Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series

Abstract

Introduction and Aim:The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.Materials and Methods:We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973–2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.Results:In 6 cases the PFAC was located in the midline. In the 7th case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.Discussion:We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

Neurodevelopmental and Psychiatric Symptoms in Patients with a Cyst Compressing the Cerebellum: an Ongoing Enigma

“…Symptomatic presentations of PFAC in adults in the absence of other radiological abnormalities (such as hydrocephalus or absent septum pellucidum) or significant past medical history (such as prematurity or traumatic delivery) include cranial neuropathies, headache, vomiting, vertigo, and arm and gait dysmetria(20,22). Similar symptoms are reported in the pediatric literature(23).…”

Rare case of a rapidly enlarging symptomatic arachnoid cyst of the posterior fossa in an infant: A case report and review of the literature

“…PFACs can be particularly challenging to treat depending on the cyst size, cyst location, and the presence of obstructive hydrocephalus. [ 6 21 ] To this end, there is no consensus regarding a standard or optimal surgical treatment for PFAC. Various treatment approaches exist, including microsurgical excision or fenestration by craniotomy, cyst shunting, and endoscopic fenestration.…”

Arachnoid interamigdal cyst of the posterior fossa in an adult female

“…Arachnoid cysts are benign extracerebral collections of cerebrospinal fluid (CSF) originating from the division of arachnoid membranes in utero (primary cysts); however, there are secondary cysts which often appear after trauma, surgery, or intracranial infection [1][2][3] .…”

“…They are observed with a higher frequency in the left hemisphere. They are mostly detected in the first two decades of life and are less frequently diagnosed in adults and among the elderly [1][2][3][4][5] . They appear in the different anatomical areas of the neuroaxis where arachnoids exist; most of them are supratentorial and are located in the middle fossa (50-60%), the rest can appear in the cerebellopontine angle, suprasellar Medicina Universitaria 1665-5796/© 2020 Universidad Autónoma de Nuevo León.…”

“…This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). and quadrigeminal cisterns, cerebral convexities, and the cisterna magna [1][2][3] .…”