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1.
World Neurosurg ; 132: e654-e664, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442641

RESUMO

OBJECTIVE: Posterior fossa cystic malformations are diversely classified with considerable overlap without therapeutic relevance. These cysts posterior to the cerebellum, presenting in children younger than 5 years, are labeled developmental retrocerebellar cysts (DRCCs) under a new classification in relation to neuroendoscopy. METHODS: DRCC was categorized as type 0 for asymptomatic enlarged cistern magna and was not treated. Among symptomatic cases, cysts with a compressed fourth ventricle were labeled type 1, whereas cysts in continuity with the fourth ventricle were termed type 2. They were further categorized as subtype B if hydrocephalus was greater relative to the cyst, or otherwise as subtype A. The literature was reviewed according to PRISMA guidelines. RESULTS: There were 13 children aged 3-48 months. Type 1A DRCC was noted in 5 patients, with onset before 6 months, 4 of whom (80%) had intracranial hypertension. All underwent suboccipital endoscopic deroofing and cisternostomy (SEDC), a new technique. Type 1B DRCC was seen in 2 patients, with onset at 8-9 months, who underwent endoscopic third ventriculostomy (ETV) + endoscopic ventriculocystostomy (EVC). Type 2A DRCC was observed in 4 patients, with onset at 5-47 months, who underwent SEDC. Type 2B DRCC was noted in 2 patients, with onset 6-8 months, who underwent ETV. With a mean follow-up of 32 months, all showed clinicoradiologic improvement. The application of our classification to other studies showed ETV/EVC to be successful in only 67% of type 1A DRCC and 72% of type 2A DRCC, compared with 100% efficacy of SEDC in our series. CONCLUSIONS: This is probably the first ever endoscopic classification of pediatric posterior fossa cyts, elucidating pathophysiology, presentation, and treatment. Patients with type 1 DRCC present early because of extraneous compression. Among patients with type 2 DRCC, posterior fossa compliance determines the degree of hydrocephalus. The newly described SEDC seems more appropriate for types 1A and 2A DRCC. ETV is adequate in type 2B DRCC and effective with EVC in type 1B.


Assuntos
Cistos do Sistema Nervoso Central/classificação , Malformações do Sistema Nervoso/classificação , Cistos do Sistema Nervoso Central/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Malformações do Sistema Nervoso/cirurgia , Neuroendoscopia
2.
World Neurosurg ; 128: e522-e530, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048050

RESUMO

OBJECTIVE: Rathke's cleft cysts (RCCs) may have various anatomic, clinical, and radiologic characteristics, which may be related to their differences in texture or consistency. The purpose of the study was to investigate RCCs based on consistency. METHODS: We retrospectively reviewed 25 cases of patients with RCCs who underwent endoscopic endonasal transsphenoidal surgery between 2008 and 2018. Cases were divided into 3 types based on cyst consistency: fluid (serous) or type A (n = 4); semi-fluid (mucoid) or type B (n = 17); and non-fluid (caseous) or type C (n = 4). Demographic, clinical, radiologic, and surgical characteristics for each group were analyzed. RESULTS: All type A RCCs (100%) had visual impairment. The mean age (42.8 ± 13 years) and cyst volume (2442.5 ± 533.6 mm3) were higher in these patients. T1-weighted images were hypointense and T2-weighted images were hyperintense on magnetic resonance imaging. Type B RCCs were more frequently encountered (68%). Although headache was the most common (82.3%) symptom, endocrine disorders were also prevalent (52.9%). T1-weighted images were typically isointense or hyperintense on magnetic resonance imaging. Type C RCCs had the youngest patient population (30.3 ± 10.2 years) and T2-weighted images were predominantly hypointense in this group. CONCLUSIONS: The proposed novel consistency classification of RCCs will provide a practical tool for more accurately estimating the nature of the pathology, because each type has its own specific characteristics. Furthermore, the new classification of RCCs may aid in planning a consistency-specific surgery.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Adolescente , Adulto , Idoso , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/complicações , Feminino , Cefaleia/etiologia , Humanos , Hidrocortisona/deficiência , Hiperprolactinemia/etiologia , Hipogonadismo/etiologia , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Visão/etiologia , Adulto Jovem
3.
World Neurosurg ; 104: 509-515, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28512049

