Acute subdural hematoma secondary to sacral arachnoid cyst surgery: a case report / 中华神经科杂志

Sacral cyst usually occurs around the nerve root, which is the accumulation of cerebrospinal fluid between the intima and the perineurium at the junction of the posterior spinal nerve root and the dorsal root ganglion. Its typical clinical manifestations include low back pain, lower limb radiation pain, rectal/bladder dysfunction and so on. Complications of acute subdural hematoma with cerebral hernia after posterior midline cystectomy of sacral cyst are rare. A middle-aged female patient with sacral cyst was admitted to Gansu Provincial Hospital. After the operation, acute subdural hematoma occurred in the right frontoparietal temporal occipital region, and cerebral herniation was formed. After the operation, the patient was given rehabilitation exercise and discharged well. No neurological deficits were observed during follow-up.

Spinal Anesthesia for Open Gastrostomy in an Infant after Stage I Norwood for Hypoplastic Left Heart

Infants with hypoplastic left heart are at increased risk of adverse events including mortality when they undergo procedures with general anesthesia in the inter?stage period after stage I Norwood. This is primarily caused by an imbalance between pulmonary and systemic blood flows augmented by decreased function of the single ventricle. These factors can be aggravated by general anesthesia, hence the increased risk. Many of these infants experience feeding dysfunction and require a gastrostomy to optimize nutrition. We report a case of open gastrostomy in an infant with Norwood physiology under spinal anesthesia with an excellent outcome.

Quiste aracnoideo (Galassi Tipo II) y síntomas neuropsiquiátricos: a propósito de un caso / Arachnoid Cyst (Galassi Type II) and neuropsychiatry symptoms: about a case

INTRODUCCIÓN: un quiste aracnoideo es originado de la alteración de una de las membranas de la meninges (aracnoides), de predominio en la fosa craneal media; es una patología poco común que cause síntomas y si ocurren, se pueden presentar manifestaciones neuropsiquiatrías. OBJETIVO: exponer los datos clínicos; y la metodología diagnóstica y terapéutica. CASO: presentamos una paciente femenina de 24 años de edad; sin antecedentes personales médicos psiquiátricos y médicos no psiquiátricos conocidos, quien presenta una historia con un mes de evolución de síntomas psicóticos y cambios conductuales. Se le realizo CAT cerebral simple y luego una resonancia magnética cerebral contrastada para definir el tamaño del quiste aracnoideo, por los posibles síntomas neuropsiquiátricos encontrados. Por medio de exámenes de laboratorios, estudios electrofisiológicos (electroencefalograma), neuroimágenes y evaluación clínica. Se decide presentar las características clínicas encontradas de la paciente quien requirió manejo con antipsicóticos, benzodiacepinas y estabilizador del humor con gradual mejoría de sus sintomatologías de ingreso (agitación psicomotora y psicosis).

INTRODUCTION: an arachnoid cyst is caused by the alteration of one of the membranes of the meninges (arachnoid), predominantly in the middle cranial fossa; It is an uncommon pathology that causes symptoms and if they occur, neuropsychiatric manifestations may take place. OBJECTIVE: expose the clinical data; and the diagnostic and therapeutic methodology. CASE: we present a 24-year-old female patient; with no personal history of psychiatric and known non-psychiatric medical records, whom presents a story with a month of evolution of psychotic symptoms and behavioral changes. A simple cerebral CAT was performed and then a cerebral magnetic resonance imaging with contrast to define the size of the arachnoid cyst, due to the possible neuropsychiatric symptoms found. Through laboratory tests, electrophysiological studies (electroencephalogram), neuroimaging and clinical evaluation. It was decided to present the clinical characteristics of the patient who required management with antipsychotics, benzodiazepines and mood stabilizer with gradual improvement of her admission symptoms (psychomotor agitation and psychosis)

