Transforaminal endoscopic excision of bi-segmental noncommunicating spinal extradural arachnoid cysts:A case report and literature review

BACKGROUND Spinal extradural arachnoid cysts(SEACs)are a rare cause of spinal cord compression.Typically,these cysts communicate with the intradural subarachnoid space through a small defect in the dural sac.For symptomatic SEACs,the standard treatment is to remove the cyst in total with a(hemi)laminectomy or laminoplasty.We present a rare case of bi-segmental non-communicating SEACs and describe our experience of using an endoscopic minimal access technique to remove bi-segmental non-communicating SEACs.CASE SUMMARY A 79-year-old female presented with pain related to bi-segmental SEACs at the T11-L1 segments.She underwent sequential transforaminal percutaneous endoscopic thoracic cystectomy of the SEACs.Following her first procedure,spinal magnetic resonance imaging demonstrated complete excision of the cyst at the T12-L1 segment.However,the cyst at the T11-T12 segment was still present.Thus,a second procedure was performed to remove this lesion.The patient’s right-sided lumbar and abdominal pain improved significantly postoperatively.Her Japanese Orthopaedic Association score increased from 11 to 25,her visual analogue scale score was reduced from 8 to 1.The physical and mental component summary of the 36-item short-form health survey(SF-36)were 15.5 and 34.375 preoperatively,and had increased to 79.75 and 77.275 at the last follow-up visit,respectively.CONCLUSION Bi-segmental non-communicating SEACs are extremely rare.Endoscopic surgery is a safe,effective,and reliable method for treating these cysts.In the event of bisegmental SEACs,it is important to identify whether both cysts are communicating before surgery,and if not,to remove both cysts separately during the index surgery to avoid re-operation.

Treatment strategy of intracranial arachnoid cysts

Objective To investigate treatment strategy of intracranial arachnoid cysts. Methods 47 cases of Intracranial arachnoid cysts from Sep 1,2010 to Des 1,2010 were analyzed. 25 cases received no intervention but follow . 22 cases received operation,13 of 22 cases neuroendoscopic partial cystectomy and communication between cystic cavity and brain cistern; 7 of 22 cases cysts peritoneal shunt, 2 of 22

The neurosurgical treatment of intracranial arachnoid cysts in child

Objective Arachnoid cysts are non-arachnoid fluid collections that accout for about 1% of all intracranial space-occupying lessions. So far,the optimal method of treatment for symptomatic arachnoid cysts remains controversial. In this article,we want to find an ideal technique

Y-shaped shunt for the treatment of Dandy-Walker malformation combined with giant arachnoid cysts:A case report

BACKGROUND Dandy-Walker malformation(DWM)was first reported in 1914.In this case report,a pediatric case was complicated with giant and isolated arachnoid cysts in the right cerebellar hemisphere along with the typical DWM.CASE SUMMARY The patient was at 20 mo old boy,with the complaint of staggering for more than 2 mo.He was admitted to the hospital due to high intracranial pressure and staggering.At admission,the patient had typical manifestations of high intracranial pressure,including vomiting,poor appetite and feeding difficulty.Physical examination revealed increased head circumference,closed anterior fontanelle,unstable standing,staggering,leaning right while walking and ataxia.After admission,he was diagnosed with DWM accompanied by giant isolated arachnoid cysts in the posterior fossa.He underwent Y-shaped three-way valve repair for treating differential pressure between the supratentorial hydrocephalus and the subtentorial arachnoid cysts at once.The child recovered well after the surgery.CONCLUSION In this case,supratentorial and subtentorial shunts were placed,which solved the problem of differential pressure between the supratentorial and subtentorial parts simultaneously.This provides useful information regarding treatment exploration in this rare disease.

Comparative Study on Two Surgical Procedures for Middle Cranial Fossa Arachnoid Cysts

In this study, we explored the operation options for middle cranial fossa arachnoid cysts （MCFAC）. One hundred and forty-nine patients who were operated for a symptomatic MCFAC between 1993 and 2006 in our hosptial were analyzed. Follow-up time ranged from 1 y to 14 y （mean=5.4 y）. All these patients were divided into three subgroups according to Galassi classification. Long-term outcome and complications were studied respectively. Fenestration （F） resulted in a more favorable long-term outcome and less complication for cysts of types I and Ⅱ, whereas a favorable outcome was noted in type Ⅲ patients who underwent cysto-peritoneal shunting （S）. We are led to conclude that Fenestration is suitable for cysts of types Ⅰ and Ⅱ （Galassi classification）, cysto-peritoneal shunting is better for cysts of type Ⅲ.

