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1.
World Neurosurg ; 133: 80-83, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31574329

RESUMO

BACKGROUND: Bobble-head doll syndrome is a rare neurological syndrome presenting with repetitive anteroposterior head movements. It is usually associated with expansile cystic lesions in the third ventricular region. CASE DESCRIPTION: An 8-year-old boy presented with involuntary bobbling head movements. Magnetic resonance imaging of the brain revealed an extensive suprasellar cyst resulting in obstructive hydrocephalus. Endoscopic ventriculo-cysto-cisternostomy resulted in improved clinical outcome. CONCLUSIONS: Endoscopic ventriculo-cysto-cisternostomy is an effective, less-invasive technique in the treatment of suprasellar cysts that results in resolution of the bobbling head movements.


Assuntos
Cistos Aracnóideos/etiologia , Cistos do Sistema Nervoso Central/complicações , Discinesias/etiologia , Hidrocefalia/etiologia , Terceiro Ventrículo/anormalidades , Ventriculostomia/métodos , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/cirurgia , Criança , Discinesias/diagnóstico por imagem , Discinesias/cirurgia , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Masculino , Terceiro Ventrículo/diagnóstico por imagem , Terceiro Ventrículo/cirurgia , Resultado do Tratamento
2.
Pan Afr Med J ; 34: 55, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762921

RESUMO

Intrasellar arachnoid cysts are benign malformations. They are extremely rare (approximately 3% of cases). Their pathophysiology is still poorly elucidated. We here report a case of intrasellar arachnoid cyst with suprasellar extension whose treatment was based on endoscopic transsphenoidal fenestration. The epidemiological, clinical, pathophysiological, radiological, therapeutic and evolutionary features have been analyzed. Neuroendoscopic procedures are performed with increasing frequency in surgery. Prognosis is good and recurrences are frequent, even after several years of evolution.


Assuntos
Cistos Aracnóideos/diagnóstico , Endoscopia/métodos , Sela Túrcica/patologia , Adulto , Cistos Aracnóideos/cirurgia , Feminino , Humanos , Prognóstico , Sela Túrcica/cirurgia
3.
J Clin Neurosci ; 68: 322-328, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31402262

RESUMO

BACKGROUND: Arachnoid cysts are uncommon lesions of the sellar region, and only rarely require decompressive surgery to treat symptoms. Pituitary abscesses are another rare lesion, and are an uncommon complication of pituitary surgery. A previously healthy 45 year old woman presented with a new finding of bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed a cystic sellar lesion with suprasellar extension and compression of the optic chiasm. Endoscopic transphenoidal surgery was performed and the lesion was found to be an arachnoid cyst. She was well immediately after the operation, but 1 week later presented with headaches, fever and worsening visual acuity. MRI showed a homogenous collection in the sellar region that was compressing the chiasm. The patient was treated with antibiotics, and a second transphenoidal operation was performed, with frank pus found in the pituitary fossa. Cultures of the fluid found during the operation grew Escherichia coli and Staphylococcus lugdunensis. Her symptoms resolved after the second operation, and formal visual fields and a pituitary hormone panel were normal at this time. We report on a rare case of a pituitary abscess complicating surgery for a sellar arachnoid cyst, and discuss management of these conditions.


Assuntos
Cistos Aracnóideos/cirurgia , Abscesso Encefálico/etiologia , Neuroendoscopia/efeitos adversos , Doenças da Hipófise/etiologia , Complicações Pós-Operatórias/etiologia , Drenagem/efeitos adversos , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia
4.
World Neurosurg ; 132: e645-e653, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442638

RESUMO

BACKGROUND: Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. OBJECTIVE: The present study aimed to investigate whether arachnoid cysts also affect symptoms of anxiety and depression, and if surgical cyst decompression leads to reduction of these symptoms. METHODS: Twenty-two adult patients (13 men and 9 women) with symptomatic temporal or frontal cysts were included in this questionnaire (Hospital Anxiety and Depression Scale [HADS])-based prospective study. The mean time between answering the preoperative questionnaire and surgery was 37 days. The patients answered the same HADS questionnaire 3-6 months postoperatively. RESULTS: Preoperatively, both patients with frontal (N = 4) and patients with temporal (N = 18) cyst had higher mean HADS anxiety scores than those found in the general population. For patients with temporal cyst, there was a significant or near-significant difference in anxiety and depression scores and the combined scores between those with right-sided cysts and those with left-sided cysts. Postoperatively, the HADS scores normalized and were no longer different from those of the general population. The difference in scores between patients with right and left temporal cyst also disappeared. CONCLUSIONS: Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.