RESUMO

BACKGROUND: The management of high-grade glioma (HGG) has been affected by recent landmark trials and is now more proactive. More aggressive treatment leads to hospitalization due to side effects, however. Space-occupying tumor bed cysts have been described, but not systematically assessed. We sought to analyze this complication in a contemporary HGG cohort. METHODS: We performed a retrospective review of patients with HGG treated between 2007 and 2013, identified patients with space-occupying tumor bed cysts, and reviewed their hospital notes for relevant variables. Statistical analyses were performed, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Tumor bed cysts were found in 12 of 282 patients (4%). The main symptoms were increased intracranial pressure (n = 11), new focal deficits (n = 6), and pseudomeningocele (n = 3), presenting at a median of 19 days since the last resection. Cysts were treated with cystoperitoneal (n = 7) and ventriculoperitoneal (n = 5) shunts, resulting in clinical benefit in 75% of those treated. Intraoperative opening of ventricles is a risk factor, with an OR of 39.339. We propose a classification system comprising 3 cyst types: isolated cyst, cyst with local cerebrospinal fluid (CSF) disturbance, and cyst with global CSF disturbance. CONCLUSIONS: In modern neuro-oncology, the rate of tumor bed cysts complicating HGG management appears stable compared with historical data. Shunt implantation is feasible and effective. We propose a classification system as a common data element for comparison across future studies.


Assuntos
Cistos do Sistema Nervoso Central/patologia , Cistos do Sistema Nervoso Central/cirurgia , Glioma/patologia , Glioma/cirurgia , Neoplasias Supratentoriais/patologia , Neoplasias Supratentoriais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/classificação , Edema Encefálico/diagnóstico , Edema Encefálico/patologia , Edema Encefálico/cirurgia , Carmustina/administração & dosagem , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/diagnóstico , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/cirurgia , Quimiorradioterapia Adjuvante , Terapia Combinada , Irradiação Craniana , Craniotomia , Feminino , Glioblastoma/classificação , Glioblastoma/diagnóstico , Glioblastoma/patologia , Glioblastoma/cirurgia , Glioma/classificação , Glioma/diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/classificação , Estudos Retrospectivos , Neoplasias Supratentoriais/classificação , Neoplasias Supratentoriais/diagnóstico , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
PLoS One ; 11(6): e0156245, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27257863

RESUMO

BACKGROUND: The evolution of non-hemorrhagic white matter injury (WMI) based on sequential magnetic resonance imaging (MRI) has not been well studied. Our aim was to describe sequential MRI findings in preterm infants with non-hemorrhagic WMI and to develop an MRI classification system for preterm WMI based on these findings. METHODS: Eighty-two preterm infants (gestation ≤35 weeks) were retrospectively included. WMI was diagnosed and classified based on sequential cranial ultrasound (cUS) and confirmed on MRI. RESULTS: 138 MRIs were obtained at three time-points: early (<2 weeks; n = 32), mid (2-6 weeks; n = 30) and term equivalent age (TEA; n = 76). 63 infants (77%) had 2 MRIs during the neonatal period. WMI was non-cystic in 35 and cystic in 47 infants. In infants with cystic-WMI early MRI showed extensive restricted diffusion abnormalities, cysts were already present in 3 infants; mid MRI showed focal or extensive cysts, without acute diffusion changes. A significant reduction in the size and/or extent of the cysts was observed in 32% of the infants between early/mid and TEA MRI. In 4/9 infants previously seen focal cysts were no longer identified at TEA. All infants with cystic WMI showed ≥2 additional findings at TEA: significant reduction in WM volume, mild-moderate irregular ventriculomegaly, several areas of increased signal intensity on T1-weighted-images, abnormal myelination of the PLIC, small thalami. CONCLUSION: In infants with extensive WM cysts at 2-6 weeks, cysts may be reduced in number or may even no longer be seen at TEA. A single MRI at TEA, without taking sequential cUS data and pre-TEA MRI findings into account, may underestimate the extent of WMI; based on these results we propose a new MRI classification for preterm non-hemorrhagic WMI.


