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Bridges J, Brougham J, Terrell D, Whipple S, Lee S. Posterior fossa microcystic meningioma mimicking an arachnoid cyst. Radiol Case Rep 2024; 19:1284-1287. [PMID: 38292808 PMCID: PMC10825519 DOI: 10.1016/j.radcr.2023.12.065] [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: 10/25/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Microcystic meningioma is an uncommon subtype of World Health Organization grade 1 meningiomas often associated with a shorter progression-free survival. Diagnosis through imaging alone can often be challenging due to atypical characteristics, especially when found in unexpected locations. Here, we present a 55-year-old woman who was diagnosed, based on imaging, with a posterior fossa arachnoid cyst 5 years prior after complaints of headaches and gait imbalance. After surgical resection of the "arachnoid cyst," the diagnosis of microcystic meningioma was made. This case report emphasizes the clinical importance and challenges associated with diagnosing microcystic meningiomas.
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Affiliation(s)
- James Bridges
- School of Medicine, LSU Health Shreveport , Shreveport, LA, USA
| | - Jared Brougham
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Danielle Terrell
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Stephen Whipple
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Sungho Lee
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
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Peng P, Chen Z, Xu Y, Dong F, Wan F. Growing and symptomatic intracranial arachnoid cyst in an elderly patient: a case report and literature review. Br J Neurosurg 2023; 37:1220-1222. [PMID: 33258701 DOI: 10.1080/02688697.2020.1836326] [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: 06/17/2020] [Accepted: 10/08/2020] [Indexed: 10/22/2022]
Abstract
We report an elderly patient with a symptomatic and growing arachnoid cyst. Physician should be cautious in counseling asymptomatic arachnoid cyst patients, regardless of their age, and inform them of the possibility, although rare, of growth and symptom development even in their late life.
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Affiliation(s)
- Peng Peng
- Department of Neurosurgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430030, PR China
| | - Zirong Chen
- Department of Neurosurgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430030, PR China
| | - Yu Xu
- Department of Neurosurgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430030, PR China
| | - Fangyong Dong
- Department of Neurosurgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430030, PR China
| | - Feng Wan
- Department of Neurosurgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jie Fang Avenue, Hankou, Wuhan, 430030, PR China
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Merola J, Manivannan S, Ooi S, Li Chia W, Makwana M, Lang J, Leach P, Zaben MJ. The efficacy of cystoperitoneal shunting for the surgical management of intracranial arachnoid cysts in the elderly: A systematic review of the literature. Surg Neurol Int 2022; 12:624. [PMID: 34992940 PMCID: PMC8720472 DOI: 10.25259/sni_463_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Intracranial arachnoid cysts (AC) are benign, cerebrospinal fluid filled spaces within the arachnoid layer of the meninges. Neurosurgical intervention in children and young adults has been extensively studied, but the optimal strategy in the elderly remains unclear. Therefore, we performed a single center retrospective study combined with a systematic review of the literature to compare cystoperitoneal (CP) shunting with other surgical approaches in the elderly cohort. Methods: Retrospective neurosurgical database search between January 2005 and December 2018, and systematic review of the literature using PRISMA guidelines were performed. Inclusion criteria: Age 60 years or older, radiological diagnosis of intracranial AC, neurosurgical intervention, and neuroradiological (NOG score)/clinical outcome (COG score). Data from both sources were pooled and statistically analyzed. Results: Our literature search yielded 12 studies (34 patients), which were pooled with our institutional data (13 patients). CP shunts (7 patients; 15%), cyst fenestration (28 patients; 60%) and cyst marsupialisation/resection (10 patients; 21%) were the commonest approaches. Average duration of follow-up was 23.6, 26.9, and 9.5 months for each approach, respectively. There was no statistically significant association between choice of surgical intervention and NOG score (P = 0.417), COG score (P = 0.601), or complication rate (P = 0.955). However, CP shunting had the lowest complication rate, with only one patient developing chronic subdural haematoma. Conclusion: CP shunting is a safe and effective surgical treatment strategy for ACs in the elderly. It has similar clinical and radiological outcomes but superior risk profile when compared with other approaches. We advocate CP shunting as first line neurosurgical intervention for the management of intracranial ACs in the elderly.
