Temporal arachnoid cysts: are they congenital?

CASE REPORT: The authors report two cases of arachnoid cysts (ACs) neither detected during pregnancy nor shortly after birth when newborns underwent CT scan evaluation after birth head trauma. ACs were diagnosed at 10 months and 6 years, respectively. The first one becomes symptomatic, and the other one was incidentally found during a head trauma investigation. DISCUSSION: These cases give support for the postnatal pathogenesis for some of the assumed congenital ACs. We collected data from the literature that supports the acquired hypothesis for ACs.

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.

[Microsurgical treatment of intracraneal arachnoid cysts]. / Tratamiento microquirúrgico de los quistes aracnoideos intracraneales.

Craniotomy and fenestration of membranes is one of the main treatment options for symptomatic arachnoid cysts. Open surgery advantages include, direct inspection of the cyst, biopsy sampling, fenestration in multilocular cysts and, in certain locations, cyst communication to basal cisterns. The aim of this paper is to review the advantages and disadvantages of this treatment modality for arachnoid cysts taking into account the different anatomical locations.

[Arachnoid cysts. Historical evolution of the concept and pathophysiological theories]. / Quistes aracnoideos. Evolución histórica del concepto y teorías fisiopatológicas.

Arachnoid cysts of central nervous system are benign collections filled with a liquid that is equal o similar to cerebrospinal fluid, coated with a single layer or flattened arachnoid cells membrane, congenital or secondary to trauma, meningitis or hemorrhage. First described by Bright in 1931, its definition and possible pathophysiology has been debated to date. Our objective is to present a summary of this process.

[Imaging diagnosis of arachnoid cysts]. / Diagnóstico por imagen de los quistes aracnoideos.

Arachnoid cysts are malformed lesions that contain a fluid similar to the cerebrospinal fluid, and are usually located within the arachnoidal membrane. They represent 1% of all intracranial lesions, and in recent years, with the development of radiological techniques, the clinical detectability of arachnoid cysts seems to have increased. Although the majority of diagnosed arachnoid cysts are located in the cranial cavity and especially in the Sylvian fissure, a small number are located at spinal level and they can occur extra- or intra-spinally. An analysis is carried out, detailing the various tests used for the diagnosis of both intracranial and spinal arachnoids cysts, analysing the indications of each one depending on the location of the cysts and patient age.

Corrigendum: Effect comparison of neuroendoscopic vs. craniotomy in the treatment of adult intracranial arachnoid cyst.

[This corrects the article DOI: 10.3389/fsurg.2022.1054416.].

Computerized Tomography Texture Analysis in the Differential Diagnosis of Intracranial Epidermoid and Arachnoid Cysts.

PURPOSE: This study evaluated the differences between arachnoid and epidermoid cysts in computerized tomography (CT) texture analysis (TA). MATERIAL AND METHODS: The study included 12 patients with intracranial epidermoid cysts and 26 patients with intracranial arachnoid cysts who were diagnosed with diffusion-weighted magnetic resonance imaging (DW-MRI) and who had undergone an unenhanced CT examination before treatment. The LIFEx application software was used to obtain texture features. Eighty-two texture features from 38 lesions were automatically calculated for each lesion. The Shapiro-Wilk test was used to test the normality of the scores, and the Mann-Whitney U Test was used to test the difference between the groups. Receiver operating characteristic (ROC) curves and multivariate logistic regression modeling examined the parameters' diagnostic performances. RESULTS: The median age of the patients was 53 years (range: 19-88 years). Eighty-two texture parameters were evaluated in the first order: gray-level co-occurrence matrix (GLCM), gray-level run length matrix (GLRLM), neighbor gray-tone difference matrix (NGTDM), and gray-level size zone matrix (GLSZM) groups. There was a statistically significant difference between the arachnoid cyst and the epidermoid cyst in the variables of compacity, compactness 1, compactness 2, sphericity, asphericity, sum average, coarseness, and low gray-level zone (p<0.05). According to the multiple logistic regression model, it was determined that the sum average in the GLCM group (B=-0.11; p=0.015), coarseness (B= 869.5; p=0.044) in the NGTDM group, and morphological sphericity (B=24.18; p=0.047) were the radiomics variables that increased the probability of epidermoid diagnosis. According to the classification table of the model, the sensitivity rate was found to be 83%, and the specificity rate was found to be 96%. Therefore, the probability of accurate model classification was 92%. CONCLUSION: CT TA is a method that can be applied with high diagnostic accuracy in the differential diagnosis of intracranial epidermoid and arachnoid cysts, especially in patients who cannot undergo an MRI examination.

A rare case of pediatric ptosis: Coexistence of giant intracranial arachnoid cyst and facial asymmetry.