Assuntos
Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/diagnóstico , Imagem por Ressonância Magnética/métodos , Substância Branca/patologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Estudos Retrospectivos
5.
Pathologe ; 37(3): 230-7, 2016 May.
Artigo em Alemão | MEDLINE | ID: mdl-27103256

RESUMO

Inflammatory findings in the pituitary glands account for approximately 1 % of operations in the sellar region. Primary inflammation (e.g. lymphocytic and idiopathic granulomatous hypophysitis) have to be differentiated from secondary types (e.g. concomittant inflammation with Rathke's cleft cysts, craniopharyngiomas and germinomas) and involvement of the pituitary in generalized inflammation (IgG4-related disease, sarcoidosis and septicopyemia). Langerhans cell histiocytosis also has to be considered for the differential diagnostics. Lymphocytic hypophysitis shows lymphocytic infiltrations of varying density, predominantly of the T­cell type. Granulomatous hypophysitis has the features of sarcoidosis and can only be diagnosed by exclusion of generalized sarcoidosis. Secondary hypophysitis has a mixed cell infiltration, especially by histiocytic infiltration and predominantly originates from ruptures or bleeding from Rathke's cleft cysts. The frequently very sparse remnants of cyst epithelium should be confirmed by pankeratin immunostaining.


Assuntos
Hipofisite/diagnóstico , Hipofisite/patologia , Hipófise/patologia , Hipofisite Autoimune/classificação , Hipofisite Autoimune/diagnóstico , Hipofisite Autoimune/patologia , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/diagnóstico , Cistos do Sistema Nervoso Central/patologia , Diagnóstico Diferencial , Histiócitos/patologia , Humanos , Hipofisite/classificação , Ruptura Espontânea
6.
Neurocir.-Soc. Luso-Esp. Neurocir ; 26(5): 234-240, sept.-oct. 2015. ilus
Artigo em Espanhol | IBECS | ID: ibc-142309

RESUMO

La prevalencia de los quistes aracnoideos en niños es del 1-3%. Son más frecuentes en el sexo masculino. Pueden localizarse tanto en el espacio intracraneal como a nivel espinal. Los intracraneales se clasifican en supratentoriales, infratentoriales y supra-infratentoriales. Los supratentoriales se subclasifican en de fosa media, hemisféricos de la convexidad, interhemisféricos, de la región selar e intraventriculares. Los infratentoriales se subdividen a su vez en supracerebelosos, infracerebelosos, hemisféricos, clivales y de ángulo pontocerebeloso. Por último, los espinales se clasifican según su localización extra o intradural y su afectación de raíces nerviosas (AU)


The prevalence of arachnoid cysts in children is 1-3%. They are more frequent in boys. They can be located intracranially or in the spine. Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch). Supratentorial are divided into middle cranial fossa, convexity, inter-hemisferic, sellar region, and intraventricular. Infratentorial are classified into supracerebellar, infracerebellar, hemispheric, clivus, and cerebellopontine angle. Finally spinal arachnoid cysts are classified taking into account whether they are extra- or intradural, and nerve root involvement (AU)


Assuntos
Criança , Humanos , Cistos Aracnóideos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Cistos Aracnóideos/classificação , Cistos do Sistema Nervoso Central/classificação , Espectroscopia de Ressonância Magnética
7.
J Coll Physicians Surg Pak ; 25(8): 588-91, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26305305

RESUMO

OBJECTIVE: To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from 2003 to 2012. METHODOLOGY: All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. RESULTS: A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ±13.2 years), 32 arachnoid cysts (mean age 24.8 ±20.2 years), 6 dermoid cysts, 3 enterogenous cysts and Rathke's cleft cysts each and 1 ependymal cyst. All cyst types mainly presented in young adults in both genders with signs and symptoms of a mass lesion. CONCLUSION: Non-neoplastic cyst mainly presented like a CNS mass lesion in young adults. Epidermoids were the most common type of these cysts in the present series followed by the colloid and the arachnoid cysts.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Cisto Epidérmico/cirurgia , Adolescente , Adulto , Distribuição por Idade , Idoso , Cistos Aracnóideos/epidemiologia , Cistos Aracnóideos/cirurgia , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/epidemiologia , Cistos Coloides/epidemiologia , Cistos Coloides/cirurgia , Cisto Epidérmico/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
9.
Zhonghua Yi Xue Za Zhi ; 90(41): 2932-4, 2010 Nov 09.
Artigo em Chinês | MEDLINE | ID: mdl-21211400