Assuntos
Ansiedade/etiologia , Cistos Aracnóideos/complicações , Cistos Aracnóideos/cirurgia , Depressão/etiologia , Adulto , Cistos Aracnóideos/psicologia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
5.
J Craniofac Surg ; 30(5): e400-e402, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299791

RESUMO

The study reported a case of an intrasellar arachnoid cyst with visual disturbances as the main symptom. Arachnoid cyst is a common intracranial benign space-occupying lesion, but rarely seen in intrasellar region with less than 100 cases reported available in English language literature. Therefore, it is still controversial about the diagnosis and treatment of such patients. This article reviewed previous literature and discussed the differential diagnosis and surgical strategies of intrasellar arachnoid cyst in combination with our own case.


Assuntos
Cistos Aracnóideos/diagnóstico , Diagnóstico Diferencial , Adulto , Cistos Aracnóideos/cirurgia , Feminino , Humanos , Sela Túrcica/patologia
6.
World Neurosurg ; 130: 154-156, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301440

RESUMO

BACKGROUND: Intracranial de novo arachnoid cysts in adults are rare, suggesting the involvement of head trauma and inflammatory diseases. We report a symptomatic adult case of nontraumatic de novo arachnoid cyst on the ventral medulla oblongata. CASE DESCRIPTION: A 56-year-old man came to our hospital complaining of dysphagia and writing difficult since 3 months ago. There was no history of head injury or inflammatory disease. A 25-mm cystic lesion was found on the ventral side of the medulla oblongata on brain magnetic resonance imaging, and the lower cranial nerve and medulla oblongata were highly compressed. The lesion did not exist on magnetic resonance imaging performed 9 years ago. Capsular resection was performed, and the histologic diagnosis was a typical arachnoid cyst. After the operation, all neurologic symptoms disappeared and no recurrence has been observed after 6 months. CONCLUSIONS: The pathophysiology of nontraumatic de novo arachnoid cysts has many unknown features, and it appears necessary to accumulate further case reports.


Assuntos
Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Bulbo/cirurgia , Recidiva Local de Neoplasia/cirurgia , Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Tomografia Computadorizada por Raios X/métodos
7.
Pediatr Neurosurg ; 54(4): 253-257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31266048

RESUMO

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.


Assuntos
Cistos Aracnóideos , Ângulo Cerebelopontino , Paralisia Facial/etiologia , Cistos Aracnóideos/congênito , Cistos Aracnóideos/cirurgia , Tronco Encefálico , Ângulo Cerebelopontino/fisiopatologia , Craniotomia , Drenagem , Feminino , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Lobo Occipital
8.
World Neurosurg ; 131: 43-46, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31362104

RESUMO

BACKGROUND: Spinal arachnoiditis and associated arachnoid adhesions can cause debilitating neurological symptoms due to nerve root and spinal cord compression or tethering. Adhesiolysis using a microscopic approach has traditionally been used for this condition. This procedure has been further refined in recent years with the use of flexible endoscopes. CASE DESCRIPTION: We report the case of a patient with progressive thoracic myelopathy secondary to arachnoid adhesions associated with arachnoiditis. A minimally invasive technique of adhesiolysis and placement of a cysto-arachnoid shunt was performed with the assistance of a flexible endoscope. CONCLUSIONS: The present case report has highlighted the advantages of using a flexible endoscope to treat spinal arachnoiditis adhesiolysis and placement of a cysto-arachnoid shunt, including a smaller skin incision and extended visualization.


