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Jaja PT, Yuri YA, Sufianov AA. Neuroendoscopic cysto-cisternostomy for middle cranial fossa arachnoid cysts: a systematic review of the practice principles from 169 cases. J Neurosurg Sci 2024; 68:482-491. [PMID: 38949058 DOI: 10.23736/s0390-5616.24.06240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Arachnoid cysts are primarily dysembryogenetic splitting or duplication of the embryonic meningeal mesenchyme, hence the paediatric preponderance. Neuroendoscopic cysto-cisternostomy is now the favoured treatment option. We pooled data on middle fossa arachnoid cysts (MCFAC) demographics, clinical presentations, cyst characteristics, neuro-endoscopic cysto-cisternostomy and its outcomes. EVIDENCE ACQUISITION Using search words (from the keywords; 'endoscopic treatment' and 'middle fossa arachnoid cysts') combined using Boolean operators, a systematic review of the PubMed and Cochrane CENTRAL was started on 1st February 2023, as per protocol (PROSPERO CRD42023394345); 65 records and then 46 reports were screened, 169 cases were pooled from the 19 recruited reports for the qualitative and quantitative syntheses, after methodological assessment (significantly excellent 57.9% quality) using the Joanna Briggs Institute critical appraisal tools. EVIDENCE SYNTHESIS The male-to-female ratio was 2.4:1, with a weighted average-age of 11.25 years in the modal childhood (32.0%) age-group. Headaches (53/29.3%), seizures (30/16.6%) and macrocephaly (25/13.8%) were the commonest presentations. Right-sided (30/55.6%) and Galassi II (55/48.3%) and III (53/46.5%) lesions were common. Rigid (124/93.9%) endoscopes aided cysto-cisternostomy using mostly bipolar diathermy (31/43.7%) and ventriculostomy forceps (18/25.4%); creating one (22/18.3%), two (14/11.6%) or more (78/65.0%) stomas. Fenestration sites were specifically CNIII&ICA (32/25.8%), CNII&ICA (27/21.8%), CNIII&tentorium cerebelli (23/18.6%), CNIII&PCA (1/0.8%) and through the side of CNVI (1/0.8%) into the pre-pontine cistern. Good clinical and radiological outcomes were reported. CONCLUSIONS Largely excellent-to-good quality, low-level evidence reported MCFACs presenting in childhood with headaches, seizures and macrocephaly. At least two fenestrations using bipolar-diathermy/forceps and balloon-catheter expansion were used for cysto-cisternostomy, with good outcomes.
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Affiliation(s)
- Promise T Jaja
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russia -
- Directorate of Medical and Dental Services, Rivers State Hospitals' Management Board, Port Harcourt, Nigeria -
- Department of Pediatric Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russia -
| | - Yakimov A Yuri
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Pediatric Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russia
| | - Albert A Sufianov
- Department of Neurosurgery, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Pediatric Neurosurgery, Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, People's Friendship University, Moscow, Russia
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Sarigecili E, Bilen S, Gokay SS, Ucar HKOC, Dilek O. Optic nerve ultrasonography in the evaluation of the relationship between arachnoid cyst and headache. Childs Nerv Syst 2022; 38:1573-1579. [PMID: 35460353 DOI: 10.1007/s00381-022-05535-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/16/2022] [Indexed: 11/25/2022]
Abstract
AIM This study is aimed to show the difference between optic nerve sheath diameter (ONSD) values in migraine patients with and without arachnoid cysts from migraine patients and control groups, and to evaluate the relationship with the arachnoid cyst size on magnetic resonance imaging (MRI) and their clinical severity. METHODS This cross-sectional study included pediatric patients who were previously diagnosed with migraine and the control group. The patients consist of 3 groups. The first group was 24 patients with arachnoid cysts on brain magnetic resonance imaging (MRI) who met the diagnostic criteria for migraine (group 1); the second group was 20 patients with only headache without arachnoid cysts or other findings on brain magnetic resonance imaging (MRI) (group 2); the third group was completely healthy 20 control group. Demographic data of the patients, the onset of headache time, clinical severity, electroencephalography (EEG) findings, optic nerve sheath diameter (ONSD) measurements by ultrasonography, and the volume of arachnoid cyst on brain MRI were determined and compared. RESULTS The optic nerve sheath diameter (ONSD) value was the highest in group 1 and the lowest in the control group (p: 0.001). The clinical severity was statistically different between the groups (p: 0.038). Accordingly, the majority of the clinical severity of group 1 was determined in grades 3 and 4. A weak positive correlation was found between the arachnoid cyst size on MRI and the ONSD measurement (r = 0.410, p = 0.047). The ONSD value statistically significantly increased with clinical severity in group 1 (p: 0.003). CONCLUSION The reliability of the optic nerve sheath diameter (ONSD) measurements in determining the increase of the intracranial pressure was shown in previous studies. This is the first study in the literature presenting that the intracranial pressure effects of arachnoid cysts can be demonstrated by ONSD. We have considered that arachnoid cysts detected in headaches can create a compression effect and cause the pain to intensify.
