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Yassin A, Al-Mistarehi AH, Tremont-Lukats IW, El-Salem K, Shawagfeh A, Al-Hafez B, Levine N. Acute diffuse cerebral vasospasm as a complication of endoscopic resection of a colloid cyst: a case report. Br J Neurosurg 2023; 37:1362-1366. [PMID: 32955376 DOI: 10.1080/02688697.2020.1820946] [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: 05/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endoscopic resection can be used for removing colloid cysts as a substitute for open craniotomy. Cerebral vasospasm, a possible complication of the craniotomy procedure, has not been reported as a complication of endoscopic removal of colloid cysts. CASE DESCRIPTION A 58-year-old man developed the worst headache of his life. The CT and MRI showed a 1.3 cm midline third ventricular cyst at the level of the foramen of Monro, consistent with a colloid cyst. The patient elected to undergo an endoscopic resection of the colloid cyst. The image-guided frameless stereotactic endoscopic colloid cyst resection proceeded without events. Postoperative MRI showed a gross total resection. The patient continued to improve until post-operative day #9 when he experienced an episode of slurred speech and several episodes of legs buckling. An MRI did not show a stroke. A CT angiogram showed diffuse vasospasm, including the basilar artery and bilateral middle cerebral arteries, when compared to the patient's preoperative MRA. The patient's antihypertensive medications were stopped. The patient was started on Nimodipine, 60 mg every 4 hours, and triple H therapy (Hypertension, Hypervolemia, and Hemodilution) was applied. His blood pressure rose and his neurologic exam improved over several days. The patient returned to his baseline in 14 days without any neurological deficits. To our knowledge, this is the first case report of a patient undergoing endoscopic colloid cyst resection that was complicated by diffuse cerebral vasospasm. CONCLUSIONS We report the first case of acute, transient cerebral vasospasm following endoscopic resection of a colloid cyst.
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Affiliation(s)
- Ahmed Yassin
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ivo W Tremont-Lukats
- Department of Neurosurgery and the Kenneth R. Peak Brain and Pituitary Treatment Center, Houston Methodist Hospital, Houston, TX, USA
| | - Khalid El-Salem
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahmad Shawagfeh
- Plummer Movement Disorders Center, Baylor Scott and White Clinics, Temple, TX, USA
| | - Baraa Al-Hafez
- Department of Neurosurgery, University of Texas, Memorial Hermann Southeast Hospital, 18955 Memorial N, Humble, TX, USA
| | - Nicholas Levine
- Department of Neurosurgery, University of California San Francisco, 155 N Fresno St, Fresno, CA, USA
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Hamzah A, Alharbi AS, Abdulhamid AS, Turkistani AN, Aref MH. Management of postoperative cerebral vasospasm in skull base surgeries: A systematic review of case reports and series. Surg Neurol Int 2023; 14:214. [PMID: 37404488 PMCID: PMC10316141 DOI: 10.25259/sni_441_2023] [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: 05/22/2023] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Background This study provides a comprehensive overview of the management of postoperative vasospasm after skull base surgeries. This phenomenon is rare but can be of serious sequelae. Methods Medline, Embase, and PubMed Central were searched, along with examining the references of the included studies. Only case reports and series that reported vasospasm following a skull base pathology were incorporated. Cases with pathologies other than skull base, subarachnoid hemorrhage, aneurysm, and reversible cerebral vasoconstriction syndrome were excluded from the study. Quantitative data were presented as mean (Standard Deviation) or median (range), accordingly, while qualitative data were presented as frequency (percentage). Chi- square test and one-way analysis of variance were used to assess for any association between the different factors and patient outcomes. Results We had a total of 42 cases extracted from the literature. The mean age was 40.1 (±16.1) with approximately equal males and females (19 [45.2%] and 23 [54.8%], respectively). The time to develop vasospasm after the surgery was 7 days (±3.7). Most of the cases were diagnosed by either angiogram or magnetic resonance angiography. Seventeen of the 42 patients had pituitary adenoma as the pathology. Anterior circulation was nearly affected in all patients. For management, most patients received pharmacological with supportive management. Twenty-three patients had an incomplete recovery as a result of vasospasm. Conclusion Vasospasm following skull base operations can affect males and females, and most patients in this review were middle-aged adults. The outcome of patients varies; however, most patients did not achieve a full recovery. There was no correlation between any factors and the outcome.