BACKGROUND: Intracranial arachnoid cysts are cystic congenital malformations, filled with cerebrospinal fluid (CSF) originating from the arachnoid membrane. Generally, giant arachnoid cysts present with symptoms related to increased intracranial pressure, hydrocephalus or cognitive disorders, endocrinological problems, growth retardation, seizures, headache, and nonspecific symptoms such as dizziness. They can be detected by imaging when they become symptomatic or incidentally in childhood and adulthood. Our case was referred to our clinic because of ptosis and facial asymmetry found on examination. Subsequently, a intracranial giant arachnoid cyst was found incidentally on cranial computed tomography (CT). CASE: In an 18-month-old male infant admitted with ptosis, left frontal bulging and a dystopic globe with ptosis of the left upper lid were noted. The left half of the facial region and the left nostril also appeared to be asymmetrically elongated downward relative to the right. Fundus examination revealed an optic disc coloboma in the left eye. On general physical examination, he was unable to walk. A giant fronto-temporo-parietal arachnoid cyst with the cerebral parenchyma shifted 2cm to the right of the midline was observed on cranial CT. After a cysto-peritoneal shunt was performed, the physical appearance of our patient returned to normal. CONCLUSION: Ptosis cases accompanied by abnormalities such as optic disc coloboma and facial asymmetry should be evaluated for possible midline defects and intracranial pathologies prior to eyelid surgery.

Effect comparison of neuroendoscopic vs. craniotomy in the treatment of adult intracranial arachnoid cyst.

Purpose: Intracranial arachnoid cysts are common, accounting for about 1%-2% of intracranial space-occupying lesions. There is controversy over the method of surgical intervention, and in order to provide guidance for surgical decision making, this study compares the efficacy of craniotomy vs. neuroendoscopic surgery in treating arachnoid cysts. Methods: The adult patients with arachnoid cyst admitted to our department from October 2016 to August 2021 were retrospectively analyzed. Thirteen adult patients were recruited, and divided into two groups: neuroendoscopic group (group A) and craniotomy group (group B). We compared the gender, age, clinical symptoms, preoperative and postoperative cyst sizes, symptom improvement, complications, length of hospital stay, and hospital costs between two groups to analyze the therapeutic effects of these two surgical methods. Results: The cost of hospitalization in group A was significantly lower than that in group B (47,292.8 vs. 65,151.8 yuan, P < 0.05), and there was no difference in the length of hospital stay between the two groups. The preoperative cysts in group A were significantly larger than those in group B (6.38 vs. 2.97 cm, P < 0.05). In groups A and B, the short-term symptom improvement rates were 100% and 75.0%, respectively. The long-term symptom improvement rates were 77.78% and 75.0% (P > 0.05), respectively. Conclusion: Both neuroendoscopic and craniotomy have good curative effects for the treatment of intracranial arachnoid cysts. There was no significant difference in the outcomes between the two surgical techniques. The cost of hospitalization can be reduced with neuroendoscopic surgery. Neuroendoscopic treatment is recommended for large intracranial arachnoid cysts, and craniotomy is suitable for small intracranial arachnoid cysts.

What provokes a disappearing arachnoid cyst? - Case study and literature review.

OBJECTIVE: Intracranial Arachnoid cysts (AC) are stable cerebral spinal fluid (CSF)-filled sacs that can rarely undergo progressive shrinkage or disappearance throughout life. In this manuscript, we present a case of post-traumatic complete resolution of an AC, review the possible triggers of this phenomenon, and discuss the pathophysiological mechanisms behind them. METHODS: After presenting our case, we performed a literature review using the PubMed Database of all the reported cases of AC reduction or resolution (last updated in February 2021). Spontaneous cases were excluded. An analysis of the remaining cases (1985-2021) according to their inciting event, demographical, and clinical characteristics was then presented. RESULTS: 58 patients were identified, 33 of which spontaneously resolved. The remaining 25 were included in the survey in addition to the case we presented. The mean age was 20.2 years, average time to resolution was 25.3 months, with only two third of the cases showing complete disappearance of the AC. A central nervous system infection was the inciting cause of resolution in one infant (4%), a history of head trauma in 16 (62%) patients and an intracranial procedure in 9 (35%) patients. DISCUSSION: AC disappearance is a rare phenomenon that can occur spontaneously or after an inciting event. The cyst wall rupture and CSF flow perturbation theories seem to be the most applicable pathophysiological mechanisms in triggered AC resolution.

A rare giant intracranial arachnoid cyst confused the diagnosis and treatment of Wilson disease.

Background: Hepatolenticular degeneration (HLD), also known as Wilson disease (WD), is a rare autosomal-recessive hereditary disease, which is often missed and misdiagnosed because of its various clinical manifestations. And WD is even more rare with giant subarachnoid cysts. In this report, we will provide a case of WD with an intracranial arachnoid cyst (IAC). Case description: A 27-year-old woman was hospitalized in a traditional Chinese medicine hospital in Guangzhou with the first manifestation of a "slight involuntary tremor of her left upper limb". There was no improvement after acupuncture treatment, and then she was transferred to another large general hospital in Guangzhou. MRI examination of the head showed "left frontal, parietal and temporal giant subarachnoid cyst" and the patient underwent "left frontotemporal arachnoid cyst celiac shunt operation." After the operation, the patient's left limb shaking remained unchanged. Subsequently, the patient was referred to another big hospital in Guangzhou, considered "Parkinson's disease," and given "Medopa, Antan" and other treatments. However, the patient's limb shaking continued to increase and gradually developed to the extremities. At last, the patient was referred to our hospital, combined with the medical history, neurological signs, and auxiliary examination results, improve the examination of corneal K-F ring, blood ceruloplasmin, gene screening, and other tests; the diagnosis was confirmed as hepatolenticular degeneration. Conclusion: After expelling copper and symptomatic treatment, the condition is improved.

