Arachnoid cyst: adversity ans plasticity

Abstract

-We report four cases of surgically treated intracranial arachnoid cysts, one with cyst-peritoneal shunt and three with craniotomy and arachnoid membrane resection. Their classification and etiopathogeny are discussed, and especially the different methods of treatment comparing the drastic complications (adversities) with the favorable solutions in severe clinical cases (plasticity) treated at our institution.KEY WORDS: arachnoid cyst, shunt, intracerebral hemorrhage, brain plasticity, craniotomy, endoscopy. Cisto aracnóideo: adversidade e plasticidadeRESUMO -Apresentamos revisão da classificação dos cistos de aracnóide, etiopatogenia e diferentes formas de tratamento em relação às complicações drásticas (adversidade) e às soluções favoráveis (plasticidade) em casos graves, tratados na instituição de origem. Foram tratados quatro casos através de derivação cistoperitoneal ou craniotomia extensa com ressecção da membrana cística, sempre analisados de acordo com a gravidade dos sintomas, localização e extensão da lesão. PALAVRAS-CHAVE: cisto aracnóideo, derivação, hemorragia intracerebral, plasticidade cerebral, craniotomia, endoscopia.The arachnoid cyst consists of a fluid collection covered by a membrane similar to arachnoid, located between the arachnoid and the piamater 1,2 . The congenital arachnoid cyst or primary cyst should be differentiated from other congenital or acquired abnormalities which range from prosencephalic cyst, dilated cisterns, loculations of the subarachnoid space secondary to brain traumatism, hemorrhage or inflammatory processes 2-8 . The heterogeneous cysts are denominated secondary cysts. Arachnoid cysts represent approximately 1% of the intracranial expansive lesions 9 . The origin of the arachnoid cyst is probably related to an abnormal development of the arachnoid, which can divide or duplicate itself 10,11 . Structural features of the arachnoid cyst wall is different from the normal arachnoid membrane 12 . Its symptoms are very diverse, such as headaches, epilepsy, hydrocephaly, intracranial hypertension, macrocephaly, calvarium proeminence, cranial nerves palsies, vertigo, discrete proptosis, hemiparesis, mental retardation or even be asymptomatic. The arachnoid cyst of the middle fossa, the most frequent, is generally discovered in patients under the age of 20, however, it can be found at any age 9 . It is much more common and also more frequent in diagnosed males on the left side. The clinical picture in elderly patients is similar to that of chronic subdural hematoma or normal pressure hydrocephalus, usually in form of dementia, hemiparesis, ataxia, bladder incontinence or gait disturbances 13 .We present a review of the cysts classification , etiopathogeny, different methods of treatment in addition to the drastic complications (adversities) and the favorable solutions in severe clinical cases (plasticity), treated at the institution of origin.

Near Reflex Paresis - A Rare Presentation of Arachnoid Cyst

“…It is more common in males and on the left side. 5 MRI is the diagnostic procedure of choice because of its ability to demonstrate investigation the exact location, extent, and relationship of the arachnoid cyst to adjacent brain or spinal cord. The near reflex or accommodation reflex is characterised by pupillary constriction to sharpen the J image on the retina, convergence of optic axis and increased convexity of the lens to increase its refractive power.…”

Cisto aracnoide: relato de caso

“…De acordo com Faleiro 3 e Borges 4 respectivamente, sua prevalência continua evidente em adolescentes com até duas décadas de vida e é mais comum e frequente serem diagnosticados no sexo masculino, em especial, no lado esquerdo, o que corrobora com o caso descrito. Por ser uma patologia praticamente assintomática, bem como sua relação como um achado clínico, como afirma Castro 5 , nos dias atuais, a avaliação clínica requer certas medidas para verificar se é necessária a remoção cirúrgica.…”

“…Além disso, também, afirmaram que os cistos são envoltos por várias camadas de células da membrana aracnoide reforçadas por fibras colágenas e preenchidas por liquido semelhante ao líquor. Seus sintomas, segundo Borges 4 , são diversos, como cefaleias, epilepsia, hidrocefalia, hipertensão intracraniana, macrocefalia, proeminência calvariana, paralisia dos nervos cranianos, vertigo, proptose discreta, hemiparesia, retardo mental ou em sua maioria, assintomático. No entanto, para Castro 5 , é conhecida a propensão de ocorrer hemorragias no interior dos cistos.…”

Arachnoid Cyst: An Asymptomatic Exuberance

“…The signs and symptoms vary according to their size and location. Arachnoid cysts may present as asymptomatic incidental neuroimaging findings, generally small cysts, or provoking severe headaches, seizures, hydrocephaly, intracranial hypertension, cranial nerves palsies, vertigo, proptosis, hemiparesis, and mental status changes due to mass effect caused by larger cysts [1,2]. Arachnoid cysts may have a fast evolution.…”