Causes of arachnoid cyst development and expansion

Basaldella, Luca; Orvieto, Enrico; Tos, Angelo Paolo Dei; Barbera, Mila Della; Valente, Marialuisa; Longatti, Pierluigi

doi:10.3171/foc.2007.22.2.4

Cited by 65 publications

(39 citation statements)

References 11 publications

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“…Though the possibility of coexistence of this association being incidental cannot be ruled out, it can have a causal relationship and further support the congenital theory explaining the origin of arachnoid cyst due to its occurrence with epidermoid cysts which are congenital lesions as we have seen in the present case [4]. The importance of being aware of such an association is also clinically relevant as the management, outcome and prognosis vary between arachnoid and epidermoid cysts [9,10,11,12]. DWI helped us to diagnose this rare association and should be performed in any extra-axial lesion of the brain to unravel such an association [6].…”

Section: Discussionmentioning

confidence: 57%

“…The pathogenesis of arachnoid cysts, however, is controversial [9]. Numerous theories have been proposed explaining the origin of arachnoid cysts: (1) a ball-valve mechanism, (2) an osmotic gradient between the intra- and extracystic medium, (3) primary congenital malformation of the arachnoid membrane and (4) hypersecretive fluid production by cells lining the luminal cyst’s wall [9]. Both of these can mimic each other and can be difficult to distinguish radiologically on CT scans.…”

Section: Discussionmentioning

confidence: 99%

“…Intracranial epidermoid tumors are congenital cystic lesions arising from epithelial inclusions at the time of neural tube closure during the third to fifth week of gestation [4]. The pathogenesis of arachnoid cysts, however, is controversial [9]. Numerous theories have been proposed explaining the origin of arachnoid cysts: (1) a ball-valve mechanism, (2) an osmotic gradient between the intra- and extracystic medium, (3) primary congenital malformation of the arachnoid membrane and (4) hypersecretive fluid production by cells lining the luminal cyst’s wall [9].…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Middle Fossa Arachnoid Cyst and Ambient Cistern Epidermoid Cyst: Case Report and Endoscope-Assisted Microsurgical Management

et al. 2010

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Simultaneous occurrence of dual intracranial pathology is very rare. Most of such reported cases occur in the setting of a genetic or hereditary predisposing condition like neurofibromatosis. Though some cases of coexistence of multiple intracranial pathologies have been reported, occurrence of an arachnoid and epidermoid cyst in the same patient has never been reported. A 16-year-old boy was referred to us with a diagnosis of left temporal arachnoid cyst. Careful review of the MRI showed the presence of 2 different signal intensities with restricted diffusion in the cyst in the ambient cistern and normal diffusion in the cyst anterior to the temporal tip suggesting the presence of an arachnoid cyst adjacent to an epidermoid cyst which was managed using endoscope-assisted microsurgical transcranial surgery. The possibility of such an association could be explained based on the congenital origin of both lesions. Diffusion-weighted imaging can be invaluable in unraveling such a relationship.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Simultaneous Middle Fossa Arachnoid Cyst and Ambient Cistern Epidermoid Cyst: Case Report and Endoscope-Assisted Microsurgical Management

et al. 2010

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“…Arachnoid cysts are thought to form from a ball-valve mechanism of fluid through a congenital or traumatic arachnoid defect, an osmotic gradient between the intra-and extra-cystic space, or a malformation causing trapped fluid within the arachnoid membranes or to develop secondary to hypersecretive fluid production by cells in the cyst wall. 5 …”

Section: Discussionmentioning

confidence: 99%

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Griessenauer¹,

Bauer²,

Moore

et al. 2014

SPI

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Object Various pathologies involving the thoracic arachnoid mater uniformly manifest as thoracic myelopathy and may present a significant management dilemma. The authors undertook this study to assess outcome in cases of thoracic myelopathy due to thoracic arachnoid pathology. Methods The authors have cared for and followed 28 patients with thoracic myelopathy from thoracic arachnoid pathology over the last 17 years. A chart review and contemporary follow-up of these patients was performed and outcomes were reported. Results Patients with thoracic myelopathy from thoracic arachnoid pathology often have improvement in their condition after surgical decompression/detethering procedures. While not universal, patients in this series had improvement in mJOA scores at 1 year after surgery (p = 0.0001) and at last follow-up (p = 0.04). Results indicated that across a wide variety of pathologies the extent of thoracic spinal cord involvement is a predictor of the disease course and outcome. Comparison of the group of patients with cord involvement limited to 2 vertebral segments (short-segment pathology) versus the group with cord tethering of more than 2 segments (long-segment pathology) showed that patients in the short-segment group more frequently had ventral or dorsal arachnoid bands (p = 0.003), more frequently had signal change in the cord on MRI (p = 0.02), and less frequently presented with a syrinx (p = 0.02), and a smaller percentage of patients in this group underwent reoperation (p = 0.02). While patients with short-segment pathology typically improved after a single operative intervention, patients with long-segment pathology typically improved after multiple operations, frequently for CSF diversion. Conclusions Thoracic arachnoid pathology causing thoracic cord dysfunction and myelopathy is varied, has multiple etiologies, and can be difficult to treat over the long term. Surgical management, when indicated, is case specific. Serial long-term follow-up is essential to document enduring clinical and radiographic success.

