Endoscopic Treatment of Temporal Arachnoid Cysts in 34 Patients

Couvreur, Tim; Hallaert, Giorgio; Heggen, Tatjana Van Der; Baert, Edward; Dewaele, Frank; Okito, Jean-Pierre Kalala; Vanhauwaert, Dimitri; Deruytter, Marc J.; Roost, Dirk Van; Caemaert, Jacques

doi:10.1016/j.wneu.2015.04.053

Cited by 40 publications

(19 citation statements)

References 38 publications

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“…On the other hand, many authors have reported excellent results after surgical intervention [3,4,12,13,20,22]. Good seizure control was gained after surgical interference in 63-90% of patients, as was the case in our patient [12,23].…”

Section: The Role Of Surgery In the Treatment Of Iacsupporting

confidence: 66%

Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature

Broekx

Vandevenne

Weyns

2020

SN Compr. Clin. Med.

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Intracranial arachnoid cysts (IACs) are benign, slow-growing developmental anomalies. In 4-14% of cases, IACs are accompanied by seizures. Since most cysts do not cause any symptoms, many lesions remain clinically silent and are found incidentally. As these lesions are slow-growing, they can become symptomatic over time and may give rise to epileptic seizures. Since IAC localization and seizure focus do not always coincide, a unifying theory between IACs and epileptogenesis is still lacking. We present a case of a 49-year old man who presented himself as a result of a first tonic-clonic insult. No major risk factors nor antecedents in his medical history were present. MRI confirmed a voluminous cystic lesion at the transition of motor cortex and supplementary motor area. Due to the large volume (with risk of cyst rupture) and compatible clinical, radiographic, and electroencephalographic features, cyst fenestration through craniotomy was performed. Epileptic seizures were resolved completely after this procedure. IACs are not uncommon and are frequently encountered incidentally in patients who present with epilepsy. Some authors have been classifying this association as rather exceptional. However, we illustrated a case in which excellent surgical results were obtained in a patient with focal epilepsy in which both clinical and electroencephalographic features were compatible with arachnoid cyst localization. Therefore, in patients with no other identifiable causes for epilepsy, thorough evaluation should be performed and surgical intervention should be considered. We developed a flowchart in order to guide clinicians in the appropriate approach of these patients. Therefore, this summary could serve as a scaffold for future highquality studies concerning this topic.

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Section: The Role Of Surgery In the Treatment Of Iacsupporting

confidence: 66%

Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature

Broekx

Vandevenne

Weyns

2020

SN Compr. Clin. Med.

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“…Previous reports by Couvreur et al [9] have shown the efficacy of endoscopic technology through fenestration of cysts via transcranial neuroendoscopy. They claimed seizure control in a third of patients with TLE.…”

Section: Discussionmentioning

confidence: 97%

Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy

Saffarian

Derakhshan

Taghipour

et al. 2019

Iran. J. Neurosurg.

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Background and Importance: Arachnoid cysts are developmental cystic lesions which may be found as an incidental finding on neuroimaging or present with symptoms of headache, seizure and neurologic deficit. Presentation with seizure is more common with larger sizes and temporal location. Presentation with Temporal Lobe Epilepsy (TLE) is rare, and fenestration of cysts has variable results for seizure control. We reported controlling TLE symptoms following endoscopic transsphenoidal fenestration of an arachnoid cyst. The anteromedial location in middle fossa, extension toward sphenoid sinus and normal appearance of mesial temporal structures on MRI encouraged us to consider this surgical approach.Case Presentation: A 26-year-old patient with a 13-year history of TLE with uncontrolled symptoms despite taking a combination of AEDs (LTG, CBZ, LEV, CLB) was referred to our clinic. Neuroimaging revealed an arachnoid cyst in anteromedial part of temporal fossa which extended to sphenoid sinus, but showed no abnormality in mesial temporal structures. Endoscopic endonasal transsphenoidal fenestration of the arachnoid cyst was performed, and followed by reconstruction of the skull base. The procedure improved the seizure control during the 9-month follow-up and no sign of radiologic recurrence was observed. Conclusion:Transsphenoidal endoscopic fenestration is a safe and feasible surgical approach for treatment of symptomatic arachnoid cysts in anteromedial part of middle fossa especially when they extend toward lateral wall of sphenoid sinus. This surgical corridor has the privilege of avoiding cortical injury accompanied by transcranial approaches, which is deleterious in epileptic patients. Citation: Saffarian A, Derakhshan N, Taghipour M, Faramarzi M, Asadipooya AA, Dehghanian AR, Eghbal K. Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy Iran J Neurosurg. 2019; 5(2):93-98. http://dx.

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“…16 Best outcomes after endoscopic treatment are seen in temporal lobe cysts especially those presenting with macrocrania, acute neurologic deficits, or temporal lobe seizures. 17 Though radiologic success is not proven to correlate with clinical success, cyst reduction rates after endoscopic procedure has been reported to vary from 75 to 97%. [18][19][20] Microsurgical excision of the cyst, needless to say, provides a wider exposure of the cyst wall.…”

Section: Discussionmentioning

confidence: 99%

Experience with Management of Intracranial Arachnoid Cysts

Deopujari

Shaikh

Karmarkar

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objectives The aim of this study was to analyze the demographics, clinical presentation, and surgical outcome of intracranial arachnoid cysts and to review the surgical options. Methods This is a retrospective observational study of 56 cases of symptomatic arachnoid cysts among all age groups treated between 2004 and 2020 at the Bombay Hospital, Mumbai. Endoscopic fenestration, microsurgical cyst excision, and shunt insertion were the interventions performed. Clinical presentation, cyst reduction post-intervention, and complications were studied. The follow-up period varied from 1 month to 16 years. Statistical analysis was done for 43 patients with a minimum of 3 years' follow-up. Results In all, 75% of patients were <18 years of age. Of these, the majority were between the age of 1 and 10 years. There were 14 cases of temporal, 13 cases of retrocerebellar, 10 cases of quadrigeminal cistern, and 7 cases each of interhemispheric and suprasellar arachnoid cysts. The most common clinical presentation was headache and vomiting. Concomitant hydrocephalus was seen on imaging in 24 cases. Endoscopic fenestration of cyst was the most routinely performed procedure (35 cases). Four patients of endoscopic fenestration underwent a redo endoscopic procedure on follow-up. Post-operative reduction in cyst size was found to be significantly better after endoscopic fenestration (p < 0.05). Conclusion Though the best available treatment for arachnoid cysts remains controversial, surgery has been found to be beneficial in symptomatic cases. Endoscopic fenestration is considered the first-line surgical option and it may be followed by shunt, if necessary. Shunts may be preferred in very young children where there is associated hydrocephalus/macrocephaly.

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Endoscopic Treatment of Temporal Arachnoid Cysts in 34 Patients

Cited by 40 publications

References 38 publications

Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature

Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature

Endoscopic Transsphenoidal Fenestration of a Medial Temporal Arachnoid Cyst With Extension to Sphenoid Sinus in a Patient With Temporal Lobe Epilepsy

Experience with Management of Intracranial Arachnoid Cysts

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