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Affiliation(s)
- Esra Sarigecili
- Department of Pediatric Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey.
| | - Sevcan Bilen
- Department of Pediatric Emergency, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Sinem Sari Gokay
- Department of Pediatric Emergency, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Habibe K O C Ucar
- Department of Pediatric Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Pérez-Pereda S, Madera J, González-Quintanilla V, Drake-Pérez M, Marzal Espí CN, Serrano Munuera C, García SC, Aguilella Linares C, Fernández Recio M, Velamazán Delgado G, Pascual J. Is conventional brain MRI useful for the diagnosis of cluster headache in patients who meet ICHD-3 criteria? Experience in three hospitals in Spain. J Neurol Sci 2021; 434:120122. [PMID: 34979370 DOI: 10.1016/j.jns.2021.120122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/24/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the frequency of symptomatic structural lesions and the diagnostic yield of conventional brain MRI in cluster headache (CH). BACKGROUND In contrast to migraine, brain MRI is recommended in patients with CH to exclude potential mimics. The prevalence of symptomatic CH is not known. METHODS We retrospectively analysed in detail the brain MRIs of patients diagnosed as CH in 3 Neurology Services in Spain and reviewed their clinical history. Clinical diagnoses were reassessed based on the ICHD-3 criteria. RESULTS We included 130 patients: 113 (86.9%) were male; mean age at diagnosis being 41.4 years (range 7-82). Forty-nine (37.7%) showed some abnormal MRI finding. Only in two cases potential symptomatic lesions were found: one trigeminal schwannoma and one craneopharyngioma, but both presented atypical features (facial hypoesthesia on examination and episodes of prolonged duration that had progressed to continuous refractory pain without specific pattern, respectively) and therefore did not fulfil the ICHD-3 CH criteria. The remaining abnormal MRI findings were: white matter lesions (24 patients; 18.4%), sinus inflammatory changes (13; 10.0%), small arachnoid cysts (5; 3.8%), empty sella turca (3; 2.3%), and other unspecific findings (8; 6.2%). All of them were not symptomatic based on neuroimaging characteristics, clinical course and response to treatment. CONCLUSIONS Brain MRI in patients who meet ICHD-3 CH criteria, with no atypical clinical features, does not show any clinically-relevant findings, suggesting that these criteria are highly predictive of its primary origin and that systematic MRI is not useful for the diagnosis of typical CH.
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Affiliation(s)
- Sara Pérez-Pereda
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Jorge Madera
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Vicente González-Quintanilla
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain
| | - Marta Drake-Pérez
- Service of Radiology, University Hospital Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | - Silvia Cusó García
- Service of Neurology, Fundació Hospital Sant Joan de Déu, Martorell, Barcelona, Spain
| | | | | | | | - Julio Pascual
- Service of Neurology, University Hospital Marqués de Valdecilla, University of Cantabria and IDIVAL, Santander, Spain.
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Long RJ, Zhu YS, Wang AP. Cluster headache due to structural lesions: A systematic review of published cases. World J Clin Cases 2021; 9:3294-3307. [PMID: 34002138 PMCID: PMC8107893 DOI: 10.12998/wjcc.v9.i14.3294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/21/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cluster headache (CH) is a severe incapacitating headache disorder. By definition, its diagnosis must exclude possible underlying structural conditions.
AIM To review available information on CLH caused by structural lesions and to provide better guides in the distinguishing process and to ensure that there is not a potentially treatable structural lesion.
METHODS We conducted a systematic review of 77 published cases of symptomatic CH and cluster-like headache (CLH) in PubMed and Google Scholar databases.
RESULTS Structural pathologies associated with CH were vascular (37.7%), tumoral (32.5%) and inflammatory (27.2%). Brain mass-like lesions (tumoural and inflammatory) were the most common diseases (28.6%), among which 77.3% lesions were at the suprasellar (pituitary) region. Cases of secondary CH related to sinusitis rose dramatically, occupying 19.5%. The third most common disease was internal carotid artery dissection, accounting for 14.3%. Atypical clinical features raise an early suspicion of a secondary cause: Late age at onset and eye and retroorbital pains were common conditions requiring careful evaluation and were present in at least one-third of cases. Abnormal neurological examination was the most significant red flag for impaired cranial nerves. CLH patients may be responsive to typical CH treatments; therefore, the treatment response is not specific. CLH can be triggered by contralateral structural pathologies. CLH associated with sinusitis and cerebral venous thrombosis required more attention.
CONCLUSION Since secondary headache could perfectly mimick primary CH, neuroimaging should be conducted in patients in whom primary and secondary headaches are suspected. Cerebral magnetic resonance imaging scans is the diagnostic management of choice, and further examinations include vessel imaging with contrast agents and dedicated scans focusing on specific cerebral areas (sinuses, ocular and sellar regions). Neuroimaging is as necessary at follow-up visits as at the first observation.