Assuntos
Cistos Aracnóideos/cirurgia , Aracnoidite/cirurgia , Hematoma Subdural Espinal/cirurgia , Neuroendoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/cirurgia , Aderências Teciduais/cirurgia , Idoso , Cistos Aracnóideos/diagnóstico por imagem , Aracnoidite/diagnóstico por imagem , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Espaço Subaracnóideo , Aderências Teciduais/diagnóstico por imagem
9.
Rev. chil. radiol ; 25(2): 75-78, jun. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-1013853

RESUMO

Los quistes aracnoideos corresponden a lesiones benignas expansivas del canal medular secundarias a defectos anatómicos durales, mientras que los meningoceles anteriores consisten en la herniación de la duramadre hacia la pelvis a través de forámenes dilatados o defectos óseos. Ambas entidades son infrecuentes y sus manifestaciones clínicas puede variar de acuerdo a estructuras anatómicas que comprimen. Una historia clínica completa, la pesquisa diagnóstica y la adecuada interpretación de imágenes orientan al diagnóstico y manejo de estos pacientes. Se presenta el caso de una paciente adulta mayor con historia de masa pélvica, dolor lumbar severo y monoparesia en quien se realizó el diagnóstico incidental de quiste aracnoideo sacro y meningioma sacro anterior.


Arachnoid cysts are benign expansive lesions of the spinal canal secondary to dural defects, whereas the anterior meningoceles consist of the herniation of the dura into the pelvis through dilated foramina or bone defects. Both pathologies are infrequent and its clinical manifestations vary according to compressed anatomical structures. A complete clinical history, the diagnostic investigation and the correct imaging studies interpretation guide the diagnosis and management of these patients. We present the case of an elderly adult patient with a history of pelvic mass, severe lumbar pain and monoparesis in whom the incidental diagnosis of sacral arachnoid cyst and anterior sacral meningioma was performed.


Assuntos
Humanos , Feminino , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Meningocele/complicações , Meningocele/diagnóstico por imagem , Recidiva , Região Sacrococcígea , Imagem por Ressonância Magnética , Cistos Aracnóideos/cirurgia , Meningocele/cirurgia
10.
BMJ Case Rep ; 12(4)2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31040140

RESUMO

The association between intracranial arachnoid cyst rupture and mild brain trauma is infrequently reported. The purpose of this case report is to describe the case of a child with a left temporal arachnoid cyst who suffered rupture with haemorrhage after mild trauma during a football match. The child presented with chronic headache of mild intensity that progressed to a more intense headache after a traumatic event. He underwent surgical intervention after diagnosis of chronic haemorrhage in an arachnoid cyst in the ipsilateral subdural space. The risk of intracranial arachnoid cyst rupture should be considered during the evaluation of oligosymptomatic patients because it is a potentially catastrophic event.


Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Concussão Encefálica/complicações , Craniotomia/métodos , Diplopia/etiologia , Cefaleia/etiologia , Hematoma Subdural Crônico/diagnóstico por imagem , Ruptura Espontânea/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Traumatismos em Atletas , Concussão Encefálica/diagnóstico por imagem , Concussão Encefálica/cirurgia , Criança , Diplopia/diagnóstico por imagem , Drenagem , Cefaleia/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Ruptura Espontânea/cirurgia , Resultado do Tratamento
11.
No Shinkei Geka ; 47(4): 461-467, 2019 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-31061232

RESUMO

We report 3 cases of symptomatic intraparenchymal arachnoid cysts in adults, including 2 in elderly patients. Case 1:An 81-year-old woman developed right-sided hemiparesis and hemianopsia due to the enlargement of left occipital arachnoid cyst, which had been incidentally diagnosed 3 years ago. Under the guidance of neuronavigation, we inserted a rigid endoscope into the cyst and perforated the cyst wall toward the posterior horn of the lateral ventricle, making a good communication between the cyst and the ventricle for cerebrospinal fluid. Her symptoms improved within 3 days after the surgery, and the cyst mass reduced. Case 2:A 57-year-old woman was incidentally found to have a right frontal arachnoid cyst. She had a 3-month long history of low mood and loss of interest in work. We perforated the transparent septum via the cyst wall toword the left lateral ventricle in a neuro-endoscopic procedure. After the surgery, she regained interest in work, and her symptom was considered to be indicative of depression due to arachnoid cyst. Case 3:A 94-year-old woman in a geriatric facility developed left-sided hemiparesis due to the enlargement of a right temporal arachnoid cyst, which had been detected 10 years ago. Neuro-endoscopic perforation of the cyst wall toward the lateral ventricle remarkably improved her symptoms. Arachnoid cysts can become symptomatic in the long term, not only in the young but also in the elderly. Neuro-endoscopic fenestration is an effective treatment for symptomatic intraparenchymal cysts, especially in elderly patients. The neuronavigation system was useful in the planning of the trajectory and in the detection of the target point of fenestration.


