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1.
No Shinkei Geka ; 48(11): 1059-1065, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199664

RESUMO

Intracranial arachnoid cysts(ACs)are thought to develop during infancy and remain clinically asymptomatic in most cases. AC is often diagnosed incidentally during imaging studies. The prognosis for the recovery of newly developed symptoms is usually favorable. However, the prognosis following surgery for chronic symptoms is still unclear. Herein, we report the case of an adult patient with right convexity AC whose chronic symptoms improved after surgery. The patient was a 63-year-old woman who had an AC in her right temporal convexity since the age of 59, without any symptoms, which was incidentally diagnosed on MRI. At 61 years of age, she visited a hospital complaining of slight weakness in her left upper limb. No changes were found on the MRI scan, but her visual field indicated the presence of a left homonymous hemianopia, and her cognitive function had decreased slightly. Two years later, she developed modest left hemiparesis;therefore, she underwent cystoventriculostomy to improve the symptoms of hemiparesis. After the surgery, the left hemiparesis recovered fully, and a remarkable improvement was noted in the left homonymous hemianopia and the degenerated cognitive functions. There are no clear guidelines regarding the surgical indications for AC in adults. Many reports suggest that new symptoms related to AC can be improved with surgery. However, amelioration of chronic symptoms has rarely been reported. The present case indicates that it is possible to improve the chronic symptoms of AC in adults with surgical procedures.


Assuntos
Cistos Aracnóideos , Adulto , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Encéfalo , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paresia
2.
Niger J Clin Pract ; 23(11): 1572-1577, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221784

RESUMO

Aims: The present study aimed to evaluate the clinical usefulness of endoscopic treatment of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus and discuss the clinical features and outcomes of thirteen children treated at our institution. Method: We treated thirteen pediatric cases of suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus between January 2012 and September 2018. Five female and eight male patients were enrolled in the study. The patients had increased intracranial pressure symptoms due to hydrocephaly. Endoscopic treatment was performed in all cases. Results: The patients were followed-up for an average of 36.8 months. The postoperative intracranial pressure findings improved. There was a reduction in the size of the cyst and ventricles and enlargement of the cortical sulci. One patient suffered transient oculomotor nerve deficit. No further surgical interventions, such as shunt placement, were required during the follow-up period. The head circumference of two of the patients with macrocephaly were stable during the follow-up. There were no postoperative recurrences detected. Conclusions: Endoscopic cyst fenestration and third ventriculostomy are less invasive, safer, and more effective ways to treat suprasellar arachnoid cysts indenting the third ventricle with obstructive hydrocephalus in children with hydrocephaly.


Assuntos
Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Endoscopia/métodos , Hidrocefalia/cirurgia , Terceiro Ventrículo/cirurgia , Ventriculostomia/métodos , Adolescente , Cistos Aracnóideos/patologia , Cistos do Sistema Nervoso Central/patologia , Ventrículos Cerebrais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Hipertensão Intracraniana , Pressão Intracraniana , Masculino , Recidiva Local de Neoplasia , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Resultado do Tratamento
3.
No Shinkei Geka ; 48(10): 949-955, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071232

RESUMO

Cerebral aneurysms and arachnoid cysts are relatively common cerebral malformations and the use of recent modalities has increased their detection rates. However, cerebral aneurysms associated with arachnoid cysts are unusual. We describe two cases of ruptured cerebral aneurysms associated with arachnoid cysts. According to previous reports, clinical presentation may sometimes be unusual, as cysts can prevent subarachnoid hemorrhage. Moreover, in some cases, CT may reveal typical arachnoid cysts without subarachnoid hemorrhage, without intracystic hematoma, or with subdural hematoma alone. These clinical presentations and radiologic findings can lead to delayed diagnosis of subarachnoid hemorrhage. Therefore, we should consider the coexistence of arachnoid cyst in case of a warning sign of aneurysm rupture.


