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Cavallaro J, Singha S, Chakrabarti B, Gopalakrishnan E, Harshan M, Pramanik BK, McKeown A, Boockvar JA. Symptomatic infratentorial ependymal cyst arising from the medulla: a case report with review of literature. Neurochirurgie 2024; 70:101553. [PMID: 38547561 DOI: 10.1016/j.neuchi.2024.101553] [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: 10/01/2023] [Revised: 02/08/2024] [Accepted: 03/19/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Ependymal cysts (EC) typically present supra-tentorially near the lateral ventricle, juxta ventricular, or temporoparietal regions. Previous cases have also identified infratentorial EC of the brainstem, cerebellum, and subarachnoid spaces. They are mostly asymptomatic. In this paper, we present the first-ever case of a symptomatic medullary ependymal cyst treated with surgery, along with a comprehensive review of the literature on EC of other parts of the brain stem. CASE DESCRIPTION This 51-year-old female presented with hearing loss, dizziness, diplopia, and ataxia. Radiographic imaging indicated the presence of a non-enhancing lesion in the medulla with a mass effect on the brainstem. Pathological examination confirmed its characterization as an ependymal cyst. The patient underwent a suboccipital craniotomy for the fenestration of the medullary ependymal cyst under neuro-navigation, Intra-op ultrasound and intra-operative neuro-monitoring. Histopathological examination confirmed the diagnosis of an ependymal cyst. At one month follow-up, her KPS is 90, ECOG PS 1, and her ataxia has improved with complete resolution of diplopia. CONCLUSION Due to their rarity and potential similarity to other cystic structures, EC may be overlooked or incorrectly diagnosed resulting in mismanagement and surgical disaster. Therefore, a comprehensive understanding and awareness of their distinct characteristics are essential for accurate diagnosis and appropriate management.
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Affiliation(s)
- Julianna Cavallaro
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Souvik Singha
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Bhaskar Chakrabarti
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Eswar Gopalakrishnan
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Manju Harshan
- Department of Pathology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Bidyut Kumar Pramanik
- Department of Neuroradiology, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - Amy McKeown
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
| | - John A Boockvar
- Department of Neurosurgery, Lenox Hill Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
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Sato K, Suzuki K, Nakano Y, Murakami Y, Saito T, Yamamoto J. Neuroendoscopic cyst fenestration for delayed enlargement of perianeurysmal cyst formation through long-term follow-up after endovascular treatment: A case report and review of literature. Surg Neurol Int 2024; 15:189. [PMID: 38974552 PMCID: PMC11225393 DOI: 10.25259/sni_308_2024] [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: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 07/09/2024] Open
Abstract
Background Perianeurysmal cyst formation after endovascular treatment of cerebral aneurysms is a rare complication; however, the number of reports has gradually increased in recent years due to the development of several endovascular treatments. Case Description We present a case of delayed perianeurysmal cyst enlargement 8 years after endovascular treatment for multiple recurrences of a large cerebral aneurysm in the anterior communicating artery. The patient presented with obstructive hydrocephalus caused by an enlarged perianeurysmal cyst. The patient underwent cyst fenestration using neuroendoscopy and ventriculoperitoneal shunting, recovered from the clinical symptoms, and had a good prognosis. Histopathological findings showed that the cyst wall contained a fibrotic layer under the monoependymal layer with hemosiderosis without evidence of neovascularization or inflammatory cell infiltration. These findings suggest that the origin of the perianeurysmal cyst wall is not the aneurysm itself but the adjacent brain tissue. Conclusion Perianeurysmal cysts can develop during long-term follow-up, and clinicians should consider surgical treatment, including cyst fenestration, using neuro-endoscopy if the cyst presents with clinical symptoms.
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Affiliation(s)
- Koichiro Sato
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yu Murakami
- Department of Radiology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Takeshi Saito
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Hou C, Liu Y, Li F, Zhang Q. Cerebellar ependymal cyst: a case report. Front Neurosci 2024; 18:1372410. [PMID: 38633267 PMCID: PMC11022958 DOI: 10.3389/fnins.2024.1372410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
Rationale Intracranial ependymal cysts are relatively rare. The current case report focuses on a patient who was diagnosed with an ependymal cyst and underwent surgical treatment. Postoperative pathological examination confirmed the presence of this lesion in the cerebellum. Chief complaint A 32-year-old female patient presented with a chief complaint of dizziness and headache with no triggers for the past 1 year. She also reported an increase in the frequency and intensity of symptoms in the past 2 weeks. Diagnosis Cranial magnetic resonance imaging (MRI) showed a rounded long T1 and T2 abnormal signal foci in the left posterior part of the brainstem under the cerebellar pallidum. The lesion had a clear boundary, was approximately 4.0 × 3.1 × 3.2 cm in size, and did not exhibit any definitive enhancement. Interventions Total resection of the lesion was carried out after completion of the preoperative examination.Treatment outcomes. The patient was discharged from the hospital on postoperative day 11 once their symptoms had disappeared. The sensory and motor functions of the limbs remained unaffected by treatment. Experiences Cerebellum ependymal cysts are rare, and most patients only experience discomfort due to cerebral edema. These lesions are also often difficult to differentiate from other intracranial cysts using imaging alone. The aim of this study was to report a rare case of ependymal cyst so that it may serve as a reference for diagnosis and treatment in the future.