Assuntos
Cistos Aracnóideos , Endoscopia , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Feminino , Humanos , Ventrículos Laterais , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paresia , Resultado do Tratamento
12.
World Neurosurg ; 126: 588, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30930326

RESUMO

We present a case of symptomatic intracranial hypotension secondary to CSF overdrainage from a cystoperitoneal shunt system. Brain MRI shows distortion of the midbrain with secondary occlusion of the cerebral aqueduct resulting in obstructive hydrocephalus. The symptoms, brainstem herniation, and hydrocephalus resolved after tie occlusion of the shunt.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Encefalocele/etiologia , Hidrocefalia/etiologia , Hipotensão Intracraniana/etiologia , Cistos Aracnóideos/cirurgia , Aqueduto do Mesencéfalo/diagnóstico por imagem , Encefalocele/diagnóstico por imagem , Falha de Equipamento , Humanos , Hidrocefalia/diagnóstico por imagem , Hipotensão Intracraniana/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem
13.
World Neurosurg ; 126: 310-313, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885870

RESUMO

BACKGROUND: Stiff neck or nuchal rigidity is a significant clinical sign of neurologic disease. It is commonly associated with meningitis, subarachnoid hemorrhage, and posterior fossa tumors. It may also occur as a result of tonsillar impaction following pressure in the infratentorial compartment from an expanding posterior fossa mass. It is, however, not commonly known to be associated with uncal herniation. CASE DESCRIPTION: We report a recent experience on this association. CONCLUSIONS: In the presence of stiff neck or nuchal rigidity in a patient with clinical signs of uncal herniation from a temporal arachnoid cyst, this unusual association could possibly be owing to the effect of increased pressure in the posterior fossa from massive shift of brain tissue posteriorly following a rapid rise in middle cranial fossa pressure consequent on an acute enlargement of the cyst. A false impression of acute meningeal irritation in such a situation could be quite misleading, resulting in late diagnosis and subsequently a delay in timely intervention.


Assuntos
Cistos Aracnóideos/complicações , Hérnia/complicações , Rigidez Muscular/complicações , Cistos Aracnóideos/patologia , Cistos Aracnóideos/cirurgia , Fossa Craniana Média/patologia , Fossa Craniana Posterior/patologia , Hérnia/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Temporal/patologia , Resultado do Tratamento
14.
J Vet Intern Med ; 33(3): 1376-1383, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30844093

RESUMO

BACKGROUND: There is a successful outcome after surgical management of spinal arachnoid diverticula (SAD) in up to 82% of cases. HYPOTHESIS/OBJECTIVES: We hypothesized that Pugs have favorable short-term and poor long-term prognosis after surgical treatment of thoracolumbar SAD. The aim of the present investigation was to describe clinical findings, short- and long-term outcomes, and follow-up magnetic resonance imaging (MRI) findings in Pugs with thoracolumbar SAD. ANIMALS: Twenty-five client owned Pugs with 12-month follow-up information after surgical treatment of thoracolumbar SAD. METHODS: Multicenter retrospective case series. All medical records were searched for Pugs diagnosed with SAD. Data regarding signalment, history, surgical procedure, outcome, histopathology, and follow-up MRI results were extracted. RESULTS: Mean age at presentation was 7.32 (range 2-11) years, 80% were males. Short-term outcome was available in 25 dogs, and improvement was confirmed in 80% of dogs. Long-term outcome was available in 21 dogs, and deterioration was confirmed in 86% of cases, with late-onset recurrence of clinical signs after initial postsurgical improvement affecting 85% of Pugs. A moderate correlation (r = 0.50) was found between duration of clinical signs and outcome. In 8 dogs with deteriorating clinical signs, follow-up MRI revealed regrowth of the SAD in 2 cases, new SAD formation in 2 cases, and intramedullary T2W hyperintensity/syringomyelia in 6 cases. CONCLUSIONS AND CLINICAL IMPORTANCE: This study suggests that Pugs with thoracolumbar SAD do not have a favorable long-term prognosis after surgical treatment for reasons yet to be determined.