Assuntos
Aneurisma Roto , Cistos Aracnóideos , Aneurisma Intracraniano , Hemorragia Subaracnóidea , Aneurisma Roto/complicações , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Hematoma Subdural , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/cirurgia
5.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 165-72, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193897

RESUMO

INTRODUCCIÓN: La neuroendoscopia se ha posicionado como un tratamiento eficaz y seguro en los quistes aracnoideos en la edad pediátrica. Realizamos una revisión de los pacientes pediátricos con quistes aracnoideos tratados mediante neuroendoscopia en nuestro servicio y analizamos los resultados. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 20 pacientes intervenidos entre los años 2005 y 2018. Las variables recogidas son: género, edad, presentación clínica, localización del quiste, presencia de hidrocefalia o colecciones extraaxiales, maniobras endoscópicas realizadas y complicaciones. Se consideró éxito del procedimiento cuando se produjo mejoría de los síntomas y reducción del tamaño del quiste, manteniéndose esta situación hasta final de seguimiento. RESULTADOS: La serie consta de 13 varones y 7 mujeres (edad media: 64,6 meses; rango 4-172 meses). La localización más repetida fue supraselar/prepontina (7), seguida de intraventricular (6), después cuadrigeminales (3), interhemisféricos (2) y silvianos (2). Un 70% (14/20) de pacientes asociaba hidrocefalia en el momento del diagnóstico, elevándose hasta el 85% en quistes supraselares/prepontinos o el 100% en cuadrigeminales. Solo 4/14 pacientes precisaron un sistema de derivación ventriculoperitoneal (mediana de edad al diagnóstico: 12,5 meses). De estos 4, 3 desarrollaron un sobredrenaje valvular grave. Se consideró éxito del procedimiento en 12/20 pacientes (60%) de la serie. Diferenciando por localización: 4/7 en supraselares (57%), 1/3 en cuadrigeminales (33%), 4/6 en intraventriculares (66%), 2/2 en interhemisféricos (100%) y 1/2 en silvianos (50%). Por tanto, se registraron 8 fallos de tratamiento, con un tiempo medio hasta el fallo de 12,12 meses (rango: 0-45). De esos 8 pacientes, en 4 se realizó una nueva neuroendoscopia (éxito de 2/4), en 2 casos se optó por la colocación de derivación ventriculoperitoneal, en un caso por la colocación de derivación cistoperitoneal y en el restante se mantuvo una actitud conservadora. El seguimiento medio fue de 52,45 meses (rango 3-129 meses). CONCLUSIONES: El tratamiento neuroendoscópico es efectivo y seguro en el tratamiento de los quistes aracnoideos en edad pediátrica, permitiendo además en muchos casos el control de la hidrocefalia asociada. El tipo de procedimiento neuroendoscópico y el porcentaje de éxito dependen de la localización del quiste. Se observa una tendencia de mayor dependencia valvular en pacientes de menor edad. En esos casos, sería recomendable la aplicación de medidas de prevención de sobredrenaje


INTRODUCTION: Neuroendoscopy has become an effective and safe treatment for arachnoid cysts in the paediatric population. We review the paediatric patients with arachnoid cysts treated by neuroendoscopy in our hospital and analyse the results. MATERIAL AND METHODS: A retrospective analysis of 20 patients operated on from 2005 to 2018. The variables assessed are: gender, age, clinical presentation, cyst site, presence of hydrocephalus and/or extra-axial collections, endoscopic procedures and complications. Procedure success is defined as an improvement in symptoms and reduction in cyst size until end of follow-up. RESULTS: Our series comprised 13 males and 7 females (mean age: 64.6 months, range: 4-172 months). The most frequent site was suprasellar-prepontine (7), followed by intraventricular (6), quadrigeminal (3), interhemispheric (2) and Sylvian (2). A total of 70% (14/20) of patients had hydrocephalus at diagnosis, which increased to 85% in suprasellar-prepontine cysts and 100% in quadrigeminal cysts. Only 4/14 patients with required a ventriculoperitoneal shunt (median age at diagnosis: 12.5 months). Of these 4 patients, 3 developed severe shunt overdrainage. The procedure was successful in 60% (12/20) of the patients in the series. Success by location was 57% (4/7) in suprasellar cysts, 33% (1/3) in quadrigeminal cysts, 66% (4/6) in intraventricular cysts, 100% (2/2) in interhemispheric cysts and 50% (1/2) in Sylvian cysts. Treatment thus failed in 8 cases, with a mean time to failure of 12.12 months (range: 0-45 months). A new neuroendoscopic procedure was performed in 4 of these 8 cases (success in 2/4), a ventriculoperitoneal shunt was placed in 2 cases, a cystoperitoneal shunt was placed in 1 case and the remaining case was managed conservatively. Mean follow-up time was 52.45 months (range: 3-129 months). CONCLUSIONS: Neuroendoscopy is an effective and safe treatment for arachnoid cysts in paediatric patients that also enables managing associated hydrocephalus in most cases. The choice of neuroendoscopic procedure and success rate depend on cyst location. Younger patients have been found to have a higher shunt dependency rate. In these cases, measures to prevent shunt overdrainage are recommended


