Management of Neonatal Facial Paralysis due to Cerebellopontine Angle Arachnoid Cyst: A Case Report.

Arachnoid cysts are benign, cerebrospinal fluid-filled collections that can be located in the brain or spinal cord. Arachnoid cysts form approximately 1% of all intracranial lesions. They are accepted as arachnoid developmental anomaly and arise from membrane splitting or duplication. Generally, lesion growth causes symptoms because of mass effect or obstruction. Arachnoid cyst growing mechanisms are a largely controversial issue. We report the case of a neonatal female patient who presented with congenital facial paralysis. Magnetic resonance imaging showed a right cerebellopontine angle arachnoid cyst causing severe mass effect on the brain stem. Cyst fenestration and cystocisternal shunt was performed through retrosigmoid suboccipital craniotomy.

Cystic Abnormalities of the Spinal Cord and Vertebral Column.

Cystic lesions of the vertebral column and spinal cord are important differential diagnoses in dogs with signs of spinal cord disease. Synovial cysts are commonly associated with degenerative joint disease and usually affect the cervical and lumbosacral regions. Arachnoid diverticulum (previously known as cyst) is seen in the cervical region of large breed dogs and thoracolumbar region of small breed dogs. This article reviews the causes, diagnosis, and treatment of these and other, less common, cystic lesions.

Congenital left temporal large arachnoid cyst causing intraorbital optic nerve damage in the second decade of life.

AIM: Intracranial sylvian arachnoid cysts are often asymptomatic lesions. We present a 16-year-old female patient with progressive loss of vision together with an unusual visual field defect on the left eye accompanied by headache. METHOD: A left frontotemporal sylvian arachnoid cyst was known since she was 9 months old, but observed ever since in the asymptomatic patient. Now, ophthalmological examination revealed bi-upper quadrant anopia on the left eye. Magnetic resonance imaging (MRI) and computed tomography showed erosion of the lateral orbital wall associated with intraorbital compression of the optic nerve by the cyst at the entrance into the optic canal. Microsurgical cyst fenestration to the basal cisterns was performed using a temporal mini-craniotomy. RESULT: Full improvement of vision and visual field defects was observed in the follow-up. On postoperative MRI, an increase of the tissue surrounding the optic nerve in the conus and better delineation at the entrance of optic canal was noted. CONCLUSION: Long-standing asymptomatic sylvian arachnoid cysts may suddenly produce severe unilateral visual deficits if the cyst erodes the lateral orbital wall. These deficits may rapidly revert to normal if surgical action is not delayed. If surveillance MRIs of sylvian arachnoid cysts show a narrowing of the conus diameter compared to the contralateral side, a yearly ophthalmological surveillance examination seems to be warranted in else wise asymptomatic patients.

Intracranial Intra-arachnoid Diverticula and Cyst-like Abnormalities of the Brain.

Primary intracranial cystic or cyst-like lesions include intra-arachnoid, epidermoid, dermoid, and choroid plexus cysts. Differentiation of these cystic lesions can usually be accomplished by imaging studies alone; however, some cysts are similar in appearance and require histopathology for definitive diagnosis. Clinical signs often reflect the location of the cysts within the intracranial cavity rather than the type of cyst. If clinical signs are significant and progressive, surgical removal is warranted and may be successful, although cystic contents could be harmful if allowed to contact surrounding brain parenchyma or meninges.

Congenital basis of posterior fossa anomalies.

The classification of posterior fossa congenital anomalies has been a controversial topic. Advances in genetics and imaging have allowed a better understanding of the embryologic development of these abnormalities. A new classification schema correlates the embryologic, morphologic, and genetic bases of these anomalies in order to better distinguish and describe them. Although they provide a better understanding of the clinical aspects and genetics of these disorders, it is crucial for the radiologist to be able to diagnose the congenital posterior fossa anomalies based on their morphology, since neuroimaging is usually the initial step when these disorders are suspected. We divide the most common posterior fossa congenital anomalies into two groups: 1) hindbrain malformations, including diseases with cerebellar or vermian agenesis, aplasia or hypoplasia and cystic posterior fossa anomalies; and 2) cranial vault malformations. In addition, we will review the embryologic development of the posterior fossa and, from the perspective of embryonic development, will describe the imaging appearance of congenital posterior fossa anomalies. Knowledge of the developmental bases of these malformations facilitates detection of the morphological changes identified on imaging, allowing accurate differentiation and diagnosis of congenital posterior fossa anomalies.