Primary Extra-axial Glioblastoma: Case Report and Literature Review

Glioblastoma multiforme (GBM) is the most frequent and most aggressive primary brain tumor in adults,mainly located in the cerebral hemispheres. In the literature, few cases of primary GBM have been reported to have radiographic and intraoperative features of extra-axial lesions, leading to a diagnostic dilemma. Despite the advances in imaging modalities, the diagnosis of GBM can be challenging, and it is mainly based on the histopathologic confirmation of the excised tumor. We describe the case of a 76- year-old previously healthy female patient who presented to our hospital due to speech disturbances and cognitive impairment. The diagnosis of the tumor type on magnetic resonance imaging (MRI) was difficult, as the findings were suggestive of a malignant meningioma due to the heterogeneous enhancement of a dural-based mass with a dural tail sign. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. A histological examination confirmed the diagnosis of glioblastoma with arachnoid infiltration. The patient underwent adjuvant radiotherapy and concomitant temozolomide treatment, she had clinical improvement postoperatively, and was stable during the six months of follow-up. Glioblastoma should be considered in the differential diagnosis of primary extra-axial mass with atypical and malignant features, especially in elderly patients.

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

The present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

Quiste aracnoideo de la vaina del nervio óptico simulando defecto glaucomatoso en el campo visual / Optic nerve sheath arachnoid cyst simulating glaucomatous defect in the visual field

Resumen Introducción: el quiste aracnoideo es una colección benigna de fluido similar en composición al líquido cefalorraquídeo dentro de la aracnoides, circunscrita por tejido fibrovascular normal que comprime las leptomeninges que rodean el nervio óptico. Se describe el caso de una paciente con quiste aracnoideo de la vaina del nervio óptico con un defecto campimétrico típico de glaucoma, pero con un disco óptico sin características de glaucoma, con el fin de resaltar la necesidad de estudiar con neuroimágenes estos casos y detectar este tipo de alteraciones. El quiste aracnoideo de la vaina del nervio óptico es una entidad excepcional que generalmente tiene un comportamiento benigno, permaneciendo estable en el tiempo, aunque eventualmente puede producir una neuropatía óptica compresiva, afectando la agudeza o el campo visual por daño de la capa de fibras nerviosas. En el caso descrito, este daño se manifestó con un defecto de campo visual que simulaba neuropatía glaucomatosa.

Abstract Background: Arachnoid cyst is a benign fluid collection similar in composition to cerebrospinal fluid within the arachnoid, circumscribed by normal fibrovascular tissue that compresses the leptomeninges surrounding the optic nerve. Objective: To describe the case of a patient with an optic nerve sheath arachnoid cyst with a typical glaucoma campimetric defect, but with an optic disc without findings of glaucoma, to highlight the need to study these cases with neuroimaging to detect this type of changes. Conclusion: Optic nerve sheath arachnoid cyst is an exceptional entity that generally has a benign behavior remaining stable over time; but could eventually originate compressive optic neuropathy, affecting visual acuity or visual fields due to nerve fiber layer damage. In the patient´s case this damage was manifested with a visual field defect that simulated glaucomatous neuropathy.

Posttraumatic Arachnoid Cyst in the Thoracic Spine with Medullary Compression: Case Report / Cisto aracnóide após trauma na coluna torácica com compressão medular: Relato de caso

Abstract Arachnoid cysts are rare; they can occur at all levels of the dural sac, and can have a congenital, traumatic, iatrogenic or inflammatory origin. In the present article, we report a patient presenting a compressive thoracic myelopathy due to an unusual intradural arachnoid cyst with posttraumatic manifestation and its resolution, in addition to a literature review on the subject. These cysts mainly occur at the thoracic spine, followed by the lumbar, lumbosacral and thoracolumbar spines. Traumatic cysts are caused by an injury to the inner dural layer. These lesions produce neurological deficits through a mass effect on the spinal cord. Concomitant compressive myelopathy is even rarer. In case of myelopathy, cyst resection or drainage is the treatment of choice, and it must be performed immediately. Although rare, arachnoid cysts can be a complication of spine fractures; as such, orthopedists and neurosurgeons, who commonly see these injuries, must be prepared for this unusual situation.