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Estudos Retrospectivos , Cistos Aracnóideos/complicações , Hidrocefalia/complicações , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Ventrículo Cerebral/cirurgia
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 195-200, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193900

RESUMO

Los quistes aracnoideos espinales son entidades raras y casi siempre tienen una etiología congénita o espontánea. Los casos secundarios son muy poco frecuentes y muchas veces constituyen una causa de deterioro neurológico tras varios meses o años de un traumatismo espinal. Presentamos el caso de un varón diagnosticado de quiste aracnoideo espinal de etiología traumática, agrupamos los casos descritos hasta el momento en la literatura y revisamos las distintas opciones quirúrgicas relacionándolas con las teorías fisiopatológicas que tratan de explicar la génesis de estas lesiones


Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions


Assuntos
Humanos , Masculino , Idoso , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Cistos Aracnóideos/cirurgia , Cistos Aracnóideos/etiologia , Cistos Aracnóideos/diagnóstico , Dor Lombar/etiologia , Espectroscopia de Ressonância Magnética , Distúrbios Somatossensoriais/diagnóstico por imagem , Propriocepção
7.
World Neurosurg ; 142: 222-226, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32615296

RESUMO

BACKGROUND: Spinal extradural arachnoid cyst is an uncommon cause of spinal cord compression. It results from a small dural defect that leads to cerebrospinal fluid (CSF) accumulation in the cyst and subarachnoid space, and the cyst can compress the spinal cord and nerve roots. Surgery is the treatment of choice in symptomatic patients, and most cases have an immediately satisfying outcome after surgery. CASE DESCRIPTION: A 10-year-old Thai boy presented with progressive weakness in both legs. Magnetic resonance imaging (MRI) demonstrated a giant cystic lesion 23 cm in length from T1-L2 level. To our knowledge, this is the longest arachnoid cyst that has been reported in children. The operation included unilateral paraspinal muscle dissection with spinous process translation techniques, T1-L4 laminectomy, total cyst excision, and dural defect repair at the T4 level. The symptoms were fully resolved within 2 months after surgery. However, thoracic kyphosis was slightly increased, but the patient still has a normal sagittal profile. CONCLUSIONS: Spinal arachnoid cyst is rare, especially in children. Early diagnosis and treatment are essential for improving the chance of full recovery, and for avoiding complication and irreparable defect. Total cyst removal with dural repair remains the best treatment alternative; however, potential complications, especially spinal malalignment after extensive laminectomy, must be considered. Postoperative MRI showed normal CSF flow and no spinal cord compression. The muscle-sparing technique with multiple-level laminectomy without spinal fusion that we used in this case provided a satisfying outcome.


Assuntos
Cistos Aracnóideos/cirurgia , Espaço Epidural/cirurgia , Vértebras Lombares/cirurgia , Músculos Paraespinais/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Criança , Espaço Epidural/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Músculos Paraespinais/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
8.
J Clin Neurosci ; 78: 433-438, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600974

RESUMO

Extradural spinal meningeal cysts are rare lesions in the adult spine and are an uncommon cause of neurologic deficits. We present the case of an adult who presented with myelopathic symptoms related to a dorsally based extradural thoracic meningeal cyst in the absence of any defect in the posterior spinal elements and no history of spinal dysraphism or trauma. We also performed a review of the literature to evaluate the surgical techniques for extradural meningeal cysts. Most thoracic cysts are intradural arachnoid cysts, yet this lesion is an extradural meningeal cyst, not an intradural arachnoid cyst. Because of the rarity of this lesion, its anatomic characterization can be difficult to conceptualize. An artist's illustration helps illustrate the anatomic characteristics of this cyst and our surgical management.


