The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension

Watane, Gaurav V; Patel, B. K.; Brown, Derek F. J.; Taheri, M. Reza

doi:10.1097/rct.0000000000000668

Cited by 30 publications

(24 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Headache was the most common symptom in Agarwal et al [13], Smith and Friedman [17], Watane and Patel [7], and Chagot et al [15], as it was found in 89.3%, 84%, 82.2%, and 82% of patients, respectively. The headache characteristics in this study were similar to those of patients in Friedman et al [18] because the most common headache phenotypes were migraine, accounting for 52%; followed by tension-like, accounting for 22%; and unclassified, accounting for 7% of their patients.…”

Section: Discussionmentioning

confidence: 86%

“…Two (6.3%) patients had visual acuity less than 1/60, one (3.1%) patient had bilateral ability to count fingers, and the other had no light perception in either eye. Watane and Patel [7] and Friedman et al [18] reported diminution of vision in 45.57% and 34% of their patients, respectively. Agarwal et al [13] had a high proportion of patients with poor visual acuity (less than 6/18) and diminution of vision at presentation (36% and 62%, respectively), while the percent was 72.7% in Saber et al [12].…”

Section: Discussionmentioning

confidence: 91%

“…IIH is rare in children [5,6]. The precise pathophysiology of IIH is unknown and is mainly related to a decrease in CSF drainage, a decrease in CSF absorption, and/or an increase in venous sinus pressure [7]. IIH is diagnosed by the modified Dandy criteria [8].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

et al. 2019

View full text Add to dashboard Cite

Objective: Assessment of visual field outcomes following the medical or surgical management of increased intracranial pressure in patients with idiopathic intracranial hypertension. Patient and methods: Thirty-two patients diagnosed with idiopathic intracranial hypertension who met all the modified Dandy criteria were included in this study. Magnetic resonance brain imaging with contrast and magnetic resonance venography were performed to exclude the presence of secondary causes of intracranial hypertension. Following normal neuroimaging, a lumbar puncture was performed for all patients with papilledema to measure the cerebrospinal fluid opening pressure. The assessment of visual function, including visual acuity, fundus examination (dilated fundus examination to confirm the presence and the grade of papilledema and to exclude the other ocular causes of optic disc swelling), and formal visual field assessment by perimetry when visual acuity was more than 1/60 were performed by the ophthalmologist before and after medical or surgical treatment. Results: Thirty-two patients were included, the majority of whom were females of childbearing age (29/32; 90.6%). All patients complained of headache. Visual assessment revealed the presence of blurry vision in all patients. Papilledema with different grades was observed in 31/32 (96.9%) patients, while the other patient (3.1%) showed optic atrophy; 30/ 32 (93.8%) patients had visual acuity ˃ 1/60. The average visual field was − 18 dB ± 9.97 SD in the right eye and − 19.47 dB ± 5.43 SD in the left eye. Twenty-nine patients received medical treatment in the form of acetazolamide, which succeeded in controlling idiopathic intracranial hypertension in 24/29 (82.7%) patients, while a theco-peritoneal shunt was inserted in 8/32 (25%) patients. After management, statistically significant improvements in cerebrospinal fluid opening pressure, presenting manifestation, visual acuity, and field were noticed. Conclusions: Permanent visual loss is the most feared complication of idiopathic intracranial hypertension; therefore, early diagnosis and multidisciplinary treatment are necessary to improve visual acuity and visual field.

