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.

Intramedullary Arachnoid Cyst of the Cervical Spine: Case Report and Literature Review

Intramedullary arachnoid cysts of the spinal cord are extremely rare benign lesions of unclear pathogenesis. To our knowledge, only 21 cases were reported in the literature, 10 of which involved the cervical spine. We report the case of a 47-year-old female who presented with a symptomatic spinal intramedullary arachnoid cyst (SIAC). Magnetic resonance imaging scan of the cervical spine demonstrated an intramedullary arachnoid cyst at C3-C5 level. The patient had a cervical laminectomy and cysto-subarachnoid shunt with rapid and excellent clinical recovery and no recurrence at 2-year follow-up. Intramedullary arachnoid cysts should be considered in the differential diagnosis of intramedullary cystic lesions of the spinal cord. Their pathogenesis and natural history are not well defined in the literature. However, a cysto-subarachnoid shunt can be performed with excellent long-term clinical and radiological results.

Os cistos aracnoides intramedulares são lesões benignas extremamente raras e de origem desconhecida. Que seja do conhecimento dos autores, apenas 21 casos foram publicados, mas com apenas 10 envolvendo a coluna cervical. Os autores reportam o caso clínico de uma paciente do sexo feminino, de 47 anos de idade, com um cisto aracnoide intramedular sintomático que a ressonância magnética da coluna cervical demonstrou localizar-se no nível C3-C5. A paciente foi submetida a laminectomia cervical e derivação cisto-subaracnoide com recuperação neurológica rápida e significativa, sem recorrência após 2 anos de acompanhamento. Os cistos aracnoides intramedulares devem ser considerados no diagnóstico diferencial das lesões císticas da medula espinhal. A patogenia, bem como a história natural, não está bem estabelecida na literatura. A derivação cisto-subaracnoide é exequível com excelentes resultados clínicos e imagiológicos.

Subdural arachnoidal cyst of the spinal cord: etiology, clinical presentation, surgical strategy and results / Cisto aracnóideo subdural medular: etiologia, apresentação clínica, estratégia cirúrgica e resultados

Objective: Of this study is identifying the clinical manifestations, discuss the etiology, and present the surgical treatment nuances and outcomes of patients with sub dural arachnoidal cysts (AC). Method: A retrospective study was carried out with 7 consecutives patients with spinal cord subdural AC, diagnosed, evaluated and operated at the Neurosurgical department of Servidores do Estado Hospital, from 1996 to 2010. The radiological studies, patient records, surgical descriptions and surgical videos, were reviewed, creating a database from which information was collected. The follow-up varied from 2 to 168 months (mean, 48 months). All cysts were histopathological verified. Results: Five AC were located on the thoracic spinal cord, one were located anterior in the cervical region, and one at the lumbar spinal level. The complete resection of the cyst was performed in 4 surgeries. Three patients had cysts located ventral to the cord, which precluded complete excision. The symptoms in four patients demonstrated major improvement. There was no operative death in this series, there was no major complications related to surgery. Conclusion: AC should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts effectively ameliorated patients' symptomatology.

Objetivo: Identificar as manifestações clínicas, discutir a etiologia, apresentar as opções terapêuticas e revelar os resultados de uma série de pacientes diagnosticados com cisto aracnoide medular subdural (CA). Método: Realizamos um estudo retrospectivo em que analisamos 7 pacientes com AC que foram operados no Hospital dos Servidores do Estado, entre 1996 e 2010. Os estudos de imagem, prontuários, descrições cirúrgicas e os vídeos foram analisados e os dados, coletados. O seguimento variou de 8 a 168 meses. Em todos os cistos foi realizado estudo histopatológico. Resultados: Cinco cistos se localizavam na medula torácica, um na cervical anterior e outro no segmento lombar. Obtivemos a excisão completa dos cistos em 4 pacientes, que apresentaram importante melhora dos sintomas. Não ocorreu nenhum óbito nessa série, nem piora do sintomas pré-operatórios. Conclusão: O CA deve ser considerado no diagnóstico diferencial das lesões que causam mielopatia ou síndrome radicular. A ressecção microcirúrgica ou uma ampla fenestração das paredes do cisto geralmente revertem os sintomas do pacientes.

Cisto aracnóide intracraniano: revisão de literatura / Arachnoid cysts: a review of the literature

Objetivo: Revisão da literatura sobre os cistos aracnóides intracranianos – formação e evolução, dados epidemiológicos e clínicos, aspectos de neuroimagem e tratamento. Método: Realizamos pesquisa bibliográfica utilizando como base de dados o MEDLINE (National Library of Medicine), abrangendo operíodo de 1980 a 2006. As palavras-chave utilizadas foram arachnoid cysts e intracranial cysts. Também realizamos pesquisa manual em jornais e revistas médicas. Artigos com dados clínicos incompletos não foram incluídos no trabalho. Conclusões: Embora haja um consenso sobre a intervenção cirúrgica para os casos sintomáticos, a abordagem ideal ainda é controversa.

Objective: To review the current literature on intracranial arachnoid cysts related to its formation,evolution, the epidemiological, clinical and neuro imaging aspects and also its treatment. Method:Bibliographic review was done using Medline data base from 1980 to 2006. The key words used were arachnoid cysts and intracranial cysts. Manual research on pertinent medical publications was also done.Articles with incomplete clinical data were not included. Conclusions: Although there is a consensus that surgery should be performed only in the symptomatic cases, there is no general agreement whichis the best surgical approach to deal with arachnoid cysts.

Quiste leptomeningeo: hallazgos en TC y RM / Leptomeningeal cyst: findings in CT and MR

El quiste leptomeníngeo es una complicación de las fracturas craneales que ocurre mayoritariamente en población pediátrica. La existencia del mismo en adultos es rara. Presentamos el caso de un varón de 47 años que mostró un cuadro de acorchamiento en miembro superior derecho y desviación de la comisura bucal del que se recuperó en una hora. Los estudios de neuroimagen mostraron una destrucción irregular del hueso temporal derecho y una hipodensidad del tejido cerebral subyacente. La cirugía y el estudio histológico del hueso resecado mostraron que se trataba de un quiste leptomeníngeo asociado a un infarto cerebral.

Cisto lepotomeníngeo pós-traumático: relato de dois casos / Post-traumatic arachnoid cyst: report of 2 cases

Os autores apresentam dois casos de cisto leptomeníngeo. Por ser uma patologia infreqüente, foram encontrados poucos relatos, sendo a maioria casos isolados. Este trabalho objetiva fazer uma revisao dos dados bibliográficos, discutindo aspectos como etiologia, diagnóstico e tratamento.

Cisto leptomeníngeo traumático: relato de caso / Traumatic leptomeningeal cyst: report of case

Os autores relatam um caso de cisto leptomeníngeo em um paciente do sexo masculino de 1 ano de idade, seis meses após trauma craniano. Tais cistos sao caracterizados pelo crescimento da fratura com laceraçao ou ruptura da dura-máter e herniaçao do conteúdo intracraniano, através da progressiva separaçao das bordas da fratura, sendo mais comum em crianças abaixo dos 3 anos. Exames clínicos e radiológicos do crânio devem ser feitos até a consolidaçao da fratura, para que o diagnóstico seja feito antes que se desenvolvam sintomas neurológicos graves.