Assuntos
Cistos Aracnóideos/complicações , Doenças da Medula Espinal/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Humanos , Imagem por Ressonância Magnética , Cisto Mediastínico/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Disrafismo Espinal , Coluna Vertebral/patologia
10.
World Neurosurg ; 141: e316-e323, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32445899

RESUMO

OBJECTIVE: Suprasellar arachnoid cysts are a rare but important pediatric neurosurgical pathology with unknown ideal management. They have been previously managed with techniques including open craniotomy with microsurgical fenestration, cystoperitoneal shunting, endoscopic ventriculocystostomy, and endoscopic ventriculocystocisternostomy (VCC), without a consistent consensus on the best surgical approach. We present an overview of the literature on surgical management of suprasellar arachnoid cysts. METHODS: A literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted for all articles evaluating treatment modalities for suprasellar arachnoid cysts, using PubMed, OVID, and Web of Science. RESULTS: Twenty-five articles on management of suprasellar arachnoid cysts in children were identified. Few published studies exist that examine different types of surgical management across a single institution. The majority of studies reported best clinical outcomes in patients treated with endoscopic approaches when compared with microsurgical fenestration or cystoperitoneal shunting, reporting lower rates of infection, shunt dependence, and need for revision in addition to better resolution of clinical symptoms. Furthermore, most studies argue that VCC is superior to ventriculocystostomy, offering better long-term improvement of clinical symptoms and lower rates of failure. CONCLUSIONS: This study examines the current literature on suprasellar arachnoid cyst surgical management to conclude that an endoscopic approach in comparison with other approaches has the best outcomes. Of the endoscopic options available, VCC provides patients with the best long-term resolution of symptoms and the lowest need for revision. These findings should be further investigated with larger multicenter studies to further compare different surgical techniques and outcomes.


Assuntos
Cistos Aracnóideos/cirurgia , Neuroendoscopia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem
11.
World Neurosurg ; 140: 258-261, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32445897

RESUMO

BACKGROUND: Post-traumatic diploic leptomeningeal cyst with bilateral posterior cranial fossa epidural hygroma is a rare complication after calvarial fracture. Very few cases have been reported to date; hence, there are no specific guidelines for the management of these cases. CASE DESCRIPTION: A 4-year-old boy was brought to the emergency department after suffering from head trauma caused by a fall from a rooftop where he was treated conservatively at a local hospital. Later, he developed swelling in the occipital region and was brought to the department of neurosurgery where he was operated on. After the first surgery, recurrence of swelling was seen after a postoperative period of 2 months, and computed tomography scan reported persistent epidural hygroma with extension into the subcutaneous space. The second surgery was performed, and 12-month follow-up did not show any recurrence of swelling in the patient. CONCLUSIONS: Post-traumatic leptomeningeal cyst is commonly associated with occipital injury. The causes are as follows: the dura is very loosely attached to the intracranial lamina in young children, injury to the skull results in potential epidural space, and any tear or breach in the meninges leads to accumulation of cerebrospinal fluid in these spaces giving rise to cystic swelling. Watertight duroplasty with trials of duro-periosteal hitching has been described in the management of these cases.


Assuntos
Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Procedimentos Neurocirúrgicos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/etiologia , Pré-Escolar , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X
12.
Plast Reconstr Surg ; 145(5): 953e-962e, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332544

