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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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Nisson PL, Quintero-Consuegra MD, Lekovic GP. Arachnoid Cyst of the Cerebellopontine Angle: A Systematic Literature Review. World Neurosurg 2024; 182:e675-e691. [PMID: 38070740 DOI: 10.1016/j.wneu.2023.12.018] [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: 07/06/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE The role of surgical management of arachnoid cyst (AC) of the cerebellopontine angle (CPA) is uncertain. This topic has remained controversial with varying contradictory recommendations in the literature, which is limited to mostly case reports. We aimed to provide a comprehensive summary and analysis of symptoms, operative techniques, outcomes, and recurrence of all available surgical cases of AC of the CPA to date. METHODS A systematic literature search was performed in May 2022 querying several scientific databases. Inclusion criteria specified all studies and case reports of patients with AC located at the CPA for which any relevant surgical procedures were performed. RESULTS A total of 55 patients from the literature and 5 treated at our institution were included. Mean patient age was 29 years (range, 0.08-79 years), with nearly twice (1.7×) as many female as male patients (37 female, 22 male). Headaches (35%), hearing loss (30%), vertigo (22%), and ataxia (22%) were the most common presentations. Following surgery, 95% experienced symptom improvement, with complete resolution in 64%. Of patients with hearing loss, 44% reported a return to normal. The rate of mortality was 1.69%, and 10% of tumors recurred (mean follow-up 2.3 years [range, 0-15 years]. CONCLUSIONS Symptomatic AC of the CPA is rare. It exhibits a proclivity for females and commonly manifests with headache, hearing loss, vertigo, and ataxia. While careful selection for surgical candidacy is needed and intervention should be reserved for patients with severe symptoms, surgical decompression is an effective tool for symptom alleviation and recovery.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Neurosurgery, House Institute, Los Angeles, California, USA
| | | | - Gregory P Lekovic
- Department of Neurosurgery, House Institute, Los Angeles, California, USA.
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Lee JH, Holste KG, Selzer BJ, Garton HJL, Muraszko KM, Maher CO. Sports Participation and Sports-Related Neurologic Injuries in Pediatric Patients With Arachnoid Cysts. Neurosurgery 2023; 93:979-985. [PMID: 37199501 DOI: 10.1227/neu.0000000000002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/01/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Currently, there is no consensus recommendation regarding the safety of sports participation for pediatric patients with arachnoid cysts (ACs). OBJECTIVE To prospectively survey patients with ACs to define the risk of sports-associated neurologic injury in untreated and treated patients. METHODS A prospectively administered survey was given to all patients diagnosed with an AC who presented to a single pediatric neurosurgery clinic between December 2010 and December 2021. Data were recorded on demographic information, imaging characteristics, treatment, sports participation, and presence of sports-related neurologic injury. The type and date of surgery for the AC were noted if surgery was performed. RESULTS Of the 303 patients with completed surveys, 189 patients participated in sports, and 94 patients had prospective data available. There was no significant difference in cyst location or Galassi score between patients who did and did not participate in contact vs noncontact sports and those who did and did not experience a concussion. A cumulative total of 2700.5 seasons of sports were played (2499.7 in untreated and 200.8 in treated patients). There were 44 sports-related concussions among 34 patients: 43 in untreated patients and 1 in a treated patient. For all participants, the concussion rate was 16.3 per 1000 seasons of all sports and 14.8 per 1000 seasons of contact sports. The concussion rate after AC treatment was 4.9 per 1000 seasons of all sports. Three patients experienced sports-related AC rupture or hemorrhage, none of which required surgery or resulted in lasting neurologic symptoms or deficits. CONCLUSION The rates of sports-related concussion and cyst rupture in patients with AC in both treated and untreated populations were low. We advocate for a generally permissive posture toward sports participation in this population.
