Infratentorial Arachnoid Cysts in Children

Rocco, Concezio Di; Caldarelli, Massimo; Trapani, G. Di

doi:10.1159/000119973

Cited by 43 publications

(44 citation statements)

References 4 publications

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“…However, headaches may return in 5 to 25% of patients because of cyst reaccumulation. 10,17,25 Upfront CP shunt insertion has been proposed in patients with concomitant or resultant hydrocephalus 2, [6][7][8]26 (based on reports of high reaccumulation rates following fenestration 6 ) as well as in those with arachnoid cystrelated ventriculomegaly that fails to resolve after cyst fenestration. Cystoperitoneal shunt placement remains an appealing option given the simplicity of the surgical technique involved and the availability of intraoperative guidance via ultrasonography or neuronavigation, but complications inherent to all CSF drainage systems must be considered.…”

Section: Discussionmentioning

confidence: 99%

Arachnoid cysts: case series and review of the literature

Pradilla¹,

Jallo²

2007

FOC

216

159

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Object Arachnoid cysts are commonly encountered fluid collections in the central nervous system. Recent advances in neuroimaging have translated into an increased detection of these cysts; that is, diagnoses can be made more frequently at earlier stages. Significant advances have also been made in the surgical management of these lesions. The authors report on a case series that illustrates the diverse forms of presentation and the treatment modalities commonly used for arachnoid cysts. Methods Between January 2002 and December 2006, 20 patients with arachnoid cysts underwent surgery performed by the senior author at The Johns Hopkins Hospital. Seventy percent of the cysts were supratentorial, 5% infratentorial, and 25% spinal. All diagnoses were confirmed on neuroimaging, surgery, and histological examination. Included in the study were 12 male (60%) and eight female (40%) patients, ranging in age from 2 weeks to 39 years (mean age 10.9 years) at the time of surgery. Symptoms at presentation included headache (41%), weakness (23%), seizure (14%), hydrocephalus (9%), scoliosis (4%), cognitive decline (4%), and visual loss (4%). Twenty-five percent of the cysts were sylvian, 20% intraventricular, and 20% suprasellar. Supratentorial cysts were treated endoscopically in 73% of patients and with open resection in the remaining 27%. Complications included spasticity, hemiparesis, cerebrospinal fluid leak, hydrocephalus, and subdural hygroma. On follow-up evaluation, 60% of patients had stable cysts and improved symptoms, 13% complete symptom resolution, and 13% stable symptoms. All patients with spinal cysts underwent laminectomies and fenestration, and one cystosubarachnoid (CS) shunt was placed. Cyst reaccumulation occurred in three patients; two patients required cystoperitoneal (CP) and CS shunts. No deaths occurred. Conclusions Most arachnoid cysts are found incidentally and can be managed conservatively. Symptomatic patients are surgical candidates. Treatments include CP shunt placement, craniotomy, or endoscopic fenestration, and stereotactic aspiration. Recent advances in neurosurgical techniques and neuroendoscopy continue to favor fenestration over shunt insertion as the method of choice for initial cyst decompression.

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Section: Discussionmentioning

confidence: 99%

Arachnoid cysts: case series and review of the literature

Pradilla¹,

Jallo²

2007

FOC

216

159

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“…Incarceration of ectopic tissue in form of a secretory organ or choroid plexus may rarely develop from embryonic rests, 3,21,22,25,29,35) impeding the free circulation of the fluid. 22) The congenital origin 6,10) is indicated by the presence of ependymal tissue on the cyst wall and functional failure of outlets of the fourth ventricle accompanied by congenital scoliosis, basilar impression, and syringomyelia, 11) and/or aqueductal stenosis, agenesis of corpus callosum, deficient cerebellar lobulation, Chiari 1 malformation, arteriovenous malformation, 28) and/or absent septum pellucidum. Infratentorial arachnoid cysts can be intraarachnoid, subarachnoid, or subdural.…”

Section: Discussionmentioning

confidence: 99%

“…10) Ultrastructural differences between the cyst walls and the normal arachnoid mater support the developmental Arachnoid Cyst of the Quadrigeminal Cistern origin. 6,29) Discrimination is difficult when the structure includes both pia mater and ependyma. Microscopic studies of the cyst wall revealed flattened mesothelial cells arranged in single or multiple layers and occasional arachnoid nests lining the inner surface of the fine layer of collagen fiber.…”

Section: Discussionmentioning

confidence: 99%

“…3,9) However, the aqueduct stenosis may remain occult in adults, resulting in normal pressure hydrocephalus (NPH). 1,20,32) Defective CSF absorption mechanisms 6) or the blockade of outflow may contribute to NPH as well. 10) Long duration, 10,22) the episodic course of symptoms, 10) and postural influences 22,35) are characteristic in adults.…”

Section: Discussionmentioning

confidence: 99%

“…6,34) Infratentorial arachnoid cyst may occur in five locations: Midline cerebellum, lateral (or hemispheric) retrocerebellum, cerebellopontine angle, clivus, and quadrigeminal cistern. Retrocerebellar and cerebellopontine angle cysts are decidedly more common.…”

Section: Introductionmentioning

confidence: 99%

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Unusual Arachnoid Cyst of the Quadrigeminal Cistern in an Adult Presenting With Apneic Spells and Normal Pressure Hydrocephalus. Case Report.

Topsakal

Kaplan

Erol

et al. 2002

Neurol. Med. Chir.(Tokyo)

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A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 × 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 × 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. Patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.

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Arachnoid Cysts of the Posterior Fossa

Carvalho¹,

Hinojosa²

2008

Samii's Essentials in Neurosurgery

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Infratentorial Arachnoid Cysts in Children

Cited by 43 publications

References 4 publications

Arachnoid cysts: case series and review of the literature

Arachnoid cysts: case series and review of the literature

Unusual Arachnoid Cyst of the Quadrigeminal Cistern in an Adult Presenting With Apneic Spells and Normal Pressure Hydrocephalus. Case Report.

Arachnoid Cysts of the Posterior Fossa

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