Visual evoked potentials in a diagnosis of a visual pathway dysfunction of a child with an arachnoid cyst.

PURPOSE: The aim of this case report was to demonstrate the usefulness of the flash visual evoked potentials in monitoring the effects of intracranial hypertension in a preterm-born child with a congenital arachnoid cyst. METHODS AND RESULTS: At baseline, abnormalities were found in the right eye: exotropia and lack of foveal fixation. Visual acuity was not achieved. Pupillary responses were normal in both eyes. There was no evidence of nystagmus. Flash visual evoked potentials were normal and equal in both eyes. When repeated one year later the signal had deteriorated in both eyes; the peak times of N2 and P2 had increased. The increased VEP latencies were the only ocular signs noted. After referral to neurosurgery, intracranial hypertension was found and a shunt was performed. CONCLUSIONS: Flash visual evoked potentials may be a valuable test in monitoring patients with arachnoid cysts.

The supposed intracavernous sinus arachnoid cyst with abducens neuropathy: a case report.

Intracavernous sinus arachnoid cysts are rare intracranial congenital lesions. When present, their anatomic location frequently results in cranial nerve palsy. A 15-year-old boy was admitted to our hospital with diplopia, which had gradually worsened over the previous several months. An arachnoid cyst was identified within the right cavernous sinus and fenestration surgery was performed. The patient recovered well and three months after the surgery, diplopia was disappeared. Surgical decompression of the intracavernous sinus arachnoid cyst is beneficial for symptomatic patients with this condition.

[Congenital medulloblastoma associated with intracranial arachnoid cyst]. / Meduloblastoma congénito asociado a quiste aracnoideo intracraneal.

Arachnoid cysts are very common lesions in paediatric patients, with treatment depending on their location and symptomatology. They are usually solitary cysts but may be associated with other central nervous system diseases such as tumours and congenital deformities. We describe the case of a neonate diagnosed with an arachnoid cyst of the quadrigeminal cistern treated by endoscopy. After the operation, the child's condition worsened; a CT scan revealed a midline posterior fossa tumour not visible in the preoperative neuroradiological tests. The tumour, a medulloblastoma, was partially removed. Given the child's age and the poor prognosis, oncological treatment was not undertaken. The association between medulloblastoma and arachnoid cyst is very rare, and we could find only one such case in the literature.

Haga su diagnóstico / Make your diagnosis

El diagnóstico es Quiste aracnoideo de la fosa media con extensión a la fosa anterior Galassi III

Congenital intradiploic arachnoid cyst presenting as painless proptosis.

A 12-year-old girl presented with several years of progressive painless proptosis and orbital fullness. On imaging, she was found to have marked expansion and remodeling centered in the right greater wing of the sphenoid bone with an adjacent middle cranial fossa arachnoid cyst. A clinical diagnosis of intradiploic arachnoid cyst was made. This entity was benign, and other ophthalmic and neurologic signs or symptoms were absent. Our patient was observed without surgical intervention. To our knowledge, this is the first such case reported in a child. Although this cyst has been described in the occipital and frontal bones, this is the first description of occurrence in the sphenoid bone.

[The outcome of children presenting with a prenatally diagnosed arachnoid cyst]. / Devenir des enfants présentant un kyste arachnoïdien de diagnostic anténatal.

