Aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC. Materials and Methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years. Results: In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making. Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.
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Affiliation(s)
| | - Radhi Lawrence
- Department of Pathology MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India
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23
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Prasad GL, Sinha S, Mahapatra AK. An Extremely Rare Association of Posterior Fossa Arachnoid Cyst with Chiari I Malformation and Syringomyelia in a Child: A Short Report. Pediatr Neurosurg 2015; 50:350-2. [PMID: 26461066 DOI: 10.1159/000371892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/03/2015] [Indexed: 11/19/2022]
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Winston KR, Stence NV, Boylan AJ, Beauchamp KM. Upward Translation of Cerebellar Tonsils following Surgical Expansion of Supratentorial Cranial Vault: A Unified Biomechanical Explanation of Chiari Type I. Pediatr Neurosurg 2015; 50:243-9. [PMID: 26367858 DOI: 10.1159/000437146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/23/2015] [Indexed: 11/19/2022]
Abstract
Cerebellar tonsils moved significantly upward in 3 patients with Chiari type I who underwent supratentorial cranial vault expansion to alleviate intracranial pressure related to multisutural craniosynostosis. The Chiari type I deformities in these patients were the biomechanical consequence of posterior fossa-cerebellar disproportion caused by supratentorial craniocerebral disproportion secondary to multisutural craniosynostosis. The authors postulate that all cases of Chiari type I deformity share the sine qua non feature of posterior fossa-cerebellar disproportion.
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25
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Smith BW, Strahle J, Bapuraj JR, Muraszko KM, Garton HJL, Maher CO. Distribution of cerebellar tonsil position: implications for understanding Chiari malformation. J Neurosurg 2013; 119:812-9. [PMID: 23767890 DOI: 10.3171/2013.5.jns121825] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Prior attempts to define normal cerebellar tonsil position have been limited by small numbers of patients precluding analysis of normal distribution by age group. The authors' objective in the present study was to analyze cerebellar tonsil location in every age range. METHODS Two thousand four hundred patients were randomly selected from a database of 62,533 consecutive patients undergoing MRI and were organized into 8 age groups. Magnetic resonance images were directly examined for tonsil location, morphology, and other features. Patients with a history or imaging findings of posterior fossa abnormalities unrelated to Chiari malformation (CM) were excluded from analysis. The caudal extent of the cerebellar tonsils was measured at the midsagittal and lowest parasagittal positions. RESULTS The mean tonsil height decreased slightly with advancing age into young adulthood and increased with advancing age in the adult age range. An increasing age in the adult age range was associated with a decreased likelihood of a tonsil position 5 mm or more below the foramen magnum (p = 0.0004). In general, the lowest tonsil position in each age group was normally distributed. Patients with pegged morphology were more likely to have a tonsil location at least 5 mm below the foramen magnum (85%), as compared with those having intermediate (38%) or rounded (2%) morphology (p < 0.0001). Female sex was associated with a lower mean tonsil position (p < 0.0001). Patients with a lower tonsil position also tended to have an asymmetrical tonsil position, usually lower on the right (p < 0.0001). CONCLUSIONS Cerebellar tonsil position follows an essentially normal distribution and varies significantly by age. This finding has implications for advancing our understanding of CM.