Resumo Cistos aracnóides são raros, podem ocorrer em todos os níveis do saco dural, e sua origem pode ser congênita, traumática, iatrogênica ou inflamatória. Neste artigo, relatamos o caso de uma paciente com mielopatia torácica compressiva decorrente de um cisto aracnóide intradural incomum, de manifestação pós-traumática, assim como sua resolução, além de realizar revisão da literatura sobre o tema. A principal localização é na coluna torácica, seguida das colunas lombar, lombossacra e toracolombar. O cisto com origem traumática é causado por lesão da camada interna da dura-máter. Essas lesões produzem déficit neurológico por meio de efeito de massa sobre a medula espinhal. A existência de mielopatia compressiva associada é mais rara ainda. A ressecção ou drenagem dos cistos na vigência de mielopatia deve ser imediata, sendo o tratamento de escolha. Apesar de raros, podem ser uma complicação de fraturas da coluna vertebral que são muito comuns na prática de ortopedistas e neurocirurgiões, que devem estar preparados para essa situação incomum.

Non-neoplastic intracranial cystic lesions: not everything is an arachnoid cyst / Lesões císticas intracranianas não neoplásicas: nem tudo são cistos aracnoides

Abstract Intracranial cystic lesions are common findings on neuroimaging examinations, arachnoid cysts being the most common type of such lesions. However, various lesions of congenital, infectious, or vascular origin can present with cysts. In this pictorial essay, we illustrate the main causes of non-neoplastic intracranial cystic lesions, discussing their possible differential diagnoses as well as their most relevant imaging aspects.

Resumo Lesões císticas intracranianas são achados comuns nos exames de neuroimagem, sendo os cistos aracnoides os mais comuns. Porém, muitas outras lesões, de origem congênita, infecciosa e vascular, podem se apresentar com cistos. Neste ensaio ilustramos as principais causas de lesões císticas intracranianas não neoplásicas, discutindo seus possíveis diagnósticos diferenciais, bem como seus aspectos de imagem mais relevantes.

Prenatal diagnosis of fetal suprasellar arachnoid cysts: clinical analysis of five cases / 中华围产医学杂志

Objective:To analyze the characteristics and prognosis of fetal suprasellar arachnoid cysts.Methods:The clinical data of five fetuses with suprasellar arachnoid cysts diagnosed prenatally by ultrasound at Peking University First Hospital from March 2015 to July 2019 were analyzed retrospectively. The prenatal diagnosis, progression, and management strategies of this disease were described together with fetal MRI and follow-up data.Results:Five cases of suprasellar arachnoid cysts were diagnosed prenatally by ultrasound, including one isolated and stable case and four with enlarged lesions complicated by ventriculomegaly during pregnancy. There were four male and one female fetus. One baby was born vaginally, three through cesarean section, and the rest one was terminated in another hospital. Two babies were operated at two and six months after birth, respectively, and both recovered. And the other two babies were still under regular follow-up. Fortunately, all four children grew and developed well at the age between 15-66 months.Conclusions:For some fetuses with suprasellar arachnoid cysts, postnatal surgery may not be required. While those who have undergone surgery have a good prognosis due to early intervention.

Clinical effect of pituitary cystectomy in thirty-two patients / 中国医师进修杂志

Objective:To discuss the surgical efficacy of neuroendoscopic transsphenoidal approach for the removal of pituitary cystic lesion.Methods:Clinical data and efficacy of 32 patients with neuroendoscopic transsphenoidal surgery and pathological diagnosis of pituitary cystic lesion in the Affiliated Hospital of Jining Medical University from March 2013 to May 2019 were retrospectively analyzed.Results:Of the 32 patients, 29 patients were pathologically diagnosed with Rathke cysts and 3 patients with pituitary arachnoid cysts. The content of cyst could be completely removed and the relationship between cyst and sellarseptum and subarachnoid space could be clearly observed by using endoscopy. After followed-up for 0.5-1.0 year, headic, dizziness and visual impairment were improved. One patient relapsed, without serious complications or death.Conclusions:Transsphenoidal neuroendoscopic surgery is a safe and effective treatment for pituitary cystic lesion.