Assuntos
Cistos Aracnóideos/veterinária , Doenças do Cão/cirurgia , Animais , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Cães , Feminino , Imagem por Ressonância Magnética/veterinária , Masculino , Estudos Retrospectivos , Siringomielia/veterinária , Resultado do Tratamento
15.
BMJ Case Rep ; 12(2)2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30819681

RESUMO

Spinal arachnoid cysts (SAC) are rare in isolation and the exact aetiology is still debated. Primary (congenital) cysts are caused by structural abnormalities in the arachnoid layer and largely affect the thoracic region. Secondary cysts are induced by a multitude of factors, infection, trauma or iatrogenic response, and can affect any level of the spinal cord. While subarachnoid haemorrhage (SAH) is a relatively common condition with significant repercussions, it is extremely uncommonly associated with SAC. When present, it may develop in the months and years after the original bleed, giving rise to new neurological symptoms. Prompt treatment is needed to halt or reverse the worsening of symptoms and questions are still being asked about how best to approach this condition. A 42-year-old man presented with chronic back pain, severe worsening ataxia and numbness below the umbilicus, 7 months after treatment for a World Federation of Neurosurgical Societies grade five (WFNS V) SAH. Imaging revealed a SAC extending from T12 to L4 and causing thecal compression. This was treated with a L3 laminectomy andmarsupialisation. An improvement in neurological function was observed at 6 months. Aetiology of the SAC and its association with SAH are discussed and a review of the relevant literature is provided.


Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Paraparesia/etiologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Dor nas Costas/etiologia , Humanos , Laminectomia , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
16.
World Neurosurg ; 125: 129-135, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30738941

RESUMO

BACKGROUND: Severe kyphoscoliosis associated with multiple giant spinal epidural arachnoid cysts (SEACs) is an extremely rare condition and remains a challenge in clinical practice. This study aimed to present a case of severe spinal deformity associated with multiple giant SEACs and to discuss strategies for the preoperative diagnosis and treatment. CASE DESCRIPTION: A 22-year-old man with severe thoracolumbar kyphoscoliosis associated with multiple giant SEACs presented with progressive scoliosis, spastic paralysis, numbness, and abnormal gait. X-ray and magnetic resonance imaging revealed severe rigid kyphoscoliosis, extensive diffuse cystic space-occupying lesions, and diffuse spinal cord compression. After multidisciplinary consultation and discussion, the patient underwent a cyst-peritoneal shunting surgery followed by posterior vertebral column resection (PVCR) correction. The postoperative course was uneventful. Both kyphosis and scoliosis were significantly corrected, and muscle weakness of the lower extremities and sensory disturbance partially improved. At the 2-year follow-up visit, the patient could freely walk without the aid of crutches, but there were some residual neurologic deficits in both legs. A plain radiograph showed that bony fusion was achieved, and the correction was well maintained. CONCLUSIONS: Cyst-peritoneal shunting surgery followed by PVCR, as in our case, could be an alternative surgical strategy for multiple giant SEACs associated with severe rigid kyphoscoliosis.


Assuntos
Cistos Aracnóideos/complicações , Cistos Aracnóideos/cirurgia , Cifose/complicações , Escoliose/complicações , Adolescente , Descompressão Cirúrgica/métodos , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos
17.
World Neurosurg ; 125: 6-9, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30710718

RESUMO

BACKGROUND: Negative-pressure hydrocephalus is a rare condition with the development of symptomatic hydrocephalus despite subnormal intracranial pressure (ICP). The etiology remains unclear. Some authors proposed that the differential pressure between the ventricular space and the subarachnoid space over cerebral convexity leads to the development of ventriculomegaly, namely as the transmantle pressure theory. CASE DESCRIPTION: A 49-year-old patient with a left Sylvian fissure arachnoid cyst underwent several surgeries including cystoperitoneal shunts and fenestrations of the cyst. The patient developed a cerebrospinal fluid fistula from the cranial wound was complicated by bacterial meningitis. Consequently, the shunt was removed, and external cyst drainage was placed. After 9 days, the patient developed acute hydrocephalus requiring external ventricular drainage (EVD). Two days later, after overdrainage of the external cyst drain, the patient suffered neurologic deterioration. The ICP measured by the EVD was -4 cm H2O, and a computed tomography scan demonstrated progression of the hydrocephalus. The external cyst drainage was shut off and the EVD level was adjusted to produce between 5 and 10 mL/hour of cerebrospinal fluid under a subatmospheric pressure set at -5 cm H2O, and gradually raised in increments of 1 cm every 3 days until a positive ICP occurred. Once clinical and radiographic stability was accomplished, a programmable ventriculoperitoneal shunt was inserted set to 30 mm H2O. A marked clinical and radiologic improvement was observed in the follow-up. CONCLUSIONS: This negative-pressure hydrocephalus case report supports the main role of the transmantle pressure theory. The subatmospheric EVD method and a low-pressure valve resulted in excellent clinical and radiographic outcomes.