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Affiliation(s)
- Brandon W Smith
- Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-5338, USA
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26
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Killeen T, Tromop-VAN-Dalen C, Alexander H, Wickremesekera A. Bilateral retrocerebellar arachnoid cysts exerting mass effect and associated with cerebellar tonsillar ectopia in an otherwise healthy adult. Neurol Med Chir (Tokyo) 2013; 53:266-9. [PMID: 23615422 DOI: 10.2176/nmc.53.266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rarely, midline or unilateral posterior fossa arachnoid cysts (ACs) exert local mass effect resulting in the symptoms and signs of cerebellar and brainstem dysfunction. These cysts are sometimes seen in conjunction with cerebellar tonsillar ectopia (TE), although the relationship between these two entities is unclear. Bilateral ACs in the posterior fossa are virtually unprecedented. We describe the case of a 33-year-old man with a history of multiple minor head injuries observed to harbour asymptomatic, bilateral cerebrospinal fluid-density collections over the cerebellar hemispheres. Six years later, he presented with headaches, limb paraesthesias, and drop attacks. Computed tomography, magnetic resonance imaging, and operative findings during burrhole drainage of the lesions showed bilateral posterior fossa ACs, with associated cerebellar TE of 11 mm. The cysts partially recurred, necessitating reopening of the burrholes, after which the patient's symptoms resolved entirely. We then discuss the challenges in diagnosing this unusual case, the relationship between AC and TE, and the role of minor head injury in the symptomatic progression of AC.
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Affiliation(s)
- Tim Killeen
- Department of Neurosurgery, Wellington Regional Hospital, Wellington, New Zealand.
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27
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Apok V, Constantini S, Roth J. Microsurgical fenestration of retrocerebellar cysts as a treatment for syringomyelia. Childs Nerv Syst 2012; 28:653-6. [PMID: 22147240 DOI: 10.1007/s00381-011-1652-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/28/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Vino Apok
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Manchester, UK
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28
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Sengul G, Tuzun Y, Cakir M, Duman S, Colak A, Kadioglu HH, Aydin IH. Neuroendoscopic approach to quadrigeminal cistern arachnoid cysts. Eurasian J Med 2012; 44:18-21. [PMID: 25610199 DOI: 10.5152/eajm.2012.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 09/07/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The introduction of neuroendoscopy has provided a minimally invasive modality for the surgical treatment of quadrigeminal arachnoid cysts. Three pediatric patients with arachnoid cyst of the quadrigeminal cistern treated by endoscopic fenestration are reported. MATERIALS AND METHODS The hospital records of patients were retrospectively rewieved. All patients had hydrocephalus. A lateral ventricle-cystostomy and endoscopic third ventriculostomy were performed by using rigid neuroendoscopes. RESULTS There were one boy and two girls with ages 7 months, 9 months and 14 years, respectively. One patient had undergone shunting prior to neuroendoscopic surgery. The postoperative course was uneventful in all cases, with no complications. They showed disappearance of intracranial hypertension symptoms and significant reduction of the cyst size. CONCLUSION Neuroendoscopic technique is an effective and suitable method for the treatment of quadrigeminal cistern arachnoid cysts and accompanying hydrocephalus.
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Affiliation(s)
- Goksin Sengul
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Yusuf Tuzun
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Murteza Cakir
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Sencer Duman
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Abdullah Colak
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Hakan Hadi Kadioglu
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ismail Hakki Aydin
- Department of Neurosurgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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29
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Martínez-Lage JF, Pérez-Espejo MA, Almagro MJ, López-Guerrero AL. Hydrocephalus and arachnoid cysts. Childs Nerv Syst 2011; 27:1643-52. [PMID: 21928029 DOI: 10.1007/s00381-011-1481-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 05/04/2011] [Indexed: 11/30/2022]
Abstract
AIM The management of arachnoid cysts (AC) remains controversial. An additional problem derives from the management of hydrocephalus associated with an AC. In this work, we discuss existing procedures proposed in the current literature for their treatment. METHODS We reviewed selected reports on intracranial ACs placing special interest in those about the association of hydrocephalus and ACs. We also briefly surveyed data of our patients with this association. RESULTS AND DISCUSSION Hydrocephalus is often found in midline and posterior fossa ACs. Interhemispheric lesions may also evolve with ventriculomegaly, while middle fossa lesions rarely produce hydrocephalus. Patients' age, cyst location and size, and macrocephaly have all been related to the development of hydrocephalus. Some authors remark on the role played by hydrocephalus and hypothesize that some ACs would result from disturbed cerebrospinal fluid (CSF) dynamics. They also propose that ACs might represent a localized form of hydrocephalus. We also comment on hydrocephalus in relation to the diverse locations of ACs. Neuroendoscopic techniques have transformed previous ways of management as cystoperitoneal shunting and open fenestration. CONCLUSIONS ACs may be pathogenetically related with hydrocephalus, and conversely, ACs may cause hydrocephalus. In some patients, aberrant CSF dynamics seems to play a major role in the development of both cyst and hydrocephalus. Hydrocephalus and ACs may be treated exclusively with neuroendoscopic procedures, although some patients will still require CSF shunting. The ideal option seems to consist of choosing the method that offers the highest success with a single procedure for treating the hydrocephalus and the AC simultaneously.
