Choroidal Fissure Cysts in Children - Pediatrician Dilemma for Follow-up.

Background: Choroidal fissure cyst is a small cyst present in the choroidal fissure and this is a developmental variant. These are location based cysts and can either be of neuroglial or neuroepithelial, or of arachnoid in nature. These are seen as incidental finding in routine radiological cross sectional imaging studies. There is dilemma in follow up of these cysts because of their asymptomatic nature or of some vague complaints and invites a lot of debate on their follow-up. Methods: Five children of age group 10-16 years who reported to the outpatient department with vague headache, vertigo or unexplained seizures were subjected to non contrast computerized tomography (NCCT) or magnetic resonance imaging (MRI) of the head to rule out any intracranial pathology. Results: Three cases were having pure cysts in the brain while other two were found to be having various sizes and types of tuberculomas resembling with that of cystic appearances. One of the brain cyst cases was 14 years old female where NCCT head findings revealed a small cyst in the right choroid fissure location. This was subsequently confirmed as choroidal fissure cyst on multiplanar and multisectional plain MRI study. The other two cystic pathologies were vesicular stage of cysticercosis and posterior fossa arachnoid cyst. Rest of the two were tuberculomas with ring enhancement, which were confirmed on MR spectroscopy. Conclusion: The case with choroidal fissure cyst required special attention because of the concern of patient as well as clinician for the follow up. We reviewed the literature for the fate and follow up of these types of cases.

Growing Hemorrhagic Choroidal Fissure Cyst

Choroidal fissure cysts are often incidentally discovered. They are usually asymptomatic. The authors report a case of growing and hemorrhagic choroidal fissure cyst which was treated surgically. A 22-year-old female presented with headache. Cranial MRI showed a left-sided choroidal fissure cyst. Follow-up MRI showed that the size of the cyst had increased gradually. Twenty months later, the patient was admitted to our emergency department with severe headache. MRI and CT showed an intracystic hematoma. Although such cysts usually have a benign course without symptoms and progression, they may rarely present with intracystic hemorrhage, enlargement of the cyst and increasing symptomatology.

Neuroanatomical correlation between choroid plexus mass in thechoroidal fissure and the interventricular foramen area

Introduction: Our aim was to evaluate the correlation between choroid plexus mass (g) in the choroidalfissure and the ipsilateral interventricular foramen area, bilaterally. Material and methods: We analyzed sevencadaveric specimens with exposed brain, reaching the transcallosum access in all specimens, dissecting thecorpus callosum to reach the left and right choroidal fissure. After identifying the thalamostriate and septalveins, we localized the interventricular foramen scrapping all the choroid plexus in that region as well asits posterior extension allowing us to completely visualize the III ventricle. The area of the interventricularforamen was calculated with a pachimeter using the formula ðR2. The choroid plexus mass was measured withan appropriate scale. The choroid plexus mass and ipsilateral interventricular foramen correlation was evaluatedby the Pearson correlation. Results and conclusion: Neither difference between right and left choroid plexusmass was observed (Student t test – p = 0.374) nor with interventricular foramen area (p = 0.345) andwe decided to evaluate the 14 results together. There was correlation between choroid plexus mass and itsrespective IF (r = 0.6863; p < 0.01). A better knowledge of the choroidal fissure is very important to a moreprecise approach to the pathologic processes that affect the III ventricle. Different from the transforaminal,interforniceal, subchoroidal, and subforniceal, the choroidal fissure access is a natural approach. We speculatethat undetermined etiology hydrocephaly may have its origins in a deficit of ventricular drainage or in thechoroid plexus excess.

Temporal choroidal fissure cyst and temporal lobe epilepsy: report of two cases / Cistos da fissura coroidal temporal e epilepsia do lobo temporal: dois relatos de casos

STUDY DESIGN: Two case reports of a choroidal fissure cyst in the temporal horn associated with complex partial seizure. OBJECTIVES: To describe the clinical course, image findings and literature review of choroidal fissure cysts. SUMMARY AND BACKGROUND DATA: there are few reported cases of choroidal fissure cysts. RESULTS: We report two patients with complex partial seizures and temporal choroidal fissure cysts. The seizures were controlled in both patients. CONCLUSION: The choroidal fissure cyst diagnosis must highlight the importance of considering this lesion in the differential diagnosis of temporal lobe cyst and temporal lobe seizure.

DESENHO DO ESTUDO: Dois relatos de caso de cisto de fissura coroidal no corno temporal associado com crise parcial complexa. OBJETIVOS: Descrever o curso clínico, achados radiológicos e fazer uma revisão da literatura a respeito de cistos da fissura coroidal. RESUMO DOS DADOS DA LITERATURA: existem poucos casos descritos de cistos da fissura coroidal. RESULTADOS: Nós descrevemos dois pacientes com crises parciais complexas e cistos de fissura coroidal. As crises foram controladas em ambos os pacientes. CONCLUSÃO: O diagnóstico de cisto da fissura coroidal deve ser levado em conta no diagnóstico diferencial de cistos do lobo temporal e em crises de lobo temporal.

Microsurgical Anatomy of the Choroidal Fissure

The authors had studied the microsurgical anatomy of the choroidal fissure and the operative approaches directed through the fissure. In this study, eight formalin-fixed cadaveric hemisheres were examined. In four hemispheres, the intracranial vessels were perfused with colored silicone latex. The choroidal fissure is divided into three portion : (a) body portion, (b) atrial portion, and (c) temporal portion. Dissection through the body portion of the choroidal fissure exposes the velum interpositum, internal cerebral vein, and third ventricle. The quadrigeminal cistern, pineal region, and posterior part of the ambient cistern can be exposed through the atrial portion of the choroidal fissure. Opening through the temporal portion of the choroidal fissure exposes the structures in the ambient cistern, which include the basal vein, posterior cerebral artery, anterior and lateral posterior choroidal arteries, and hippocampal formation. This study provides valuable knowledges of microsurgical approaches to the third ventricle and basal cistern by demonstrating the neural nd vascular relaionship around the choroidal fissure.

MR imaging of choroidal fissure cyst of the brain / 中华放射学杂志

Objective To investigate the MR manifestations and diagnostic value in patients with choroidal fissure cyst of the brain. Methods Characteristic MR findings in 16 patients with choroidal fissure cyst were retrospectively analyzed, and the correlation between MR imaging and clinical manifestations was reviewed. Results The cysts were situated within the choroidal fissure in all cases, representing as cystic lesion with clear border, no detectable soft tissue mass in the cyst wall or adjacent area, homogenous signal intensity identical to CSF on all sequences, with the average size of 0.9 cm?1.3 cm?1.5 cm, and no associated edema. Gd-DTPA was performed in 6 cases and revealed no evidence of enhancement. Conclusion The choroidal fissure cyst of the brain is a benign and congenital developmental abnormality, and has minor clinical significance. Because of its specific anatomic location, the choroidal fissure cysts simulate intraparenchymal cystic lesions on axial images. Coronal and sagittal MR imaging can be used to delineate its extraaxial location and make the correct diagnosis, and, thus, differentiate with other cystic lesions.