Prepontine arachnoid cyst presenting with headache and diplopia: A case report study

Abstract

Background:Arachnoid cysts are found everywhere in cerebrospinal axis, most often in the middle cranial fossa. They are very rare in prepontine location.Case Description:In this study, we report a 26-year-old female presenting with a 3-month history of headache and diplopia. On physical examination, she had clinical manifestations of sixth cranial nerve palsy. Magnetic resonance imaging revealed a prepontine arachnoid cyst with extension into interpeduncular and suprasellar cisterns. Computed tomography scan demonstrated no evidence of hydrocephalus. The patient was treated surgically by endoscopic fenestration of the cyst with endonasal transsphenoidal approach. The cyst was opened to prepontine, interpeduncular, and suprasellar cisterns.Conclusion:Endoscopic endonasal fenestration of the cyst to adjacent cistern may be safe in prepontine arachnoid cysts with sellar and suprasellar extension; it may be effective and less invasive compare to transcranial approach.

Cranial Nerve Palsies in the Setting of Arachnoid Cysts: A Case Series and Literature Review

“…No large-scale study has been performed to determine the comorbidity of ACs and CN palsy, but there is a sizeable case report literature demonstrating their association. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Given the neurologic risk that ACs can present, 1 it is important to develop clear guidelines for their evaluation and treatment.…”

“…In 11 of these cases, craniotomy was performed [2][3][4][5][6]9,11,13,14,16,19 before fenestration of the cyst, whereas endoscopic fenestration was performed once. 18 Endoscopic fenestration has recently replaced craniotomy as the preferred treatment approach for ACs 20 because of its less-invasive nature. However, complication rates for endoscopic fenestration have been reported at 21%, 21 demonstrating the vital need to carefully select candidates for neurosurgery.…”

“…Cranial nerve (CN) palsies caused by ACs affecting CN III, IV, and VI have been reported. 2–19 Furthermore, the course of CN III, CN IV, and CN VI involves many structures where ACs have been reported. 1…”

“…Cranial nerve (CN) palsies caused by ACs affecting CN III, IV, and VI have been reported. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Furthermore, the course of CN III, CN IV, and CN VI involves many structures where ACs have been reported. 1 The best treatment approach for symptomatic patients affected by intracranial ACs is contested, 20 and no guidance exists for the management of diplopia caused by ACs.…”