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Affiliation(s)
- Abdulaziz Hamzah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdullah S. Alharbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed S. Abdulhamid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Alaa Nabil Turkistani
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohmmed Hani Aref
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Gray L, Quig N, Kang M. Delayed hydrocephalus after excision of a colloid cyst: a case report. J Med Case Rep 2022; 16:226. [PMID: 35668448 PMCID: PMC9172114 DOI: 10.1186/s13256-022-03453-0] [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: 10/26/2021] [Accepted: 05/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background In this case report we describe an unusual case of a patient who underwent resection of a colloid cyst and then presented 6 weeks postoperatively with obstructive hydrocephalus. There appear to be no prior reports of such a delayed complication after colloid cyst resection. Case presentation A 50-year-old Caucasian woman underwent resection of a colloid cyst with an uncomplicated perioperative course. Postoperative imaging demonstrated complete resection of the cyst. She was discharged home on postoperative day 4 but presented 6 weeks later with symptoms of obstructive hydrocephalus resulting in poor neurologic outcome and ultimately death. Conclusion Patients presenting with symptoms of hydrocephalus after resection of a colloid cyst should be followed closely, and timely placement of an external ventricular drain may be critical.
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Affiliation(s)
- Logan Gray
- Department of Anesthesiology, University of North Carolina, N2198, CB #7010, Chapel Hill, NC, 27599-7010, USA
| | - Nathan Quig
- Department of Neurosurgery, University of North Carolina, Chapel Hill, NC, USA
| | - Myungsa Kang
- Department of Anesthesiology, University of North Carolina, N2198, CB #7010, Chapel Hill, NC, 27599-7010, USA.
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Tyagi G, Singh GJ, Beniwal M, Srinivas D. Xanthogranulomatous Colloid Cyst in a 13-Year-Old Boy: A Case Report and Surgical Implications. Pediatr Neurosurg 2022; 57:202-206. [PMID: 35381594 DOI: 10.1159/000524480] [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: 07/28/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Colloid cysts are relatively uncommon lesions in the pediatric population. The xanthogranulomatous (XG) variant is very rare with less than 30 reported cases. CASE REPORT In this report, the patient was a 13-year-old boy who presented with transient episodes of headache with blurring of vision. His MRI brain showed a T2 hyperintense well-defined cystic lesion, with an eccentrically located T2 hypointense partially enhancing nodule, at the foramen of Monro. He underwent middle frontal gyrus transcortical, transchoroidal gross total excision of the cyst. The histopathology of the lesion revealed an XG colloid cyst. The patient recovered well from the procedure and was relieved of the symptoms. CONCLUSION XG colloid cyst may present with altered radiological features compared to the normal variant. This can pose a diagnostic dilemma, and it is important to differentiate it from a craniopharyngioma or a parasitic cyst, as in our case. When considered preoperatively, surgeons should be conscious to review their surgical strategies. Stereotactic aspiration of the XG cyst should be avoided as contents are thicker and heterogeneous than the usual. The spillage of cyst contents should be prevented. Also, the XG cysts are likely to have a poor cyst-fornix or -choroid plexus interface due to inflammation limiting complete resection.
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Affiliation(s)
- Gaurav Tyagi
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gyani Jail Singh
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manish Beniwal
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dwarakanath Srinivas
- Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
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Soldatelli MD, de Oliveira FH, de Medeiros Klaes AIN, da Silva RS, Martins Antunes ÁC, Bianchin MM, Duarte JÁ. Xanthogranulomatous colloid cyst: Radiologic- pathologic correlation and diagnostic difficulties. Surg Neurol Int 2019; 10:169. [PMID: 31583166 PMCID: PMC6763664 DOI: 10.25259/sni_179_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background Despite colloid cyst in the third ventricle is a very usual cause of hydrocephalus, its xanthogranulomatous variant is rare. The most important differential diagnosis is the third ventricular craniopharyngioma. To the best of the authors' knowledge, there have been few cases of xanthogranulomatous variant colloid cysts reported in the English literature. Case Description A 77-year-old white woman presented with headaches, memory loss, and abnormal gait for the past 4 months. Magnetic resonance imaging revealed a solid cystic lesion measuring 3.0 cm×2.8 cm×2.9 cm located inside the anterior portion of the third ventricle causing obstructive hydrocephalus. The posterior portion of the lesion was predominantly solid and hypointense on T2 and T1, with areas of post- contrast enhancement, and the anterior portion was predominantly cystic with both hyper- and hypointense areas on T1 and T2, with no suppression on fluid-attenuated inversion recovery and no restriction to diffusion. The patient underwent a left frontal craniotomy with pterional approach, and the lesion was removed microsurgically. Conclusion Xanthogranulomatous reaction is rarely described in colloid cysts, which happens as a response to desquamation of epithelial lining, subsequent lipid accumulation, and as tissue inflammatory response to intracystic hemorrhage. Microsurgical resection is the treatment of choice. As compared to the plain colloid cyst, these lesions are difficult to fully excise as the inflammatory reaction to the xanthomatous material leads to adhesions to adjacent structures; therefore, the aspiration of cystic contents without spillage is advisable to achieve maximal resection of cyst walls.