Assuntos
Hidrocefalia/etiologia , Cistos Aracnóideos/cirurgia , Vazamento de Líquido Cefalorraquidiano/etiologia , Derivações do Líquido Cefalorraquidiano/métodos , Doença Crônica , Drenagem/métodos , Feminino , Transtornos da Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Meningites Bacterianas/etiologia , Pessoa de Meia-Idade , Imagem Multimodal , Complicações Pós-Operatórias/etiologia , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 125: e1241-e1246, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30797913

RESUMO

OBJECTIVE: To investigate the clinical characteristics, treatment, and outcomes of chronic subdural hematomas (CSDH) in young patients. METHODS: We retrospectively reviewed young patients under 40 years of age who received diagnoses of and were surgically treated for CSDH between August 2011 and May 2017. Clinical data, computed tomographic findings, surgical outcomes, and recurrence were collected for further analysis. RESULTS: A total of 101 patients (92 male; 91.1%) were analyzed. Ages ranged from 1 to 40 years (27.3 ± 10.5), and 59 (58.4%) patients had a history of recent head trauma. The most frequent symptoms were headache (86.1%) and dizziness (26.7%). A total of 60 (59.4%) patients had arachnoid cyst (AC), and 8 (7.9%) patients had ventriculoperitoneal (V-P) shunt. After burr hole drainage craniotomy, all patients experienced good outcomes, and 1 patient experienced recurrence requiring reoperation. Sixty-eight patients with AC/V-P shunts had a higher incidence of head trauma (P = 0.014), younger age at onset (P < 0.001), and lower incidence of dizziness (P = 0.013) than did those without AC/V-P shunts. Surgical recurrence rates and outcomes did not differ significantly between patients with and without AC/V-P shunts. CONCLUSIONS: Headache is the most common symptom, and AC/V-P shunts are risk factors of CSDH in young patients. AC/V-P shunt-associated CSDH is associated with younger morbidity. Head trauma is a risk factor for AC/V-P shunt-associated CSDH, but is not significance in patients without AC/V-P shunts. Catheter drainage through a burr hole may be the first-choice surgical procedure in treatment of CSDH in young patients, including AC/V-P shunt-associated CSDH.


Assuntos
Cistos Aracnóideos/cirurgia , Traumatismos Craniocerebrais/cirurgia , Hematoma Subdural Crônico/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adolescente , Adulto , Craniotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos , Adulto Jovem
19.
Pediatr Neurosurg ; 54(2): 132-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30650412

RESUMO

Cerebral vasospasm is associated with significant morbidity, and most commonly occurs following subarachnoid hemorrhage. Rarely, vasospasm can follow tumor resection and traumatic brain injury. We present the first reported case of a young child who developed diffuse vasospasm following open fenestration of an arachnoid cyst and was promptly treated, with full recovery of neurologic function. Although vasopasm after arachnoid cyst fenestration is rare, it can be included in the differential for a new focal neurologic deficit.


Assuntos
Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Craniotomia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Vasoespasmo Intracraniano/diagnóstico por imagem , Pré-Escolar , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Vasoespasmo Intracraniano/etiologia
20.
BMC Surg ; 19(1): 11, 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30665385

RESUMO

BACKGROUND: Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected. CASE PRESENTATION: This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique. CONCLUSIONS: The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.


Assuntos
Cistos Aracnóideos/cirurgia , Fístula/diagnóstico por imagem , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Medula Espinal/cirurgia , Adulto , Fístula/cirurgia , Humanos , Região Lombossacral , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem
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