Endoscopy-assisted purely total outer wall excision for pediatric Sylvian arachnoid cysts

Background To present a novel endoscopy-assisted surgical strategy of Sylvian arachnoid cysts(ACs).Case presentation Endoscopy-assisted surgery was performed on 9 children(May 2019-December 2021).All patients were evaluated with CT and/or MRI and had regular follow-up examinations.The procedure consisted of performing a small temporal craniotomy(2 cm)behind the hairline.After dural opening,the surgery was performed with the assistance of a rigid 30-degree transcranial endoscope,self-irrigating bipolar forceps,and other standard endoscopic instruments.Steps included total excision of the AC outer wall and dissection of arachnoid adhesion around the cystic edge to communicate the residual cyst cavity with subdural space.Compared with the microscopical procedure,a 30-degree transcranial endoscope provides a wider view,especially for the lateral part exposure of the outer wall.The average age of the patients was 27.7 months(range 13-44 months).The Sylvian AC was in the right hemisphere in three patients and six in the left,respectively.1 patient suffered transient postoperative epilepsy.There was no mortality or additional postoperative neurological deficit in this series.All of the patients achieved significant clinical improvement after surgery.Radiological examination after the operation showed a significant reduction in all cases(100%,9/9)and disappearance in one case(11.1%,1/9).Postoperative subdural fluid collection occurred in six cases and completely resolved spontaneously in 9 months.Conclusion The study demonstrated the minimally invasive,safety,and effectivity of the endoscopy-assisted purely total outer wall excision.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

Perigeniculate arachnoid cysts and CSF fistulae of the fallopian canal:Histopathologic correlates of a rare clinical entity

Cerebrospinal fluid(CSF)fistulae originating from the fallopian canal of the facial nerve is hypothesized to arise due to atypical patterns of subarachnoid space extension into the geniculate ganglion or more distal regions along the intratemporal course of the facial nerve,but its pathogenesis remains poorly understood.Although a rare etiology of CSF fistulae of the temporal bone,there are significant clinical ramifications due to the risk of recurrent meningitis,difficulty in identifying the anatomic location of the CSF leak,and technical challenges associated with surgical repair.We present three clinical cases of arachnoid cysts within the geniculate fossa with or without CSF fistulization and provide histopathologic correlates of this rare clinical phenomenon from a human temporal bone collection.The pediatric and adult patients presented suggest differential pathophysiologic mechanisms associated with CSF fistulae.Temporal bone histology reveals atypical patterns of subarachnoid space extension in the fallopian canal that may underlie arachnoid cyst formation and overt CSF leak from the geniculate region.

Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report

BACKGROUND This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst(IEAC)at the posterior cranial fossa.CASE SUMMARY The clinical information of a patient with an IEAC was reported,and the related literature was reviewed.A female patient with nausea presented to our hospital.Computed tomography demonstrated an IEAC located at the posterior cranial fossa,which was large and required surgical intervention.After operation,postoperative intraparenchymal hemorrhage was detected.She had a good recovery with conservative treatment 1 mo later.CONCLUSION Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC,more attention should be paid to such a complication.

Analysis of cases of self-displaced and healed shunt of arachnoid cyst and review of literature

Objective:To investigate the causes,pathogenesis and prognosis of shunt displacement in arachnoid cyst.Methods:Retrospective analysis was made on the case of the left frontal top arachnoid cyst peritoneal shunt self-extraneous and cured in our hospital in November 2019.Combined with literature review,the treatment and prognosis of shunt displacement after arachnoid cyst peritoneal shunt were discussed.Results:Arachnoid cyst disappeared children heal,clinical symptoms improved,wipe out the shift shunt,literature review arachnoid cyst peritoneal shunt tube shift and recover rare,mainly for the shunt tube distal displacement,falling in the scrotum,emergence anus,and shift to the chest,or even a heart,required reoperation processing,timely deal with good prognosis.Conclusion:Arachnoid cyst peritoneal shunt may be an effective method for the treatment of cerebral convex arachnoid cyst in children,and it also suggests that the shunt tube can be removed after the disappearance of cerebral convex arachnoid cyst.Shunt tube displacement is rare in clinic and needs timely surgical treatment.

Left Temporal Lobe Arachnoid Cyst Presenting with Symptoms of Psychosis

Arachnoid cysts are uncommon benign neurological tumors,and having presentation like schizophrenia,which has been reported in association with this cyst.The presence of psychiatric disturbances of arachnoid cyst has not been clearly mentioned in the literature.Even though,the appearance of some of the references that focuses on a possible link between arachnoid cysts and psychotic symptoms.Here we present a case report of a 35-year-old man,characterized by the insidious onset of psychotic symptoms of varying intensity such as multiple physical assaults on people with stone.Due to organic suspicion one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation.