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Affiliation(s)
- Matheus D Soldatelli
- Departments of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departments of Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Amália Izaura Nair de Medeiros Klaes
- Departments of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departments of Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Rafael Sodré da Silva
- Department of Neurosurgery, University Hospital Sao Francisco de Paula, Pelotas, Brazil.,Departments of Neurosurgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Juliana Ávila Duarte
- Departments of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departments of Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Shao B, Banu MA, Carroll JJ, Meyers PM, Lavine SD, Feldstein NA, Anderson RCE. Cerebral Vasospasm after Open Fenestration of an Arachnoid Cyst in a 4-Year-Old Boy: Case Report and Review of the Literature. Pediatr Neurosurg 2019; 54:132-138. [PMID: 30650412 DOI: 10.1159/000495834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
Cerebral vasospasm is associated with significant morbidity, and most commonly occurs following subarachnoid hemorrhage. Rarely, vasospasm can follow tumor resection and traumatic brain injury. We present the first reported case of a young child who developed diffuse vasospasm following open fenestration of an arachnoid cyst and was promptly treated, with full recovery of neurologic function. Although vasopasm after arachnoid cyst fenestration is rare, it can be included in the differential for a new focal neurologic deficit.
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Affiliation(s)
- Belinda Shao
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Matei A Banu
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA
| | - Jason J Carroll
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA
| | - Philip M Meyers
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA
| | - Sean D Lavine
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA
| | - Neil A Feldstein
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA.,Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA
| | - Richard C E Anderson
- Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, New York, USA, .,Morgan Stanley Children's Hospital of New York-Presbyterian, New York, New York, USA,
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Swaminathan G, Jonathan GE, Patel B, Prabhu K. Xanthogranulomatous colloid cyst of the third ventricle: Alter your surgical strategy. Neuroradiol J 2017; 31:47-49. [PMID: 28665178 DOI: 10.1177/1971400917703988] [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] [Indexed: 11/16/2022] Open
Abstract
Colloid cysts are the most common benign neoplasms of the anterior third ventricle, mostly located at the level of the foramen of Monro and can often manifest as sudden onset headache or loss of consciousness. These cysts often have a well-defined cyst wall, mucinous or watery intracystic fluid and have a fairly good plane with the surrounding parenchyma. Occasionally, intracystic haemorrhage can lead to xanthogranulomatous inflammatory changes within the cyst resulting in focal thickening of the cyst wall and adhesion to the surrounding structures. Here we describe a case of xanthogranulomatous colloid cyst which is a very rare variant of colloid cyst.
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Affiliation(s)
| | | | - Bimal Patel
- 2 Department of Neuropathology Christian Medical College, India
| | - Krishna Prabhu
- 1 Department of Neurological Sciences, Christian Medical College, India
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Spoor JKH, Aben HP, Burhani B, Rutten GJ. Delayed ischaemia due to vasospasm after fenestration of a large arachnoid cyst. Br J Neurosurg 2017; 33:287-289. [PMID: 28617059 DOI: 10.1080/02688697.2017.1340583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
An 18-year-old patient developed multiple infarcts, nine days after endoscopic fenestration of a large arachnoid cyst. We consider vasospasm to be the most likely cause, presumably triggered by a chemical meningitis. Although mostly seen after subarachnoid haemorrhage, vasospasm can also occur after traumatic brain injury, brain surgery or meningitis.
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Affiliation(s)
- Jochem K H Spoor
- a Department of Neurosurgery , St Elisabeth - Tweesteden Hospital , Tilburg , The Netherlands.,b Department of Neurosurgery , Erasmus MC , Rotterdam , The Netherlands
| | - Hugo P Aben
- c Department of Neurology , St Elisabeth - Tweesteden Hospital , Tilburg , The Netherlands
| | - Bachtiar Burhani
- a Department of Neurosurgery , St Elisabeth - Tweesteden Hospital , Tilburg , The Netherlands
| | - Geert-Jan Rutten
- a Department of Neurosurgery , St Elisabeth - Tweesteden Hospital , Tilburg , The Netherlands
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9
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Intra-arterial vasodilator therapy for parainfectious cerebral vasospasm. J Neurol Sci 2014; 340:225-9. [DOI: 10.1016/j.jns.2014.02.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 11/23/2022]
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10
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Alugolu R, Chandrasekhar YBVK, Shukla D, Sahu BP, Srinivas BH. Xanthogranulomatous colloid cyst of the third ventricle. J Neurosci Rural Pract 2013; 4:183-6. [PMID: 23914099 PMCID: PMC3724301 DOI: 10.4103/0976-3147.112761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Colloid cyst in the third ventricle is a common entity, whereas a variant of it, namely xanthogranulomatous, is quite rare. The closest imaging differential diagnosis is a purely third ventricular craniopharyngioma. We herein describe a case of xanthogranulomatous colloid cyst presenting with hydrocephalus.
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Affiliation(s)
- Rajesh Alugolu
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India
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