Quiste aracnoideo intraventricular asintomático: reporte de un caso / Asymptomatic intraventricular arachnoid cyst: a case report

Introducción: Los Quistes Aracnoideos son colecciones benignas de líquido cefalorraquídeo que representan el 1% de lesiones ocupantes de espacios intracraneales. Se detecta frecuentemente antes de los 20 años, entre 60 a 90% de los casos. La prevalencia estimada es de 1,4% en adultos, siendo la menos frecuente la ubicación intraventricular. Caso Clínico: Mujer de 60 años de edad, consultó por cefalea holocraneana de larga data y ocasionales mareos. Sin alteraciones al examen físico neurológico. Se le realizó tomografía axial computarizada donde llamó la atención una leve alteración de la densidad intraventricular por lo que se procedió a realizar resonancia magnética nuclear que demostró imágenes quísticas en atrio de ventrículos laterales, bilateral. No se requirió de una intervención quirúrgica debido a que la paciente no presentaba sintomatología significativa. Discusión: El tratamiento quirúrgico es recomendado en pacientes sintomáticos, en quistes de gran extensión y en los que cursan con complicaciones. Para los pacientes que cursen sólo con dolor de cabeza, sin hidrocefalia secundaria o un aumento evidente de la presión intracraneal se recomienda la observación con o sin repetición de las imágenes.

Introduction: Arachnoid cysts are benign collections of cerebrospinal fluid that represents 1% of lesions occupying intracranial spaces. It is frequently detected before the age of 20, between 60 to 90% of cases. The estimated prevalence is 1.4% in adults, the least frequent being intraventricular location. Clinical Case: A 60-year-old woman attended for a long-standing holocranial headache and occasional dizziness. No alteration in the neurological physical examination. A computerized axial tomography was performed, where a slight alteration in the intraventricular density drew attention, for which a nuclear magnetic resonance was carried out, which showed cystic images in the atrium of bilateral lateral ventricles. No surgical intervention was required because the patient did not present a significant symptomatology. Discussion: Surgical treatment is recommended in symptomatic patients, in cysts of great extension and in those with complications. For patients with only headache, without secondary hydrocephalus or an obvious increase in intracranial pressure, observation with or without repetition of the images is recommended.

Percutaneous Treatment of Meckel Cave Arachnoid Cyst: Case Report, Surgical Strategy and Literature Review

Arachnoid cysts are benign intracranial lesions. They are usually located in the middle fossa, but can be found in other locations. We present a case of symptomatic Meckel cave (MC) arachnoid cyst - a very rare location - and a treatment strategy not elsewhere described before for this condition. A 54-year-old female with trigeminal neuralgia with previous history of radiofrequency rhizotomy treatment 6 years before admission had been experiencing pain recurrence with progression, which required successive increases in carbamazepine dosage. Magnetic Resonance Imaging (MRI) showed dilatation of the right MC with extension to the petrous apex. The lesion was compatible with arachnoid cyst, and due to the worsening of the clinical condition, surgical treatment was chosen. Percutaneous puncture of the cyst through the foramen ovale with injection of intracystic fibrin sealant was performed. The patient woke up from anesthesia with pain improvement and was discharged asymptomatic the next day. After 12 months of follow-up, she remained pain-free. In the literature review, we found only eight cases reported as MC arachnoid cyst. These are likely to progress and become symptomatic owing to their communication with the subarachnoid space and a unidirectional valve mechanism. Pain improvement with this technique is probably secondary to the interruption of these mechanisms.

Newborn with multiple congenital anomalies in newborn, intensive care unit suggestive of joubert syndrome and related disorder with an atypical presentation

Joubert syndrome (JS) is a rare autosomal recessive disorder with key finding of cerebellar vermis hypoplasia with a complex brainstem malformation that comprises the molar tooth sign on axial magnetic resonance images. This syndrome is difficult to diagnose clinically because of its variable phenotype. Molar tooth sign is not specific for JS. Another entity is termed as Joubert syndrome and related disorders (JSRD). Although the molar tooth sign and other important clinical features of the JS may be seen in these syndromes, they usually have supplementary prominent features. Author present a case of Joubert syndrome and related disorder in a term newborn delivered in the hospital of Government Medical College, Haldwani with multiple congenital anomalies. Macrocephaly, facial dysmorphism, polydactyly left hand and bilateral ballotable lumbar lump (multicystic dysplastic kidney). MRI showed molar tooth configuration of superior cerebellar peduncles, dilatation of lateral and third ventricles with aqueductal stenosis with arachnoid cyst (unusual association).