RESUMO

BACKGROUND: Currently, the pathogenesis of leptomeningeal cysts, also known as growing skull fractures, is still debated. The purpose of this study was to examine the specific skull fracture characteristics that are associated with the development of growing skull fractures and describe the authors' institutional experience managing this rare entity. METHODS: A retrospective cohort study was performed that included all patients younger than 5 years presenting to a single institution with skull fractures from 2003 to 2017. Patient demographics, cause of injury, skull fracture characteristics (e.g., amount of diastasis, linear versus comminuted fracture), concomitant neurologic injuries, and management outcomes were recorded. Potential factors contributing to the development of a growing skull fracture and neurologic injuries associated with growing skull fractures were evaluated using univariate logistic regression. RESULTS: A total of 905 patients met the authors' inclusion criteria. Of these, six (0.66 percent) were diagnosed with a growing skull fracture. Growing skull fractures were more likely to be comminuted (83.3 percent versus 40.7 percent; p = 0.082) and to present with diastasis on imaging (100 percent versus 26.1 percent; p < 0.001; mean amount of diastasis, 7.1 mm versus 3.1 mm; p < 0.001). Univariate logistic regression analysis confirmed the role of a comminuted fracture pattern (OR, 7.572) and the degree of diastasis (OR, 2.081 per mm diastasis) as significant risk factors for the development of growing skull fractures. CONCLUSIONS: The authors' analysis revealed that fracture comminution and diastasis width are associated with the development of growing skull fractures. The authors recommend dural integrity assessment, close follow-up, and early management in young children who present with these skull fracture characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Cistos Aracnóideos/epidemiologia , Fraturas Cranianas/complicações , Cistos Aracnóideos/etiologia , Cistos Aracnóideos/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Medição de Risco/métodos , Crânio/diagnóstico por imagem , Crânio/lesões , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X
13.
J Neurol Surg A Cent Eur Neurosurg ; 81(4): 362-367, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32294791

RESUMO

This report discusses the relationship between arachnoid cysts (ACs) and cognitive deficits, and we ask if cognitive impairments could justify neurosurgical treatment. In clinical practice, only AC patients with symptoms of intracranial hypertension or focal neurological deficits are referred to surgery. Occasionally, one might assume that nonspecific problems such as impairment of learning, speech, or cognitive functions are caused by an AC and can be improved by surgery. We describe three patients, in which surgery was indicated on the basis of clinical symptoms such as headaches and the size of the cysts. A neuropsychological examination before AC surgery revealed reduced cognitive potential, and the same examination repeated after surgery showed improvement. We have not found any other reason for this change, except for the decompression of the AC.


Assuntos
Cistos Aracnóideos/complicações , Disfunção Cognitiva/etiologia , Descompressão Cirúrgica , Cefaleia/etiologia , Procedimentos Neurocirúrgicos , Cistos Aracnóideos/cirurgia , Criança , Disfunção Cognitiva/cirurgia , Feminino , Cefaleia/cirurgia , Humanos , Masculino
14.
Acta Neuropathol Commun ; 8(1): 27, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32151273

RESUMO

Brain tumors represent the second most frequent etiology in patients with focal seizure onset before 18 years of age and submitted to epilepsy surgery. Hence, this category of brain tumors, herein defined as low-grade, developmental, epilepsy-associated brain tumors (LEAT) is different from those frequently encountered in adults as (A): 77% of LEAT occur in the temporal lobe; (B): the vast majority of LEAT are of low malignancy and classified as WHO I°; (C): LEAT are often composed of mixed glial and neuronal cell components and present with variable growth patterns including small cysts or nodules; (D): LEAT do not share common gene driving mutations, such as IDH1 or 1p/19q co-deletions. Characteristic entities comprise the ganglioglioma (GG), the dysembryoplastic neuroepithelial tumor (DNT), the angiocentric glioma (AG), the isomorphic diffuse glioma (IDG) and the papillary glio-neuronal tumor (PGNT), representing 73.2% of 1680 tumors collected in a large German series of 6747 patients submitted to epilepsy surgery. In the realm of exciting discoveries of genetic drivers of brain tumors new genes have been also reported for LEAT. BRAF V600E mutations were linked to GG with CD34 expression, FGFR1 mutations to DNT, MYB alterations to AG and also IDG and PRKCA fusions to PGNT, suggesting the possibility to also develop a genetically driven tumor classification scheme for LEAT. Rare availability of LEAT in a single center is a challenging obstacle, however, to systematically unravel the neurobiological nature and clinical behavior of LEAT. Other challenges in need of clarification include malignant tumor progression of LEAT entities, seizure relapse in patients following bulk tumor resection and the controversial issue of associated focal cortical dysplasia as additional pathomechanism. In order to advance our understanding and promote reliable diagnostic work-up of LEAT, we recommend, therefore, international collaboration to achieve our goals.