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Affiliation(s)
- Johan H Lee
- School of Medicine, University of Michigan, Ann Arbor , Michigan , USA
| | - Katherine G Holste
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Bela J Selzer
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Hugh J L Garton
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor , Michigan , USA
| | - Cormac O Maher
- Department of Neurosurgery, Stanford University, Stanford , California , USA
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De Novo Intraneural Arachnoid Cyst Presenting with Complete Third Nerve Palsy: Case Report and Literature Review. World Neurosurg 2017; 98:873.e27-873.e31. [DOI: 10.1016/j.wneu.2016.11.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022]
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Gurkas E, Altan BY, Gücüyener K, Kolsal E. Cerebellopontine angle arachnoid cyst associated with mirror movements. J Pediatr Neurosci 2016; 10:371-3. [PMID: 26962347 PMCID: PMC4770653 DOI: 10.4103/1817-1745.174440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Arachnoid cysts are benign developmental collections of cerebrospinal fluid (CSF). They constitute approximately 1% of intracranial masses. The cerebellopontine angle (CPA) arachnoid cysts are rare and often asymptomatic. The onset of symptoms and signs is usually due to the compression of the brain, cranial nerves and obstruction of CSF circulation. The major clinical symptoms for CPA arachnoid cysts were reported as headache, ataxia and 8th cranial nerve palsy. We report a patient with a CPA arachnoid cyst. He presented with cranial nerve palsies and mirror movements found in upper extremities. We postulated that CPA arachnoid cyst compressing the brain stem and the pyramidal decussation may lead to mirror movements. We conclude that mirror movements can be associated with CPA arachnoid cyst.
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Affiliation(s)
- Esra Gurkas
- Department of Pediatric Neurology, Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Kıvılcım Gücüyener
- Department of Pediatric Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ebru Kolsal
- Department of Pediatric Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Tunes C, Flønes I, Helland C, Goplen F, Wester KG. Disequilibrium in patients with posterior fossa arachnoid cysts. Acta Neurol Scand 2015; 132:23-30. [PMID: 25335644 DOI: 10.1111/ane.12340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Arachnoid cysts (AC) are benign, congenital malformations of the leptomeninges. In our experience, dizziness and vertigo are common complaints in patients with such cysts. OBJECTIVE To quantify dizziness and imbalance in patients with arachnoid cysts in the posterior fossa using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short-Form (VSS-SF) and Computerized Dynamic Posturography (CDP). We also wanted to investigate whether any dizziness and imbalance are reversible after surgical cyst decompression. METHODS The study includes four patients with AC in the posterior fossa (two in the cerebellopontine angle and two supracerebellar in the midline) and 15 control subjects undergoing ENT surgery for benign lesions of the larynx (n = 10) or the parotid glands (n = 5). All participants answered the DHI and VSS-SF and underwent CDP the day before, and at follow-up after surgery. The AC patients also graded their dizziness through the use of a Visual Analogue Scale (VAS). RESULTS Preoperatively, cyst patients scored higher than controls on subjective symptoms (DHI, VSS-SF A and VSS-SF V) and had a lower score on postural sway (CDP). Symptom scores decreased after surgery; the cyst patients improved in the subjective tests (DHI, VAS and VSS-SF), and three of the patients improved their CDP scores. In the controls, symptom and CDP scores were unchanged after surgery. CONCLUSION Patients with fossa posterior cyst had a significant preoperative impairment compared with the controls, and they exhibited post-operative improvement in their subjective dizziness.
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Affiliation(s)
- C. Tunes
- Department of Clinical Medicine K1; University of Bergen; Bergen Norway
| | - I. Flønes
- Department of Clinical Medicine K1; University of Bergen; Bergen Norway
| | - C. Helland
- Department of Clinical Medicine K1; University of Bergen; Bergen Norway
- Department of Neurosurgery; Haukeland University Hospital; Bergen Norway
| | - F. Goplen
- Department of Otorhinolaryngology, Head and Neck Surgery; Haukeland University Hospital; Bergen Norway
| | - K. G. Wester
- Department of Clinical Medicine K1; University of Bergen; Bergen Norway
- Department of Neurosurgery; Haukeland University Hospital; Bergen Norway
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Messerer M, Dubourg J, Hamlat A. Cerebellopontine angle cyst. J Neurosurg Pediatr 2011; 8:335; author reply 335-6. [PMID: 21882929 DOI: 10.3171/2011.5.peds11134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Olaya JE, Ghostine M, Rowe M, Zouros A. Endoscopic fenestration of a cerebellopontine angle arachnoid cyst resulting in complete recovery from sensorineural hearing loss and facial nerve palsy. J Neurosurg Pediatr 2011; 7:157-60. [PMID: 21284461 DOI: 10.3171/2010.11.peds10281] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebellopontine angle arachnoid cysts are usually asymptomatic, but are frequently found incidentally because of increased use of neuroimaging. Nevertheless, as these cysts enlarge, they may compress surrounding structures and cause neurological symptoms. Patients may present with vague, nonspecific symptoms such as headache, nausea, vomiting, and vertigo. Cranial nerve palsies, including sensorineural hearing loss and facial weakness, although rare, have also been reported in association with posterior fossa arachnoid cysts. Although surgery for these entities is controversial, arachnoid cysts can be treated surgically with open craniotomy for cyst removal, fenestration into adjacent arachnoid spaces, shunting of cyst contents, or endoscopic fenestration. Reversal of sensorineural hearing loss following open craniotomy treatment has been described in the literature in only 1 adult and 1 pediatric case. Improvement in facial weakness has also been reported after open craniotomy and arachnoid cyst fenestration. The authors report the first case of complete recovery from sensorineural hearing loss and facial weakness following endoscopic fenestration in a patient with a cerebellopontine angle arachnoid cyst.