Quiste aracnoideo sacro recidivante con meningocele anterior gigante: reporte de caso / Sacral arachnoid recurrent cyst with giant anterior meningocele: a case report

Los quistes aracnoideos corresponden a lesiones benignas expansivas del canal medular secundarias a defectos anatómicos durales, mientras que los meningoceles anteriores consisten en la herniación de la duramadre hacia la pelvis a través de forámenes dilatados o defectos óseos. Ambas entidades son infrecuentes y sus manifestaciones clínicas puede variar de acuerdo a estructuras anatómicas que comprimen. Una historia clínica completa, la pesquisa diagnóstica y la adecuada interpretación de imágenes orientan al diagnóstico y manejo de estos pacientes. Se presenta el caso de una paciente adulta mayor con historia de masa pélvica, dolor lumbar severo y monoparesia en quien se realizó el diagnóstico incidental de quiste aracnoideo sacro y meningioma sacro anterior.

Arachnoid cysts are benign expansive lesions of the spinal canal secondary to dural defects, whereas the anterior meningoceles consist of the herniation of the dura into the pelvis through dilated foramina or bone defects. Both pathologies are infrequent and its clinical manifestations vary according to compressed anatomical structures. A complete clinical history, the diagnostic investigation and the correct imaging studies interpretation guide the diagnosis and management of these patients. We present the case of an elderly adult patient with a history of pelvic mass, severe lumbar pain and monoparesis in whom the incidental diagnosis of sacral arachnoid cyst and anterior sacral meningioma was performed.

Intracranial aneurysm and arachnoid cyst: just a coincidence? A case report

ABSTRACT CONTEXT: Presence of an arachnoid cyst and a non-ruptured intracystic brain aneurysm is extremely rare. The aim of this paper was to describe a case of a patient with an arachnoid cyst and a non-ruptured aneurysm inside it. Clinical, surgical and radiological data were analyzed and the literature was reviewed. CASE REPORT: A patient complained of chronic headache. She was diagnosed as having a temporal arachnoid cyst and a non-ruptured middle cerebral artery aneurysm inside it. Surgery was performed to clip the aneurysm and fenestrate the cyst. CONCLUSIONS: This report raises awareness about the importance of intracranial vascular investigation in patients with arachnoid cysts and brain hemorrhage.

Surgical Outcome of Endoscopic Cysto-Cisternostomy for Arachnoid Cyst

Arachnoid cysts are present in 1% of the populace and generally found in the temporal, frontal, pineal and posterior fossa, frontotemporal fossa. Clinical and radiologic introductions can vary incredibly. In spite of serious research, it is as yet easily proven wrong which patients will profit by medical procedure. Objective: This study intends to research the pre-treatment parameters impacting the result after neuro-endoscopic treatment of arachnoid cysts. Methods: A review investigation of 14 patients who experienced an endoscopic fenestration of arachnoid cysts between 2012 to 2017. Results: In symptomatic patients, 85.71 percent of cases have improved clinically. The best results in treating symptoms related to intracranial hypertension, acute neurological defects and macrocrania and seizure were found. Conclusion: The clinical outcome and complication rate vary by technique and symptomatology, although the outcome after the endoscopic cysto cysternostomy is satisfactory.

Spontaneous Disappearance of an Arachnoid Cyst after Burr Hole Drainage of Chronic Subdural Hematoma / 대한신경손상학회지

It is well known that the presence of arachnoid cysts (ACs) in young patients is a risk factor for developing a chronic subdural hematoma (CSDH) after a minor head injury. Although there have been controversies with the treatment, most authors recommend only draining the CSDH if the AC is asymptomatic. This judgement is based on the facts that this surgical approach has shown good clinical outcomes, and the AC usually remains unchanged after the surgery. Our case demonstrates that the AC of a young patient who developed a CSDH after a minor head injury completely disappeared after a burr hole drainage of the CSDH. Although the chances of an AC disappearing are low, this case shows that an AC might disappear after only draining a CSDH when a rupture of the AC membrane is identified. In such cases, we recommend first draining only the CSDH for the treatment of AC-associated CSDHs.