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Affiliation(s)
- Joseph Merola
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton General Hospital, Southampton General Hospital, Southampton, United Kingdom
| | - Setthasorn Ooi
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, University Hospital of Wales, United Kingdom
| | - Wen Li Chia
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, University Hospital of Wales, United Kingdom
| | - Milan Makwana
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Jozsef Lang
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Paul Leach
- Department of Neurosciences, University Hospital of Wales, Cardiff, United Kingdom
| | - Malik J Zaben
- Department of Neurosurgery, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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Gregori F, Colistra D, Mancarella C, Chiarella V, Marotta N, Domenicucci M. Arachnoid cyst in young soccer players complicated by chronic subdural hematoma: personal experience and review of the literature. Acta Neurol Belg 2020; 120:235-246. [PMID: 31654391 DOI: 10.1007/s13760-019-01224-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/10/2019] [Indexed: 11/28/2022]
Abstract
Arachnoid cysts (ACs) are congenital intracranial benign cavities originating from the meninges during embryological development. Several studies have shown the existence of a relationship between AC and a higher risk to develop ipsilateral chronic subdural hematoma (CSH) especially in a young population. In the presence of an AC, the practice of sport activities may expose young patients to minor head trauma and to an increased risk of developing CSH. We describe three cases of young soccer players with AC associated with CSH. Then, we performed a literature review of all the reported cases in the literature of patients younger than 18 years with AC-associated CSH related to sport practice. A total of 33 cases, including the three cases reported by us, are analyzed. Soccer is the most represented sport activity in this association (39% of cases). The treatment of choice is surgical in all patients, with burr hole or craniotomy in similar proportions. In one-third of patients, the AC has been fenestrated. Outcome is good in all the reported cases. We reviewed the main pathogenic theories, the main surgical strategies described in literature, as well as recurrence rate of CSH, the association of AC and cranial deformities, and the clinical outcome. AC might be associated with skull deformities, but their real incidence remains unclear. The clinical detection of such anomalies should suggest performing further radiological investigations. If the presence of AC is confirmed, the practice of sport activities should not be avoided, as the real incidence of AC-associated CSH is not clear yet and the reported outcomes in literature are good. Surgical treatment of AC-associated CSH should be hematoma removal through burr hole, reserving AC fenestration only for cases with intracystic bleeding or recurrences. The surgeon should adequately advise and inform the young patients and their families that they could have an increased risk of developing CSH given by the presence of the AC, and that they should be referred to a neurosurgical center if they become symptomatic.
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Affiliation(s)
- Fabrizio Gregori
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
| | - Davide Colistra
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | | | - Vito Chiarella
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Nicola Marotta
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Maurizio Domenicucci
- Department of Human Neurosciences, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy
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A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults. World Neurosurg 2019; 123:e259-e272. [DOI: 10.1016/j.wneu.2018.11.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
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Mormont E, Dorban S, Gustin T. Parkinsonism and cognitive impairment due to a giant frontal arachnoid cyst and improving after shunting. Acta Neurol Belg 2017; 117:347-349. [PMID: 27023341 DOI: 10.1007/s13760-016-0632-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
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Clinical and radiological outcomes of surgical treatment for symptomatic arachnoid cysts in adults. J Clin Neurosci 2015; 22:1456-61. [DOI: 10.1016/j.jocn.2015.03.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 11/13/2022]
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Zafar N, Alaid A, Rohde V, Mielke D. Intermittent visual field defects caused by a dilated Virchow–Robin space close to the optic radiation: Therapeutic and pathomechanical considerations. Br J Neurosurg 2015; 29:549-51. [DOI: 10.3109/02688697.2015.1019417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rabiei K, Tisell M, Wikkelsø C, Johansson BR. Diverse arachnoid cyst morphology indicates different pathophysiological origins. Fluids Barriers CNS 2014; 11:5. [PMID: 24581284 PMCID: PMC4078003 DOI: 10.1186/2045-8118-11-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/03/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There are few, limited, and to some extent contradictory, reports on the cellular and subcellular morphology of arachnoid cysts. In the literature cyst membranes are described as similar to, or as vastly different from, normal arachnoid membranes. METHODS This paper reports electron microscopic analyses of symptomatic cysts from 24 patients (12 males and 12 females; age 10-79), that underwent fenestration surgery. Fourteen cysts were located in the middle cranial fossa (temporal), one in the interpeduncular cistern, five in the posterior fossa, and four were overlying the frontal cortex. RESULTS Microscopic findings confirmed the diverse nature of this clinical condition. Twelve cyst walls resembled normal arachnoid, four had a conspicuous core of dense fibrous tissue with a simple epithelial lining, and the remaining aberrant cysts exhibited non-arachnoid luminal epithelia with plentiful microvilli and/or cilia, and also nervous tissue components in the wall. The possible identity and origin of various cyst types are discussed. We hypothesize that cysts are formed mostly at an early stage of embryonic development, as a teratological event. CONCLUSIONS Cysts with various epithelial linings and extracellular components most likely have different barrier properties and fluid turnover characteristics. Further studies are needed to elucidate relations between cyst morphology, fluid composition, pathogenesis, and clinical behaviour including growth rate and relapse tendency.
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Affiliation(s)
- Katrin Rabiei
- Institute of Neuroscience and Physiology, c/o Neurosurgical Clinic, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden.
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