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.

Association between ELP4 rs986527 polymorphism and the occurrence and development of intracranial arachnoid cyst.

OBJECTIVE: The association between ELP4 rs986527 polymorphism and the occurrence and development of intracranial arachnoid cyst was studied in this paper. METHODS: Eighty-five patients diagnosed with intracranial arachnoid cysts by cerebral computed tomography scan were selected. Sixty-three healthy volunteers for medical examination in hospitals served as controls. The cognition, depressive symptoms, and the likelihood of headache, dizziness, head trauma history, dementia, depression, and epilepsy were assessed. ELP4 genotypes and its allele frequency were determined by PCR, endonuclease restriction analysis, and gel electrophoresis. RESULTS: ELP4 rs986527 had three genotypes: TT, TC, and CC. The intracranial arachnoid cyst group showed no statistically significant difference in genotype frequencies compared with healthy controls. There was no significant correlation between ELP4 rs986527 polymorphism and location of intracranial arachnoid cyst. TC and C genotype frequencies were associated with a higher incidence of clinical symptoms than TT genotype frequencies, and C allele frequencies were associated with a significantly higher incidence of clinical symptoms compared with T allele frequencies. There was no significant difference in TNF-α and IL-1ß levels between TT/TC/CC genotypes before treatment. After treatment, the levels of TNF-α and IL-1ß were significantly decreased in different genotypes, and the decrease in CC was the greatest. The frequency of TT and TC genotypes was higher than that of CC genotypes. CONCLUSION: ELP4 rs986527 polymorphism affected the incidence of clinical symptoms and the levels of TNF-α and IL-1ß in patients with intracranial arachnoid cysts.

Neurological Fallacies Leading to Malpractice: A Case Studies Approach.

A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myths. Myths that may lead not only to misdiagnosis and treatment harms but to seemingly never-ending medical malpractice lawsuits, potentially culminating in a settlement or judgment against an unsuspecting neurologist. This article provides a case studies approach exposing the fallacies and highlighting proper management of these common neurologic presentations.

Clinical and radiological outcomes of surgical treatment for symptomatic arachnoid cysts in adults.

We retrospectively analyzed 63 patients (31 males and 32 females) with arachnoid cysts managed over a 15 year period at our institution. Surgical indications and modalities for the treatment of intracranial arachnoid cysts are controversial, although endoscopic fenestration is often recommended as a standard procedure. In our cohort, clinical postoperative results and radiological assessments based on the presenting symptoms, cyst location, cyst volume and surgical modalities were recorded. The most common symptoms included headaches (66.7%), dizziness (46%) and seizures (36.5%). Cyst wall excision with microsurgical craniotomy was carried out in 28 patients (44.4%), cyst fenestration in 16 (25.4%), cystoperitoneal or ventriculoperitoneal shunting in 15 (23.8%) and endoscopic fenestration in four patients (6.3%). A satisfactory clinical outcome was achieved in 51 patients (80.9%) and cyst reduction was achieved in 49 (77.8%), at the last follow-up. Clinical improvement correlated significantly with volume reduction in patients with suprasellar and infratentorial cysts (r=0.495; p=0.022) while a similar result was not found after surgery in patients with frontal and temporal cysts. Surgical complications were not correlated with surgical modalities, occurring in only seven patients (11.1%). The various surgical modalities did not influence outcomes. Patients with nonspecific symptoms such as headache may obtain favourable outcomes from surgical treatment with no severe complications, although, intracranial hypertension and neurological deficits are more definite surgical indications for arachnoid cysts.

Intracranial arachnoid cyst associated with traumatic intracystic hemorrhage and subdural haematoma.

BACKGROUND: Brain arachnoid cysts are fluid collections of developmental origin. They are commonly detected incidentally in patients imaged for unrelated symptoms. CASE DESCRIPTION: A 15-year-old healthy boy with a recent history of head trauma experienced headache that gradually worsened over the course of 10 days. He underwent CT and MRI brain scans which revealed the presence of subdural haematoma caused by the rupture of a middle cranial fossa arachnoid cyst. This was accompanied by intracystic haemorrhage. The subdural haematoma was removed, while communication of the cyst with the basal cisterns was also performed. The postoperative course of the patient was uneventful. CONCLUSIONS: The annual haemorrhage risk for the patients with middle cranial fossa cysts remains very low. However, when haemorrhage occurs, in most occasions it can be effectively managed only with haematoma evacuation.