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“…The combination of the presence of excessive amounts of CSF in the subarachnoid space and an impaired CSF dynamics would lead, in the long-term, to the dissection between the congenitally split arachnoid layers ultimately leading to expansion of the cysts due to a unidirectional slit-valve mechanism. 4,14 The fact that the incidence of bilateral arachnoid cysts in children with previous diagnoses of benign extracerebral fluid collections in infancy found in the present study was higher than that of previous series of arachnoid cysts in the general population suggests that, at least in the subpopulation presenting with benign extracerebral fluid collection in infancy, the development of arachnoid cysts appears to be related to a more general process of impaired CSF absorption (the "second-hit" of the proposed pathophysiological scheme) rather than only to localized congenital defects in the embryological development of the meninges.…”

mentioning

confidence: 99%

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

Mattei¹,

Bond²,

Sambhara³

et al. 2013

PED

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Object Intracranial arachnoid cysts are a relatively common benign intracranial pathology, accounting for as many as 0.75%–1% of nontraumatic CNS lesions. Although it has already been demonstrated that rupture of arachnoid cysts may lead to subdural hematomas/hygromas, no study to date has investigated benign extracerebral collection in infancy as a possible predisposing factor for further development of arachnoid cysts. Methods The authors performed a retrospective imaging and chart review of macrocephalic infants 12 months old or younger who were referred to neurosurgical care at OSF St. Francis Medical Center from 2003 to 2010, and who were diagnosed with benign extracerebral fluid collection in infancy on thin-slice (1-mm) head CT scans. Special attention was given to the investigation of risk factors for further development of de novo arachnoid cysts. Several epidemiological factors in the infants and mothers were analyzed, including gestational age at delivery, mode of delivery, mother's age at delivery, delivery complications, birth weight, age of macrocephaly development, degree of macrocephaly, family history of macrocephaly, prenatal and postnatal history of infection, fontanel status, presence of papilledema, previous history of head trauma, and smoking status. Imaging characteristics of the initial scans, such as location of subdural collection (frontal vs frontoparietal and frontotemporal) and presence of ventriculomegaly, were also evaluated. For those patients in whom arachnoid cysts were identified on subsequent CT scans, the size and location of the cysts were also analyzed. Results The authors identified 44 children with benign extracerebral fluid collection in infancy. From this group, over a mean follow-up of 13 months (range 6–13 months), 18 children developed intracranial arachnoid cysts (a 40.9% incidence of de novo development of arachnoid cysts), with 27.8% presenting with bilateral cysts. In the multiple logistic regression analysis, infants who presented with an extracerebral collection restricted to the bilateral frontal region were more likely to develop intracranial arachnoid cysts (p = 0.035) than those with collections involving the frontotemporal and frontoparietal regions (odds ratio [OR] = 5.73). Additionally, children with benign extracerebral fluid collections and plagiocephaly were more likely to develop intracranial arachnoid cysts (p = 0.043) than those without plagiocephaly (OR = 4.96). Conclusions This is the first report in the neurosurgical literature demonstrating that benign extracerebral fluid collections in infancy may constitute a significant risk factor for development of de novo arachnoid cysts. These findings support a 2-hit hypothesis for the development of arachnoid cysts, in which the combination of an embryological defect in arachnoid development followed by a second event leading to impairment of CSF fluid absorption in early childhood could lead to abnormal CSF dynamics and the consequent expansion of fluid collections in the intraarachnoid spaces.

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Causes of arachnoid cyst development and expansion

Cited by 65 publications

References 11 publications

Simultaneous Middle Fossa Arachnoid Cyst and Ambient Cistern Epidermoid Cyst: Case Report and Endoscope-Assisted Microsurgical Management

Simultaneous Middle Fossa Arachnoid Cyst and Ambient Cistern Epidermoid Cyst: Case Report and Endoscope-Assisted Microsurgical Management

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

Benign extracerebral fluid collection in infancy as a risk factor for the development of de novo intracranial arachnoid cysts

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