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Affiliation(s)
- Chengye Hou
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Yuanqin Liu
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Feng Li
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Neurosurgery, Jinan, China
| | - Qinglu Zhang
- Department of Ultrasound Medicine, Shandong Provinicial Third Hospital, Shandong University, Jinan, Shandong, China
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Paulla Galdino Chaves J, Henrique Dallo Gallo B, Louise Gonçalves Souza e Silva N, Luvison Gomes da Silva L, Alberto Mattozo C. Intracranial ependymal cyst - A modern systematic review with a pathway to diagnosis. J Clin Neurosci 2022; 99:10-16. [DOI: 10.1016/j.jocn.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
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Kim E. Cerebellar Glioependymal Cyst. Brain Tumor Res Treat 2021; 9:31-34. [PMID: 33913270 PMCID: PMC8082285 DOI: 10.14791/btrt.2021.9.e6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Glioependymal cyst (GEC) is an uncommonly observed clinical entity in the posterior cranial fossa. A 36-year-old female with cystic lesion in the right cerebellum was hospitalized for evaluating headache and dizziness. Brain images showed a well-defined, ovoid mass adjacent to the fourth ventricle. After drainage and excision of the cyst, the patient became symptom free. Pathology examination disclosed low cuboidal epithelium and glial cells in the cyst wall. The radiological features, neurological manifestations, and the operations for GECs of the present localization are described in this short communication.
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Affiliation(s)
- El Kim
- Department of Neurosurgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
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Retrocerebellar Ependymal Cyst Presenting with Obstructive Hydrocephalus in an Infant. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1718777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractIntracranial ependymal cysts (ECs) are rare benign lesions. They are frequently asymptomatic and arise in the supratentorial regions. Retrocerebellar ECs is a rare location. We present a case of 3-months-old infant who developed obstructive hydrocephalus, bulging fontanel, and macrocephaly secondary to a retrocerebellar EC. Magnetic resonance imaging (MRI) showed a large retrocerebellar cyst that compressed the cerebellum and the brainstem, producing fourth ventricle outlet obstruction and supratentorial hydrocephalus. Microsurgical fenestration of the cyst to the obex of the fourth ventricle and a cystic wall biopsy were performed. The procedure improved supratentorial hydrocephalus, as well as the patient's clinical condition. A histopathological study confirmed the diagnosis of an EC.As far as we know, after a thorough review of the literature, this is the first reported case of retrocerebellar EC. It is a rare cause of hydrocephalus due to outlet obstruction of the fourth ventricle. Treatment of the cause itself was shown to be effective.
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Ding HT, Han Y, Sun DK, Nie QM. Efficacy and safety profile of neuroendoscopic hematoma evacuation combined with intraventricular lavage in severe intraventricular hemorrhage patients. Brain Behav 2020; 10:e01756. [PMID: 32810378 PMCID: PMC7507080 DOI: 10.1002/brb3.1756] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The present study was conducted to explore the effect of neuroendoscopic hematoma evacuation in severe intraventricular hemorrhage (IVH). METHODS Totally 81 patients with severe IVH in our hospital from November 2017 to March 2019 were divided into the intervention group (38 cases who received neuroendoscopic hematoma evacuation combined with intraventricular lavage) and the control group (40 cases who received trepanation drainage). The perioperative condition, hematoma clearance rate, Glasgow coma score (GCS), hematoma recurrence rate, and prognosis were observed and compared between the two groups after treatment. RESULTS The operative time, time of cerebrospinal fluid drainage, and intracranial infection rate in the intervention group elicited superior results to those in the control group (p < .05). The clearance rate of hematoma in the intervention group was higher than that in the control group at 6 hr, 1, 3, and 7 days postoperatively (p < .05). The postoperative 3- and 7-day GCS scores in the intervention group were higher than those in the control group, and the recurrence rate of hematoma in the intervention group was significantly lower than that in the control group (p < .05), and the good/excellent rate of ADL in the intervention group was significantly higher than that in the control group (p < .05). CONCLUSION Neuroendoscopic hematoma evacuation combined with intraventricular lavage showed evident beneficial outcomes in patients with severe IVH. It can effectively improve the perioperative condition and improve the hematoma clearance rate and is beneficial to the prognosis of patients with severe IVH.