The therapeutic strategies for the slit ventricle syndrome after cyst-peritoneal shunting for the temporal arachnoid cyst in children:six cases report and literatures review

Objective To investigate early diagnosis evidences,optimal therapeutic strategies and the prophylactic methods of the slit ventricle syndrome (SVS) in the temporal lobe arachnoid cysts patients who received the cyst-peritoneal(CP) shunting. Methods Six cases of SVS in the temporal lobe arachnoid cysts patients

Intra-Sellary Arachniodocele: About a Case at the Medical Clinic “The Stars” of Bamako

Intrasellar arachnoidocele is a herniation of the optochiasmatic cistern through a dehiscence of the sellar diaphragm producing an empty sella turcica, hence its name empty sella turcica syndrome. It is an extremely rare benign malformative pathology. We report a case of intra-sellar arachnoidocele in a 34-year-old woman revealed during an annual control of a sellar mass under dossinex by cerebral magnetic resonance imaging (MRI) which found the cystic formation of liquid signal identical to that of the LCS in hypo signal T1 and hyper signal T2 without enhancement after injection of Gadolinium. The epidemiological, clinical and radiological aspects of arachnoidocele were analyzed. The purpose of this work is to bring the interest of MRI in the management of this pathology.

Chronic subdural hematoma associated with arachnoid cyst:report of two cases

Intracranial arachnoid cysts, which often occur in children （75%）, account for 1% of intracranial masses.The cyst is most commonly located at the middle cranial fossa and more frequently on the left side. The disease is usually asymptomatic, but can become acutely symptomatic because of hemorrhage and cyst enlargement, which may result from minor head trauma and are often complicated with a subdural hematoma. Here we report two cases of intracranial arachnoid cyst associated with ipsilateral chronic subdural hematoma.

Arachnoid cyst complicated with an inner aneurysm:case report

The arachnoid cyst complicated with an inner aneurysm and intracystic hematoma is rarely encountered. In 2005, we treated such a patient by craniotomy through the left pterion approach. The possible causes of the intracysfic hematoma and the reasons of the delay of the diagnosis are discussed.

小儿蛛网膜囊肿术后单侧动眼神经麻痹案

The paper reports a successful case of unilateral oculomotor palsy treated with acupuncture in a Chinese boy aged 5 years and 3 months.Filiform needles were applied for ptosis,ocular motility impairment and blurred vision of the left oculomotor palsy after arachnoid cyst surgery.Two stages of treatment with acupuncture were composed.Acupuncture in the first stage focused on resolving stasis,unblocking meridians and activating qi and blood circulation,especially at the acupoints around the eye,combined with the distal points(four gate points)to enhance qi movement and activate blood circulation,once daily.Besides,the western medicines for nerve nutrition were added.One month later,all the symptoms were alleviated,and the eyelid could be lifted.Then,the second stage of acupuncture started,during which,the western medicine for nerve nutrition was withdrawal,acupuncture was continued with the same acupoints as the first stage,once every two days.Besides,the thumb-tack needle was used to maintain the effect of filiform needle,and Zusanli(ST36)was added to replenish qi of spleen and stomach and promote circulation of meridians.Another month later,the lift of the left eyelid and the ocular motility were basically symmetrical to the right eye,and the left eye vision returned normal.Follow-up until the time of publication,the motility and function of the affected eye were basically the same as those of the healthy side.This case suggests that the staged intervention with acupuncture could be effective in child with unilateral oculomotor palsy after arachnoid cyst surgery and were acceptable for child.Further studies are needed to confirm the effect and mechanism of acupuncture intervention on postoperative oculomotor palsy.

Differential diagnosis of arachnoid cyst from subarachnoid space enlargement by phase-contrast cine MRI

Objectives To reveal the relationship of brain motion and cerebrospinal fluid (CSF) flow by phase-contrast cine MRI, and to evaluate this technique in differentiating between arachnoid cysts and subarachnoid space enlargement. Methods Using a phase-contrast cine MRI pulse sequence, we measured brain motion and CSF flow during the cardiac cycle in 10 healthy volunteers and 10 patients with MRI-suspected arachnoid cyst or subarachnoid space enlargement. CSF stroke volume curve was illustrated according to flow quantification, and time-signal intensity curve was traced. The two curves were compared. Results This study showed that brain motion was due to the volume difference between arterial and venous blood flow during a cardiac cycle, and thus drives CSF pulsation. Arachnoid cysts and subarachnoid space enlargement carried different curve patterns, demonstrating that phase-contrast MRI and flow quantification can be a useful and reliable technique for non-invasive evaluation of brain motion and CSF flow. Conclusion Arachnoid cysts can be successfully differentiated using phase-contrast cine MRI from subarachnoid space enlargement.