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.

Cisto aracnóideo intradiploico não traumático ­ Relato de caso / Nontraumatic Intradiploic Arachnoid Cyst ­ Case report

Existem apenas 14 casos descritos de cistos aracnóideos intradiploicos sem traumatismo craniano prévio. O objetivo deste estudo é relatar um caso de cistos aracnóideos intradiploicos e alertar para a possibilidade deste diagnóstico entre as lesões osteolíticas do crânio. Umpacientemasculino de 74 anos, com histórico de adenocarcinoma de próstata, tratado com radioterapia há 2 anos, realizou tomografia de crânio para investigação de tontura. Esta mostrou lesão lítica de 2 cm parietoccipital direita. Não havia história de trauma ou alteração neurológica. A ressonância magnética mostrou tecido isointenso ao parênquima cerebral preenchendo a cavidade óssea. O paciente foi submetido à craniectomia ao redor da lesão e foi identificada herniação de tecido encefálico para dentro da díploe craniana. Ao exame anatomopatológico não foram encontradas células neoplásicas, mas sim a presença de cavidade intraóssea com superfície interna recoberta por faixa de tecido conjuntivo fibrilar frouxo e tecido cerebral com morfologia preservada, estabelecendo o diagnóstico de cisto intradiploico com herniação de tecido cerebral. Cistos aracnóideos intradiploicos são geralmente achados incidentais. A cirurgia é necessária para o diagnóstico, mas pode ser evitada em pacientes assintomáticos e quando não há evidência de neoplasia maligna. Portanto, se o tratamento conservador for escolhido, sugere-se seguimento clínico e imagenológico, já que a história natural é desconhecida.

There are only 14 reported cases of intradiploic arachnoid cysts without prior head injury. The aim of this study is to report a case of intradiploic arachnoid cysts. Neurosurgeons must be aware of this possibility among osteolytic lesions of the skull. A male patient, 74 years old, with a history of prostate adenocarcinoma treated with radiotherapy for two years, held cranial tomography for investigation of dizziness. This showed a 2 cm parietal-occipital osteolytic lesion. There was no history of trauma or neurological disorder. The magnetic resonance imaging showed tissue filling the bone cavity that was isointense to brain parenchyma. The patient underwent craniectomy around the lesion, and brain tissue herniation was identified into the cranial diploe. Histopathology did not demonstrate neoplastic cells; the inner surface of the bone cavity was covered by loose fibrillar connective tissue and brain tissue with preserved morphology, establishing the diagnosis of IAC with brain tissue herniation. Intradiploic arachnoid cysts are usually incidental findings. Surgery is required for diagnosis, but it can be avoided in asymptomatic patients when there is no evidence of malignancy. Therefore, if conservative treatment is chosen, close clinical and imaging follow-up is advised, since IAC natural history is unknown.

Meningioma de la vaina del nervio óptico: colaterales optociliares y quiste aracnoideo perióptico / Meningioma of the optic nerve sheath: collateral optociliary veins and the perioptic arachnoidal cyst

En la década sesenta, antes del advenimiento de la tomografía computarizada de las órbitas, los meningiomas de la vaina del nervio óptico eran considerados de rara ocurrencia y su diagnóstico positivo solo era posible en aquellos casos en que por su tamaño producían proptosis ocular, la que conducía a su estirpación quirúrgica. El tumor de crecimiento tubular, comprime el nervio en forma progresiva hasta atrofiarlo por completo. Sus manifestaciones clínicas incluyen la pérdida gradual de la agudeza visual hasta alcanzar la ceguera, edema del nervio óptico y luego atrofia del mismo, y presencia de venas colaterales optociliares. Este complejo signológico se designa como triada de Hoyt-Spencer. Un hecho patológico distintivo de estos tumores objetivado mediante resonancia magnética de órbitas con administración de gadolinio y supresión de grasa, es la presencia de una dilatación quística del espacio subaracnoideo perióptico entre el limite distal del tumor y el polo posterior del ojo. Presentamos el caso de un paciente ilustrativo con demostración histopatológica de las colaterales venosas y del quiste aracnoideo