Assuntos
Neoplasias Encefálicas/patologia , Epilepsias Parciais/patologia , Neoplasias Neuroepiteliomatosas/patologia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/genética , Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Astrocitoma/complicações , Astrocitoma/genética , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/genética , Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Cisto Dermoide/complicações , Cisto Dermoide/genética , Cisto Dermoide/patologia , Cisto Dermoide/cirurgia , Cisto Epidérmico/complicações , Cisto Epidérmico/genética , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Epilepsias Parciais/etiologia , Epilepsias Parciais/cirurgia , Ganglioglioma/complicações , Ganglioglioma/genética , Ganglioglioma/patologia , Ganglioglioma/cirurgia , Humanos , Técnicas de Diagnóstico Molecular , Gradação de Tumores , Neoplasias Neuroepiteliomatosas/complicações , Neoplasias Neuroepiteliomatosas/genética , Neoplasias Neuroepiteliomatosas/cirurgia , Oligodendroglioma/complicações , Oligodendroglioma/genética , Oligodendroglioma/patologia , Oligodendroglioma/cirurgia , Proteína Quinase C-alfa/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas c-myb/genética , Receptor Tipo 1 de Fator de Crescimento de Fibroblastos/genética , Transativadores/genética
15.
BMC Neurol ; 20(1): 89, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164549

RESUMO

INTRODUCTION: Intracranial neoplasms are an uncommon cause of symptomatic parkinsonism. We here report a patient with an extensive middle and posterior fossa arachnoid cyst presenting with parkinsonism that was treated by neurosurgical intervention. METHODS: Retrospective chart review and clinical examination of the patient. CASE REPORT: This 55-year-old male patient with hemiparkinsonism and recurrent bouts of headaches was first diagnosed in 1988. CT scans revealed multiple cystic lesions compressing brainstem and basal ganglia, which were partially resected. Subsequently, the patient was free of complaints for 20 years. In 2009 the patient presented once more with severe unilateral tremor and thalamic pain affecting the right arm. Despite symptomatic treatment with L-Dopa and pramipexole symptoms worsened over time. In 2014 there was further progression with increasing hemiparkinsonism, hemidystonia, unilateral thalamic pain and pyramidal signs. Repeat CT scanning revealed a progression of the cysts as well as secondary hydrocephalus. Following repeat decompression of the brainstem and fenestration of all cystic membranes parkinsonism improved with a MDS- UPDRS III score reduction from 39 to 21. Histology revealed arachnoid cystic material. CONCLUSION: We report on a rare case of recurrent symptomatic hemiparkinsonism resulting from arachnoid cysts.


Assuntos
Cistos Aracnóideos/complicações , Doença de Parkinson/etiologia , Cistos Aracnóideos/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
World Neurosurg ; 138: 68-72, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32142944

RESUMO

BACKGROUND: Symptomatic intramedullary arachnoid cysts are rarely observed lesions, particularly in the pediatric age group. Treatment includes cyst fenestration or resection of the cyst wall, and recurrence after surgery has never been reported. We report a rare case of a spinal intramedullary arachnoid cyst, which recurred after cyst fenestration and required reoperation after a certain period. CASE DESCRIPTION: A 4-year-old boy presented to our hospital with tetraparesis and bladder and rectum disorder. A cystic intramedullary lesion in the cervical spinal cord was detected in preoperative imaging. An emergency fenestration of cyst was performed, and his symptoms were resolved immediately. One month after the operation, the symptoms and cyst recurred. The symptoms improved in the natural course without reoperation. However, the cyst increased in size and the symptoms recurred after 27 months from the first relapse and the cyst was removed urgently. The diagnosis was an arachnoid cyst. After the reoperation, the cyst has disappeared and not recurred. CONCLUSIONS: To the best of our knowledge, this is the first report of recurrence of an intramedullary arachnoid cyst. This case indicates the importance of considering the resection of cyst wall as possible because of the probability of cyst recurrence after fenestration, while careful observation is the option in the short term, especially for children or high-risk cases.