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Affiliation(s)
- Ru-Jin Long
- Emergency Medicine Center, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - You-Sheng Zhu
- Emergency Medicine Center, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
| | - An-Ping Wang
- Emergency Medicine Center, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230000, Anhui Province, China
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Hadidchi S, Surento W, Lerner A, Liu CSJ, Gibbs WN, Kim PE, Shiroishi MS. Headache and Brain Tumor. Neuroimaging Clin N Am 2019; 29:291-300. [DOI: 10.1016/j.nic.2019.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Trigeminal autonomic cephalalgias (TACs) are primary headache syndromes that share some clinical features such as a trigeminal distribution of the pain and accompanying ipsilateral autonomic symptoms. By definition, no underlying structural lesion for the phenotype is found. There are, however, many descriptions in the literature of patients with structural lesions causing symptoms that are indistinguishable from those of idiopathic TACs. In this article, we review the recent insights in symptomatic TACs by comparing and categorizing newly published cases. We confirm that symptomatic TACs can have typical phenotypes. It is of crucial importance to identify symptomatic TACs, as the underlying cause will influence treatment and outcome. Our update focuses on when a structural lesion should be sought.
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Affiliation(s)
- Ilse F de Coo
- Department of Neurology Leiden University Medical Centre, Leiden, The Netherlands,
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Robin AM, Pabaney AH, Mitsias PD, Schwalb JM. Further evidence for a pain pathway involving the cingulate gyrus: a case of chronic cluster headache cured by glioblastoma. Stereotact Funct Neurosurg 2015; 93:194-8. [PMID: 25833317 DOI: 10.1159/000380957] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
The authors report a case of a 49-year-old man with long-standing, chronic cluster headache (CH) refractory to medical therapy and occipital nerve stimulation that resolved a few weeks prior to the diagnosis of glioblastoma involving primarily the right cingulate gyrus. An attempt to explore the underlying role of the cingulate cortex in pain modulation by appraising the current literature is presented. This report suggests that the cingulate gyri could be a potential target for neuromodulation in patients with medically refractory chronic CH.
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Affiliation(s)
- Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Mich., USA
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Abstract
"Do I have a tumor?" This is a question in every person's mind when first confronted with a new-onset headache, a question that causes considerable anxiety among patients, leading them to seek medical evaluation. This publication reviews the current literature with respect to the epidemiology, pathophysiology presentation, and treatment of headaches in association with intracranial neoplasm.
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Eidlitz-Markus T, Zeharia A, Haimi Cohen Y, Konen O. Characteristics and Management of Arachnoid Cyst in the Pediatric Headache Clinic Setting. Headache 2014; 54:1583-90. [DOI: 10.1111/head.12470] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Tal Eidlitz-Markus
- Pediatric Headache Clinic; Department of Ambulatory Day Care Hospitalization; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avi Zeharia
- Pediatric Headache Clinic; Department of Ambulatory Day Care Hospitalization; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yishai Haimi Cohen
- Pediatric Headache Clinic; Department of Ambulatory Day Care Hospitalization; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Osnat Konen
- Department of Pediatric Radiology; Schneider Childen's Medical Center of Israel; Petach-Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Edvardsson B. Symptomatic cluster headache: a review of 63 cases. SPRINGERPLUS 2014; 3:64. [PMID: 24570848 PMCID: PMC3928394 DOI: 10.1186/2193-1801-3-64] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/28/2014] [Indexed: 11/25/2022]
Abstract
Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. Symptomatic cases have been described, for example tumours, dissections and infections, but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases. The proper diagnostic evaluation of cluster headache is an issue unresolved. The literature has been reviewed for symptomatic cluster headache or cluster headache-like cases in which causality was likely. The review also attempted to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging. Sixty-three cluster headache or "cluster headache-like"/"cluster-like headache" cases in the literature were identified which were associated with an underlying lesion. A majority of the cases had a non-typical presentation that is atypical symptomatology and abnormal examination (including Horner’s syndrome). A striking finding in this appraisal was that a significant proportion of CH cases were secondary to diseases of the pituitary gland or pituitary region. Another notable finding was that a proportion of cluster headache cases were associated with arterial dissection. Even typical cluster headaches can be caused by structural lesions and the response to typical cluster headache treatments does not exclude a secondary form. It is difficult to draw definitive conclusions from this retrospective review of case reports especially considering the size of the material. However, based on this review, I suggest that neuroimaging, preferably contrast-enhanced magnetic resonance imaging/magnetic resonance angiography should be undertaken in patients with atypical symptomatology, late onset, abnormal examination (including Horner’s syndrome), or those resistant to the appropriate medical treatment. The decision to perform magnetic resonance imaging in cases of typical cluster headache remains a matter of medical art.
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Affiliation(s)
- Bengt Edvardsson
- Department of Clinical Sciences Lund, Faculty of Medicine, Neurology, Skane University Hospital, S-221 85, Lund, Sweden
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