During the 1970s, before the advent of computerized tomography of orbits, optic nerve sheath meningiomas were considered of rare ocurrence and their positive diagnosis was only posible in those cases in which its size produced ocular proptosis, which led to its surgical removal. Tumor growths in a tubular, compreses progressively the optic nerve and in time produces its atrophic thinning. Clinical manifestation include gradual visual acuity loss until total blindness, optic nerve edema and then optic atrophy, and the presence of collateral optociliary veins. This complex clinical picture is designated as the triad of Hoyt-Spencer. A distinctive fact in these tumors is the presence of a cystic dilatation of the perioptic subarachnoid space between the distal adge of the tumor and the posterior pole, which can be defined using magnetic resonance imaging of the orbits with fat supression following intravenous gadolinium administration. We present the case of a patient with histopatological demostration of the collateral veins and the distal aracnoidal cyst

[Intracranial arachnoid cyst [review of 20 cases]]

The purpose of this study is to evaluate the distribution, clinical features, and treatment modalities of arachnoid cyst in our department. The study was carried out between April 1, 1996 and October 1, 2006 in the neurosurgery department, Ghaem hospital, Mashhad University of Medical Sciences. Twenty patients with arachnoid cyst underwent surgery between April 1, 1996 until October 1, 2006, consisting of 12 males and 8 females aged 5 to 68 years [mean age 32.4 years]. Twelve patients underwent surgery and one patient underwent endoscopic fenestration, and cystoperitoneal shunting [medium pressure] was performed in 7 patients. All patients were followed for minimum of 6 months after surgery. During the study period, 20 patients were investigated. The cysts location was the middle cranial fossa in 12 patients [60%], suprasellar region in 1 patient [5%], the cerebral convexity in 1 patient [5%], posterior cranial fossa in 2 patients [10%], cerebellopontine angle in 3 patients [15%], and quadrigeminal cisterns in 1 patient [5%]. All cysts had clearly unilateral distribution, 12 [60%] were located on the left side and 8 [40%] on the right side. The most common symptoms on presentation were epileptic seizures [46%], increased intracranial pressure [34%], visual impairment [5%], headache [10%], and cerebellar signs [5%]. Arachnoid cysts have a strong predilection for the middle cranial fossa which may be explained by a meningeal mal-development theory. We also conclude that the major indication for surgery in patients with arachnoid cyst is the presence of intractable seizures, increased intracranial pressure, and compression of nervous tissues. Headache is not a surgical indication on its own

Presentación inusual de los quistes aracnoideos / Unusual presentation of arachnoid cysts

Objetivo: Describir y analizar la asociación entre quistes aracnoideos e higroma subdural. Esta es considerada una complicación excepcional, con sólo 24 casos reportados en la literatura, siendo de 5 casos la serie publicada más numerosa. Método. Se realizó el análisis retrospectivo de las historias clínicas de 5 pacientes portadores de quiste aracnoideo, en los que la forma de presentación consistió en higroma subdural e hipertensión endocraniana. Resultados. El rango de edad fue entre 3 y 15 años (promedio: 7 años). La relación M/F fue 3/2. En 3 casos los síntomas se presentaron después de un traumatismo encefalocraneal leve y en los 2 restantes fue espontáneo. Todos se manifestaron con síntomas de hipertensión encefalocraneana y edema de papila bilateral, en 2 de ellos se constató paresia del VI par izquierdo. A todos se le realizó TAC y en 2 casos IRM. En los 5 pacientes se constató un higroma subdural con efecto de masa y quiste aracnoideo de fosa media. Se realizó tratamiento quirúrgico de urgencia en los 5 casos. Todos los pacientes evolucionaron favorablemente con desaparición del higroma subdural. Actualmente se encuentran asintomáticos con un exament neurológico y fondo de ojo normal. Conclusión. Si bien el higroma subdural con hipertensión endocraneana en una complicación poco usual, debe ser tenida en cuenta como una de las formas de presentación clínica de los quistes aracnoideos, la cual requiere inmediata resolución quirúrgica. Palabras clave: complicaciones, higroma subdural, hipertensión endocraneana, quiste aracnoideo.