Assuntos
Cistos Aracnóideos/patologia , Doenças da Medula Espinal/patologia , Cistos Aracnóideos/cirurgia , Medula Cervical/patologia , Pré-Escolar , Humanos , Masculino , Recidiva , Reoperação , Doenças da Medula Espinal/cirurgia
17.
Arq Neuropsiquiatr ; 78(1): 9-12, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32074184

RESUMO

INTRODUCTION: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. METHODS: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. RESULTS: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. DISCUSSION: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. CONCLUSION: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.


Assuntos
Cistos Aracnóideos/cirurgia , Hidrocefalia/cirurgia , Pseudotumor Cerebral/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/fisiopatologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Hidrocefalia/fisiopatologia , Hidrodinâmica , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Pseudotumor Cerebral/fisiopatologia , Reoperação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos , Adulto Jovem
18.
World Neurosurg ; 137: 93, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035207

RESUMO

Surgical options for symptomatic intracranial arachnoid cysts include cyst shunting and microscopic or endoscopic fenestration.1 We advocate a microsurgical keyhole approach for the durable fenestration of middle fossa arachnoid cysts, taking advantage of the superior magnification, depth perception, and illumination of the operating microscope, as well as the ability to use bimanual surgical technique and variable suction to ensure safe manipulation of arachnoid membranes and fenestration of these lesions into the deep cisterns.2 Key technical aspects of this approach demonstrated in this video (Video 1) include performance of a dime-sized temporal craniotomy; strict microsurgical technique with sharp dissection via a No. 11 blade, sharp microdissectors, and microscissors; disruption of the arachnoid membranes overlying cranial nerves II/III, the internal carotid artery, and the posterior communicating artery; and fenestration of the membrane of Lilliquist through the opticocarotid, oculomotor, and/or supratrochlear triangles. The utility of this approach is illustrated by the case of a 5-year-old male with a history of headaches and interval progression of a left temporal grade 2 arachnoid cyst, who experienced symptom resolution and cyst shrinkage after keyhole microsurgical fenestration.


Assuntos
Cistos Aracnóideos/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Pré-Escolar , Fossa Craniana Média/cirurgia , Humanos , Masculino
19.
Acta Neurochir (Wien) ; 162(5): 1041-1050, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31960141

RESUMO

INTRODUCTION: Arachnoid cysts are congenital, benign lesions in the brain and are often incidental radiological findings. Frequently, the arachnoid cysts are left untreated; however, recent studies have shown that arachnoid cysts can cause cognitive dysfunction that affect quality of life. Moreover, the function can improve after surgical decompression. Hence, there is controversy regarding symptomatology and treatment effects of arachnoid cysts. The aim of the study was to analyse if arachnoid cysts can cause cognitive impairment and subjective symptoms and if these impairments are reversible after surgical treatment. MATERIAL AND METHODS: Twenty-one consecutive patients with radiologically confirmed supratentorial arachnoid cysts were cognitively evaluated using a battery of seven neuropsychological tests. Twelve of these patients underwent surgery and were evaluated before and after surgery. The patients were also evaluated with neuropsychological testing after surgery. Further information was extracted from the medical records. The cognitive test results were compared to standard population values using z-test, and the test results from the surgically treated patients were compared before and after surgery using paired t-test. RESULTS: The surgically treated patients had a statistically significant improvement of neurocognitive test results after surgery in six out of the seven tests (p < 0.05). The total patient group showed lower mean values in all tests when compared to standard population. Statistical significance was, however, only detected in two of the seven tests. All surgically treated patients reported diminished symptoms after surgery. CONCLUSIONS: The patients with arachnoid cysts presented with cognitive dysfunction compared to the normal population which improved after surgical decompression. Arachnoid cysts should not be considered asymptomatic unless thoroughly evaluated with clinical and neuropsychological work-up.


Assuntos
Cistos Aracnóideos/cirurgia , Disfunção Cognitiva/etiologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/psicologia , Disfunção Cognitiva/psicologia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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