Post-traumatic intradiploic leptomeningeal fistula and cyst

Açıkgöz, Bektaş; Tekkök, İsmail H.

doi:10.1054/jocn.2002.1066

Cited by 25 publications

(29 citation statements)

References 18 publications

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“…11 The thick musculature covering the occiput was thought to prevent the erosion of the outer table, allowing considerable expansile growth. 7 In our case report, our hypothesis is that CSF communication was established between the Dandy-Walker cyst to the occipital diploic space through the surgically created dural and inner table defect. The disconnected VP shunt resulted in increased pressure on the Dandy-Walker cyst as well as in the ventricular system, facilitating the egress of CSF around the occluded catheter of the cystoperitoneal shunt into the diploic space and increasing cyst growth.…”

Section: Discussionmentioning

confidence: 73%

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Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Sato¹,

Moritani²,

Hitchon³

2008

AJNR Am J Neuroradiol

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SUMMARY: We report a rare and unique complication of ventriculoperitoneal (VP) shunt malfunction. A progressively expansile, CSF-containing occipital intradiploic cyst developed in a 15-year-old boy at the site of cystoperitoneal shunt draining a Dandy-Walker cyst; the shunt was placed when the boy was 4 years old. A proposed pathogenesis of the lesion is discussed. Many complications of ventriculoperitoneal (VP) shunts have been previously described from common complications (eg, tube disconnection/obstruction, infection, and intraperitoneal CSF pseudocyst) to more esoteric ones (eg, bowel perforations, pleural effusions, shunt migration to the heart, and extrusion into or through the anus/vagina/scrotum).1,2 We report the case of a 15-year-old boy with a previous medical history including a diagnosis of a Dandy-Walker cyst with hydrocephalus, which required a VP shunt at age 6 months and a posterior fossa Dandy-Walker cystoperitoneal shunt connecting to the VP shunt through a Y connector at age 4 years. At 15 years old, the boy had an asymptomatic large, expansile, intradiploic occipital cyst containing CSF as a result of a disconnected VP shunt tube in the chest wall and an occluded intracranial catheter of the posterior fossa cystoperitoneal shunt. Case ReportThe reported patient is a 15-year-old boy who presented for a VP shunt evaluation before trying out for a football team. At age 6 months, the patient was diagnosed with a Dandy-Walker cyst and had a VP shunt placed for relief of his hydrocephalus. At age 4 years, the patient experienced progressive headaches and projectile vomiting and was found to have a disconnected shunt. MR imaging examination showed an enlarging Dandy-Walker cyst with compression of the brain stem and cerebellum. A cystoperitoneal shunt was placed, which was connected to the repaired VP shunt via a Y connector (Fig 1). At the time of surgery, it was found that the Dandy-Walker cyst was under pressure.When the patient presented for a football pregame check-up at age 15 years, he was asymptomatic and denied any signs or symptoms of shunt malfunction. Plain radiographs revealed a break in the shunt catheter at the level of the right upper chest. Skull radiographs showed a cystic expansion of the occipital diploic space measuring 10 ϫ 10 ϫ 5 cm in the transverse, superoinferior, and anteroposterior dimensions, respectively (Fig 2). The reservoir of the posterior fossa cystoperitoneal shunt had migrated into the enlarged diploic space. Head CT examination confirmed the intradiploic location of the reservoir and the expansion of the diploic space extending from the supraoccipital into the basioccipital part of the occipital bone, including the occipital condyle and lower clivus (Fig 3).The patient was taken to the operating room, where it was found that the protruded occipital outer table was paper thin and the expanded diploic space contained CSF under pressure. The intracranial

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Section: Discussionmentioning

confidence: 73%

“…[3][4][5][6][7][8] To the best of our knowledge, no cases of intradiploic expansile CSF cysts as a complication of shunt procedures have been reported in the literature.…”

Section: Discussionmentioning

confidence: 97%

Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Sato¹,

Moritani²,

Hitchon³

2008

AJNR Am J Neuroradiol

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“…Those cysts are benign and exploratory surgery should be avoided unless they are symptomatic [19] . CT gives more information than MRI on bony changes in skull injuries [21] . Figure 9.…”

Section: Traumamentioning

confidence: 99%

Solitary benign parietal lesions seen on CT in cancer patients

Win

2014

JBGC

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Benign skull lesions are routinely encountered in clinical practice. The aim of this review is to describe the Computed tomography (CT) findings of solitary benign parietal lesions. Benign parietal bone lesions can exist in patients with history of cancer. Metastasis to the calvarium is rare compared to other sites in the body and primary skull tumors are even rarer. This is the second report of solitary cholesteatoma occurring in the parietal bone. All the clinical cases in this study were histologically proven. Benign solitary parietal lesions can have non-specific features on CT and in some cases, only biopsy can give a definite diagnosis.

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“…It mainly occurs in childhood and contributes to an incidence of 0.05-1.6% of paediatric skull fractures [1,2]. Rarely, an intradiploic cyst is formed as a variant of GSF.…”

Section: Introductionmentioning

confidence: 99%

Occipital Post-Traumatic Intradiploic Arachnoid Cyst Converted to Pseudomeningocele after Re-Trauma: A Rare Complication of Rare Pathology

Jaiswal

Gandhi²,

Sharma³

et al. 2015

Pediatr Neurosurg

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Background: Growing skull fracture (GSF)/pseudomeningocele is a rare complication of head injury in children. Post-traumatic intradiploic arachnoid cyst (PTIAC) is a variant but it is extremely rare. PTIACs are usually asymptomatic or with mild symptoms like headache. The rupture of PTIAC due to re-trauma leading to pseudomeningocele formation has not been seen or reported before. Patient and Method: We present a case of occipital PTIAC where pseudomeningocele developed after re-trauma, and discuss the pathogenesis and management. Result: En masse removal of the ruptured PTIAC was performed along with dural-defect repair. The post-operative recovery was good. Conclusion: PTIAC is an extremely rare occurrence as a variant of GSF. It is usually asymptomatic, but it may rupture with trivial trauma due to a thinned-out outer table and then converts into pseudomengocele. En masse excision with dural-defect repair gives good results in cases of ruptured PTIAC due to re-trauma.

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Post-traumatic intradiploic leptomeningeal fistula and cyst

Cited by 25 publications

References 18 publications

Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Solitary benign parietal lesions seen on CT in cancer patients

Occipital Post-Traumatic Intradiploic Arachnoid Cyst Converted to Pseudomeningocele after Re-Trauma: A Rare Complication of Rare Pathology

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