AIM: Evaluate the outcome of children with prenatally diagnosed arachnoid cysts. MATERIAL AND METHODS: Retrospective study of seventeen cases of children who were diagnosed with an arachnoid cyst during prenatal MRI between July 1994 and January 2007 and followed up for a mean 6 years and 6 months. Follow-up was based on evaluation of clinical files and contacts with the physicians who were following the children. The children were divided into three groups: group 1 normal development, group 2: minor clinical signs, normal schooling, group 3: major clinical symptoms, schooling disturbed. RESULTS: Eight of the 17 patients included in this study underwent derivation surgery for the cyst. Eight of the 17 children were in group 1, and 3 in group 2. Four of the 6 children in group 3 had associated symptoms. Two of the children in group 3 present with a supratentorial cyst, and 4 with a cyst of the posterior fossa. CONCLUSION: The prenatal diagnosis of a arachnoid cyst should be accompanied by a search for associated lesions. The risk of hydroencephalitis should be explained to the parents.

Symptomatic isolated lumbar interdural arachnoid cyst.

A 72-year-old man presented with an extremely rare case of symptomatic isolated lumbosacral interdural arachnoid cyst manifesting as pain and weakness in the right buttock and lower extremity that had aggravated for 2 weeks. Although the surgical strategy for the interdural cyst was not complicated, the origination of the cyst was not clearly understood. Surgery found an isolated membrane of the cyst inside double-layered dura without communication with the intact arachnoid membrane. Cerebrospinal fluid with hemorrhage accumulated within the interdural cyst indicated recent bleeding into the cyst. Our experience suggests that this cyst was congenital based on the surgical results and imaging studies.

A rare brain developmental anomaly in a patient with Usher's syndrome.

We report a rare brain developmental anomaly in Usher's syndrome. We present a 43-year-old male with visual disturbance, hearing loss, and headache. Retinitis pigmentosa and sensorineural hearing loss were determined and he was diagnosed with Usher's syndrome according to the clinical findings. Magnetic resonance imaging showed an arachnoid cyst on the left temporal lobe, cavum septum pellucidum et vergae. Uneventful cataract surgery was performed in both eyes. He was suggested to be followed up periodically for the arachnoid cyst and to use a hearing device. Although auditory and visual disturbances are the typical findings of this syndrome, it may affect other parts of the central nervous system as well. Morphological abnormalities of central nervous system and related disorders can be seen in patients with Usher's syndrome.

Asymptomatic huge congenital arachnoid cyst successfully treated by endoscopic surgery--case report.

A female neonate was the first child of a 30-year-old mother, with unremarkable medical history. Prenatal ultrasonography performed at 36 weeks of gestation suggested intracranial mass lesion. The baby was delivered by cesarean section at 41 weeks of gestation because of bradycardia and asphyxia. The birth weight, height, and head circumference were within the normal ranges with soft fontanels. Congenital anomaly was not observed with normal neurological findings. She was referred to our department at age 5 months. Physical examination revealed normal developmental milestones and intact endocrinological function without macrocephaly. Cerebral magnetic resonance (MR) imaging revealed a unilocular huge cyst appearing as homogeneously hypointense on T(1)- and hyperintense on T(2)-weighted images, and extending into the basal, suprasellar, ambient, quadrigeminal, interpeduncular, prepontine, right cerebellopontine angle, and premedullary cisterns. The pituitary stalk was markedly stretched and displaced ventrally, and the brainstem was displaced dorsally by the cyst. No other brain anomalies, dysgenesis of the corpus callosum, or ventriculomegaly were recognized. Neuroendoscopic cystocisternostomy was performed to form a communication between the cyst cavity and premedullary cistern. Pressurized watery fluid was released on puncturing the cyst wall which consisted of transparent membrane. Surveillance MR imaging at 2 and 9 months after the surgery revealed remarkable regression without regrowth of the cyst. She remained in good condition and showed normal development during the follow up for 1 year 9 months. Less invasive prophylactic surgery using the neuroendoscope may be beneficial for carefully selected cases of asymptomatic neonatal arachnoid cysts.