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Affiliation(s)
- Joffre E Olaya
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
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Ortiz-Prado E, Natah S, Srinivasan S, Dunn JF. A method for measuring brain partial pressure of oxygen in unanesthetized unrestrained subjects: the effect of acute and chronic hypoxia on brain tissue PO(2). J Neurosci Methods 2010; 193:217-25. [PMID: 20817029 DOI: 10.1016/j.jneumeth.2010.08.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/19/2010] [Accepted: 08/23/2010] [Indexed: 10/19/2022]
Abstract
The level of tissue oxygenation provides information related to the balance between oxygen delivery, oxygen utilization, tissue reactivity and morphology during physiological conditions. Tissue partial pressure of oxygen (PtO(2)) is influenced by the use of anesthesia or restraint. These factors may impact the absolute level of PtO(2). In this study we present a novel fiber optic method to measure brain PtO(2). This method can be used in unanesthetized, unrestrained animals, provides absolute values for PO(2), has a stable calibration, does not consume oxygen and is MRI compatible. Brain PtO(2) was studied during acute hypoxia, as well as before and after 28 days of high altitude acclimatization. A sensor was chronically implanted in the frontal cortex of eight Wistar rats. It is comprised of a fiber optic probe with a tip containing material that fluoresces with an oxygen dependent lifetime. Brain PtO(2) declines by 80% and 76% pre- and post-acclimatization, respectively, when the fraction of inspired oxygen declines from 0.21 to 0.08. In addition, a linear relationship between brain PtO(2) and inspired O(2) levels was demonstrated r(2)=0.98 and r(2)=0.99 (pre- and post-acclimatization). Hypoxia acclimatization resulted in an increase in the overall brain PtO(2) by approximately 35%. This paper demonstrates the use of a novel chronically implanted fiber optic based sensor for measuring absolute PtO(2). It shows a very strong linear relationship in awake animals between inspired O(2) and tissue O(2), and shows that there is a proportional increase in PtO(2) over a range of inspired values after exposure to chronic hypoxia.
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Affiliation(s)
- E Ortiz-Prado
- Department of Radiology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Chen HH, Chen CK. Arachnoid cyst presenting with sudden hearing loss. J Chin Med Assoc 2010; 73:338-40. [PMID: 20603095 DOI: 10.1016/s1726-4901(10)70073-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 04/23/2010] [Indexed: 10/19/2022] Open
Abstract
Arachnoid cysts can occur at different intracranial sites, including the cerebellopontine angle (CPA). They often occur in childhood, in the posterior fossa. They may present with symptoms such as dizziness, tinnitus and hearing loss, or they may be asymptomatic. Presentation with sudden deafness is very rare. We report the unusual presentation of a 67-year-old male with CPA arachnoid cyst and the complaint of sudden-onset deafness. In this case, the cystic lesion at the CPA was found by magnetic resonance imaging of the brain. Pathology after retromastoid suboccipital craniotomy confirmed an arachnoid cyst. The treatment of this patient is discussed and the possible causes of CPA arachnoid cyst are briefly reviewed.
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Affiliation(s)
- Hsuan-Ho Chen
- Department of Otolaryngology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
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Aubry K, Wassef M, Guichard JP, Herman P, Tran Ba Huy P. Association d’un kyste arachnoïdien et d’une hétérotopie de tissu glial dans le méat auditif interne. ACTA ACUST UNITED AC 2009; 126:133-7. [DOI: 10.1016/j.aorl.2009.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Accepted: 03/02/2009] [Indexed: 11/29/2022]
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Arachnoid Cyst Causing Third Cranial Nerve Palsy Manifesting as Isolated Internal Ophthalmoplegia and Iris Cholinergic Supersensitivity. J Neuroophthalmol 2008; 28:192-7. [DOI: 10.1097/wno.0b013e318183c57c] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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