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

et al. 2019

View full text Add to dashboard Cite

show abstract

“…3,11 Coexisting IIH also likely contributes to the skull base thinning. 3, 26 Bilateral CSF leaks or encephaloceles were more common in patients with PFDs, supporting the presence of a global process. However, our data did not demonstrate a statistically significant higher prevalence of elevated intracranial pressures, need for post-repair shunting, comorbid OSA, or greater BMIs among PFD patients.…”

Section: Discussionmentioning

confidence: 94%

Cerebrospinal Fluid Leaks of the Posterior Fossa: Patient Characteristics and Imaging Features

Yancey

Manzoor

Yawn

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Objectives The main purpose of this article is to investigate the prevalence and features of posterior fossa defects (PFD) in spontaneous cerebrospinal fluid leaks (sCSFL). Design Retrospective case series. Setting Tertiary skull base center. Participants Consecutive adults undergoing lateral skull base repair of sCSFL between 2003 and 2018. Main Outcome Measures The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma, or chronic ear disease were excluded. Results Seventy-one patients (74% female, mean age 56.39 ± 11.50 years) underwent repair of spontaneous lateral skull base leaks. Eight ears (7 patients, 11.1%) had leaks involving the posterior fossa plate in addition to defects of the tegmen mastoideum (50%), tegmen tympani (25%), or both (25%). Patients with PFDs more often had bilateral tegmen thinning on imaging (75%, odds ratio [OR]: 10.71, 95% confidence interval [CI]: 2.20–54.35, p = 0.005) and symptomatic bilateral leaks (OR: 9.67, 95% CI: 2.22–40.17, p = 0.01. All PFD patients had arachnoid granulations adjacent to ipsilateral mastoid cell opacification. However, this finding was often subtle and rarely included on the radiology report. There was no significant difference in body mass index, age, presenting complaints, or operative success between the PFD and isolated tegmen defect sCSFL cohorts. Conclusions The posterior fossa is an uncommon location for sCSFL. Careful review of preoperative imaging is often suggestive and can inform surgical approach. PFD patients are similar to those with isolated tegmen-based defects in presentation, comorbidities, and outcomes.

show abstract

“…Their corresponding lesions are usually located in the parasagittal area along the superior sagittal sinus, and occasionally at the transverse sinus. When the lesions grow beyond the inner table of the skull and involve the outer table, osteolytic lesions can be mistaken for tumorous lesions such as multiple myelomas, metastases, hemanigomas, dermoids, or epidermoids [ 2 3 4 ]. The accurate diagnosis of normal arachnoid granulations through radiologic findings may reduce rates of false diagnosis and unnecessary surgical biopsies.…”

Section: Introductionmentioning

confidence: 99%

Arachnoid Granulations Mimicking Multiple Osteolytic Bone Lesions in the Occipital Bone

Park

Hwang

2018

Brain Tumor Res Treat

View full text Add to dashboard Cite

We report a rare case of arachnoid granulations mimicking multiple osteolytic bone lesions. A 66-year-old woman was admitted to a local clinic for a regular checkup. Upon admission, brain CT showed multiple osteolytic lesions in the occipital bone. These needed to be differentiated from multiple osteolytic bone tumor. Subsequent brain MRI revealed that the osteolytic lesions were isointense to cerebrospinal fluid, hyperintense on T2-weighted image, hypointense on T1-weighted image, and with subtle capsules around the osteolytic lesions that were visible after gadolinium injection. A bone scan revealed no radiotracer uptake. The lesions were in both the transverse sinuses and the torcular herophili. With typical radiological appearances of the lesions, the osteolytic lesions were diagnosed as multiple arachnoid granulations. No further treatment was planned. A 1-year follow-up brain CT scan revealed no change. We should consider the possibility of arachnoid granulations when multiple osteolytic lesions are observed in the occipital bone.

show abstract

The Significance of Arachnoid Granulation in Patients With Idiopathic Intracranial Hypertension

Abstract: The study establishes that there is a relationship between presence of AG and IIH. Arachnoid granulation seems to act in a compensatory mechanism in patients with IIH.

Cited by 30 publications

References 13 publications

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

“Benign intracranial hypertension” is a misleading name for a more serious disease: analysis of the visual outcome in cases with idiopathic intracranial hypertension

Cerebrospinal Fluid Leaks of the Posterior Fossa: Patient Characteristics and Imaging Features

Arachnoid Granulations Mimicking Multiple Osteolytic Bone Lesions in the Occipital Bone

Contact Info

Product

Resources

About