Objective: To analize and describe the association between arachnoid cysts and subdural hygroma. This association is an unusual complication of which only 24 cases have been reported in the literature. Methods: The clinical records of 5 patients with arachnoid cysts presenting as a subdural hygroma with increased intracranial pressure were analyzed retrospectively. Results: The ages of the patients ranged between 3 and 15 years-old (mean: 7 years-old). M/F ratio was 3/2. Onset of symptoms was postraumatic in 3 and spontaneous in 2. All patients presented symptoms of increased intracranial pressure and bilateral papilledema, and in 2 out of 5 paresis of the VI cranial nerve was found. All children underwent CAT scan and MRI was performed in 2. In all patients, subdural hygroma with mass effect and arachnoid cyst of the middle fossa was found. Emergency surgery was carried out in all cases. Al patients evolved favorably with complete disappearance of the subdural hygroma. They are currently asynptomatic with normal neurological examination and fundoscopy. Conclusion: Even though subdural hygroma with increased intracranial pressure is an unusual complication, it should be known as one of the clinical presentations of arachnoid cysts, which required immediate surgical intervention. Keywords: arachnoid syst, complications, increased intracranial pressure, subdural hygroma.

Dilatación del cavum Vergae en el feto: dos casos clínicos y revisión de la literatura / Dilated cavum Vergae in the fetus: two clinical cases and literature review

Comunicamos el diagnóstico prenatal de dos casos de dilatación del cavum Vergae. También revisamos la literatura acerca de lesiones anecogénicas intracerebrales supratentoriales interhemisféricas, con el propósito de establecer criterios de diagnóstico diferencial antenatal y determinar su pronóstico.

An Atypical Case of Aicardi Syndrome with Favorable Outcome

Aicardi syndrome is a severe congenital disorder characterized by infantile spasms, chorioretinal lacunae, and agenesis or hypogenesis of the corpus callosum. A 6 month old female had developed abnormal eye movement and seizures of the complex partial type and myoclonic type. MRI pictures of the patient revealed the presence of genu associated with agenesis of the rest of corpus callosum. A funduscopic examination revealed bilateral small, solitary, pale areas with sharp borders, some of which had minimal surrounding pigmentation (chorioretinal lacunae), especially clustered around the disc, and they were more prominent on the left side. We report here on the unusual findings of a complex partial seizure, myoclonic seizure and the atypical EEG finding in addition to the well-known characteristic clinical and imaging findings of a patient with Aicardi syndrome.

Tapping of a type II Sylvian fissure arachnoid cyst: technical note.

A 28-year-old man with a large Sylvian fissure cyst was treated by making a small pre-coronal burr hole, and subsequently, under a direct view its wall was fenestrated with a Cushing's needle and the cyst fluid was tapped. The patient had complete neurological recovery. The follow-up was of 90 months.

Hemorragia de tronco cerebral após remoçäo cirúrgica de cisto aracnóide da fissura silviana: relato de caso / Brainstem hemorrhage after surgical removal of arachnoid cyst of the sylvian fissure: a case report

Os autores relatam um caso de hemorragia de tronco cerebral após craniotomia para ressecçao de grande cisto aracnóide de fissura silviana esquerda. A sintomatologia inicial pré-operatória incluía sinais de hipertensao intracraniana e a tomografia computadorizada mostrava desvio de linha média. Diversos fatores sao discutidos para explicar o sangramento parenquimatoso pós-operatório: edema cerebral, diminuiçao do retorno venoso e de fluxo sanguíneo no lado comprimido. Entretanto a fisiopatologia da hemorragia perenquimatosa em casos como o relatado permanece obscura. uma abordagem cirúrgica mais cutelosa é proposta nesse pacientes com de hipertensao intracraniana.