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Affiliation(s)
- Hai-Tao Ding
- Department of Neurosurgery, Linyi Central Hospital, Linyi, Shandong Province, China
| | - Yao Han
- Department of Neurosurgery, Linyi Central Hospital, Linyi, Shandong Province, China
| | - De-Ke Sun
- Department of Neurosurgery, Linyi Central Hospital, Linyi, Shandong Province, China
| | - Quan-Min Nie
- Department of Neurosurgery, Weifang People's Hospital, Weifang, Shandong Province, China
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Gankpé GF, Ndekha GJ, Okacha N, Chakour K, Chaoui MEF, Benzagmout M. Intracranial ependymal cyst with unusual presentation: Case report and review of literature. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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9
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Kwee RM, Kwee TC. Tumefactive Virchow-Robin spaces. Eur J Radiol 2019; 111:21-33. [DOI: 10.1016/j.ejrad.2018.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/01/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
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El Ahmadieh TY, Wolfe CB, Koueik J, Weprin BE, Iskandar BJ, Price AV. Intraventricular bone dust migration after neuroendoscopy: report of 2 cases. J Neurosurg Pediatr 2018; 22:578-583. [PMID: 30095348 DOI: 10.3171/2018.5.peds18152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 05/22/2018] [Indexed: 11/06/2022]
Abstract
Neuroendoscopy has demonstrated safety and efficacy in the treatment of a host of pediatric neurosurgical pathologies. With the increase in its applicability, several associated complications have been described in the literature. A common practice in pediatric neurosurgery is the use of Gelfoam sponge pledget in the burr hole, followed by bone fragments and dust (obtained from the created burr hole), to cover the dural defect. This technique is used to enhance burr hole sealing and potentially prevent CSF leakage from the surgical site. Reports on intracranial bone dust migration associated with this technique are scarce. The authors report 2 cases of intracranial migration of bone fragments after an endoscopic third ventriculostomy and an endoscopic colloid cyst resection. The bone fragment migration was thought to be caused by negative pressure from a lumbar puncture in one case and external trauma to the head in the other. As endoscopy becomes more widely used, it is important to be aware of this potential complication that may in some cases require an intervention. A review of the cases reported in the literature is provided and a technique is suggested to help prevent this complication.
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Affiliation(s)
- Tarek Y El Ahmadieh
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
| | - Cody B Wolfe
- 2Department of Neurological Surgery, School of Medicine, The University of Texas Southwestern, Dallas, Texas; and
| | - Joyce Koueik
- 3Department of Neurological Surgery, American Family Children's Hospital, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Bradley E Weprin
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
| | - Bermans J Iskandar
- 3Department of Neurological Surgery, American Family Children's Hospital, The University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Angela V Price
- 1Department of Neurological Surgery, Children's Medical Center, The University of Texas Southwestern, Dallas
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Intracranial glioependymal (neuroglial) cysts: a systematic review. Acta Neurochir (Wien) 2018; 160:1439-1449. [PMID: 29802560 DOI: 10.1007/s00701-018-3566-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Glioependymal cysts (GECs) are benign intracranial cysts that have been rarely reported in the literature. The exact pathogenesis of these developmental anomalies is controversial. Moreover, the terminology used to name GECs and other intracranial cysts is confusing because they are undistinguishably reported under a variety of names. The available information in the literature about GECs is scarce, and for this reason, a detailed description about these uncommon lesions is necessary. METHODS An illustrative case is presented; in addition, a PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with GECs. Different information was analyzed in these patients to describe the characteristics of this condition. In addition, different sources of literature were analyzed to complete the description of this clinical entity. RESULTS The literature review yielded 26 cases of patients with intracranial GECs showing a diversity of clinical manifestations. All studies were case reports or small case series. Different characteristics of GECs are described. Moreover, the authors suggest an updated classification of intracranial benign cysts. CONCLUSIONS The data collected from this review shows that GECs are rare and very often are erroneously named. They are congenital benign lesions with a neuroectodermal origin that share many radiological characteristics with a variety of intracranial benign cysts. The definite diagnosis of GECs is confirmed by the presence of a glial layer in the cyst wall at histological examination. The appropriate surgical technique should be selected according to the location of the cyst and its proximity to the ventricles or subarachnoid space.
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