Disappearance of Arachnoid Cyst after Burrhole Trephination: Case Series / 대한신경손상학회지

We report 3 cases of arachnoid cysts (ACs) that completely disappeared after burr hole drainage, without cyst fenestration into the subarachnoid space or cystoperitoneal shunt. The first patient was a 21-year-old female with an AC of the right cerebral convexity, found incidentally. After endoscopic AC fenestration was performed, the patient complained of persistent headache. Two-month postoperative brain imaging revealed reaccumulated AC and associated multi-stage subdural hematoma. Burr hole drainage was performed to resolve the chronic subdural hematoma (CSDH). Three months later, brain computed tomography showed that the CSDH and the AC had disappeared. The second patient was an 11-year-old male who had a history of trauma 1 month prior to presentation at the clinic. Brain magnetic resonance imaging revealed an AC in the left sylvian fissure with CSDH. We performed burr hole drainage to treat the CSDH first. Subsequently, the AC as well as the CSDH disappeared. The third case was an AC of the right parietal convexity, found incidentally. Only burr hole drainage was performed, following which, the AC disappeared. This case series shows that an AC can disappear naturally after rupture into the subdural space by trauma or the burr hole procedure.

Cervical Cerebrospinal Fluid Leakage Concomitant with a Thoracic Spinal Intradural Arachnoid Cyst / 대한신경손상학회지

We encountered a very rare case of spontaneous spinal cerebrospinal fluid (CSF) leakage and a spinal intradural arachnoid cyst (AC) that were diagnosed at different sites in the same patient. These two lesions were thought to have interfered with the disease onset and deterioration. A 30-year-old man presented with sudden neck pain and orthostatic headache. Diplopia, ophthalmic pain, and headache deteriorated. CSF leakage was confirmed in C2 by radioisotope cisternography, and an epidural blood patch was performed. While his symptoms improved gradually, paraparesis suddenly progressed. Thoracolumbar magnetic resonance imaging (MRI) revealed an upper thoracic spinal intradural AC, which was compressing the spinal cord. We removed the outer membrane of the AC and performed fenestration of the inner membrane after T3-4 laminectomy. Postoperative MRI showed complete removal of the AC and normalized lumbar subarachnoid space. All neurological deficits including motor weakness, sensory impairment, and voiding function improved to normal. We present a case of spontaneous spinal CSF leakage and consecutive intracranial hypotension in a patient with a spinal AC. Our report suggests that if spinal CSF leakage and a spinal AC are diagnosed in one patient, even if they are located at different sites, they may affect disease progression and aggravation.

DANTE prepulse SPACE MR sequence in quantitative evaluation of arachnoid granules / 中国医学影像技术

Objective To explore the value of delay alternating with nutation for tailored excitation (DANTE)- sampling perfection with application optimized contrast using different flip-angle evolution (SPACE) sequences in quantitative evaluation of arachnoid granules (AG). Methods Thirty patients with arachnoid granules confirmed by conventional imaging were enrolled. All patients underwent SPACE and DANTE-SPACE sequences scanning. Distribution characteristics of arachnoid particles in sinus cavities and cranial plate on SPACE and DANTE-SPACE sequence images were evaluated, and the measurements were performed and statistically analyzed, including maximum cross-sectional area, longest diameter, SNR and CNR. Results A total of 43 arachnoid particles were detected with SPACE sequence, 29 in the sinus cavities and 14 in the cranial plate, while 45 arachnoid particles were found with DANTE-SPACE, 31 in the sinus cavities and 14 in the cranial plate. SPACE and DANTE-SPACE sequences showed no statistically significant difference in distribution of arachnoid particles (χ2=0.155, P=0.997). In the sinus cavity, SPACE and DANTE-SPACE sequences showed significant differences of the maximum cross-sectional area ([32.55±17.08]mm2, [29.15±16.24]mm2), the longest diameter ([7.13±2.00]mm, [6.42±1.81]mm), SNR (88.82±29.57, 83.30±32.11) and CNR (45.99±28.57, 65.33±30.96) of arachnoid particles (all P0.05). Conclusion DANTE-SPACE can effectively inhibit slow blood flow artifacts in the sinus, and accurately display arachnoid particles.