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Affiliation(s)
- Juan F Martínez-Lage
- Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain.
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30
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Dlouhy BJ, Menezes AH. Osteopetrosis with Chiari I malformation: presentation and surgical management. J Neurosurg Pediatr 2011; 7:369-74. [PMID: 21456907 DOI: 10.3171/2011.1.peds10353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteopetrosis is a heterogeneous group of rare, inherited disorders of the skeleton that results in neurological manifestations due to restriction of growth of cranial foramina and calvarial thickening. A 25-year-old woman with a history of autosomal dominant osteopetrosis presented to the authors' institution with headache worsened by exertion and radiating from the occipital region forward with episodes of choking/coughing when eating and a loss of gag reflex on physical examination. On MR imaging, she was found to have severe posterior fossa calvarial thickening resulting in a small posterior fossa and tonsillar ectopia of 9 mm and compression and deformation of the brainstem. She underwent posterior fossa craniectomy, foramen magnum decompression, and partial C-1 laminectomy with external durotomy. The patient did well postoperatively with resolution of symptoms. This case describes a new neurological manifestation of autosomal dominant osteopetrosis. To the authors' knowledge, this report represents the first described case of extreme posterior fossa calvarial thickening from autosomal dominant osteopetrosis with associated Chiari I malformation (CM-I) requiring posterior fossa decompression and extradural decompression. Given previously published MR imaging data that demonstrate the association of osteopetrosis and CM may be more common than in this case alone, the authors discuss the need for further investigation of the incidence of CM-I in patients with autosomal dominant osteopetrosis. Additionally, they review osteopetrosis and other diagnoses of calvarial hyperostosis presenting as CM-I.
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Affiliation(s)
- Brian J Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
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Huang H, Li Y, Xu K, Li Y, Qu L, Yu J. Foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia: case report and literature review. Int J Med Sci 2011; 8:345-50. [PMID: 21647327 PMCID: PMC3107467 DOI: 10.7150/ijms.8.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/16/2011] [Indexed: 11/05/2022] Open
Abstract
It is very rare that a foramen magnum arachnoid cyst induces compression of the spinal cord and syringomyelia, and currently there are few treatment experiences available. Here we reported the case of a 43-year-old male patient who admitted to the hospital due to weakness and numbness of all 4 limbs, with difficulty in urination and bowel movement. MRI revealed a foramen magnum arachnoid cyst with associated syringomyelia. Posterior fossa decompression and arachnoid cyst excision were performed. Decompression was fully undertaken during surgery; however, only the posterior wall of the arachnoid cyst was excised, because it was almost impossible to remove the whole arachnoid cyst due to toughness of the cyst and tight adhesion to the spinal cord. Three months after the surgery, MRI showed a reduction in the size of the arachnoid cyst but syrinx still remained. Despite this, the symptoms of the patient were obviously improved compared to before surgery. Thus, for the treatment of foramen magnum arachnoid cyst with compression of the spinal cord and syringomyelia, if the arachnoid cyst could not be completely excised, excision should be performed as much as possible with complete decompression of the posterior fossa, which could result in a satisfying outcome.
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Affiliation(s)
- Haiyan Huang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, PR China
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