RESUMO

OBJECTIVE: To make a clear distinction of intrasellar cystic lesions: craniopharyngioma (CR), Rathke's cleft cyst (RCC), cystic pituitary adenoma (PA) and intrasellar arachnoid cyst (AC). METHODS: A total of 72 adult patients underwent transsphenoidal approach for the removal of intrasellar cystic lesions. The authors conducted a study to (1) investigate preoperative clinical, biochemical and radiographic features of patients with CR, RCC, PA and AC; (2) identify clinicopathological features of independently predicting recurrence in CR, PA and RCC in adults. These adult patients included CR (n = 10), RCC (n = 27), cystic PA (n = 32) and 1 patient with AC (n = 1). RESULTS: The CR patients presented with hypopituitarism in 80% of cases. According to the biochemical criteria, the percentage of patients with a slight prolactin increase happened in PA (55.6%) and RCC (44.4%). Cystic PA had post-contrasting enhancement in cyst wall because of tumor tissue. Calcification detectable on computed tomographic scanning was present in 70% of CR patients. It was a significantly greater proportion compared to other diseases. Typical RCC was located between anterior and posterior pituitary and the contents in RCC were variable. Mass effects vanished post-operatively in all kinds of lesions. Long-term hormone replacement therapy was administered more in CR patients (60%) and diabetes insipidus than other lesions. One PA patient and 2 CR patients had recurrence during a follow-up of 12 - 52 months (mean: 34). RCC and AC had no recurrence. CONCLUSION: Craniopharyngioma, Rathke's cleft cyst, cystic pituitary adenoma and intrasellar arachnoid cyst are a spectrum of diseases with different therapeutic strategies. An accurate diagnosis of these lesions is essential so as to determine the type of treatment to improve outcome.


Assuntos
Cistos Aracnóideos/cirurgia , Craniofaringioma/cirurgia , Neoplasias Hipofisárias/cirurgia , Adolescente , Adulto , Idoso , Cistos Aracnóideos/classificação , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/cirurgia , Craniofaringioma/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Radiat Med ; 24(6): 471-81, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16958432

RESUMO

This article describes a classification and imaging diagnosis of intracranial midline cystic malformations based on neuroembryologic analysis. Midline cystic malformations are classified into two categories from an embryologic point of view. In one category, the cyst represents expansion of the roof plate of the brain vesicle, and in the other the cyst consists of extraaxial structures such as an arachnoid membrane or migrating ependymal cells. Infratentorial cysts, such as the Dandy-Walker cyst or Blake's pouch cyst, and supratentorial cysts, such as a communicating interhemispheric cyst with callosal agenesis or a dorsal cyst with holoprosencephaly, are included in the first category. Infratentorial arachnoid cavities, such as the arachnoid cyst, arachnoid pouch, and mega cisterna magna, are in the second category. Noncommunicating interhemispheric cysts, such as interhemispheric arachnoid cyst or ependymal cyst, with callosal agenesis are also in the second category. A careful review of embryologic development is essential for understanding these midline cysts and for making a more accurate radiologic diagnosis.


Assuntos
Encéfalo/anormalidades , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/embriologia , Síndrome de Dandy-Walker/embriologia , Síndrome de Dandy-Walker/patologia , Cistos Aracnóideos/classificação , Cistos Aracnóideos/embriologia , Encéfalo/embriologia , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cistos do Sistema Nervoso Central/patologia , Síndrome de Dandy-Walker/diagnóstico por imagem , Humanos , Radiografia
11.
Neurol Med Chir (Tokyo) ; 44(8): 438-41, 2004 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15508354

RESUMO

A 19-year-old male presented with raised intracranial pressure and a peripherally enhanced multinodular lesion with a large subjacent cyst in the right medial frontal lobe. Surgery revealed a solid tuberculoma and an underlying cyst lined with normal brain tissue. A 22-year-old male with a history of tuberculous meningitis and hydrocephalus presented with an exophytic brain stem and a left temporal tuberculoma, which were excised in two stages. The temporal tuberculoma had a peripherally located cyst that was lined with tuberculous tissue. Intracranial tuberculomas are an important part of the differential diagnosis where tuberculosis is endemic and in immunocompromised patients. Cystic tuberculomas are uncommon. The cysts may be centrally or peripherally intralesional, or either subdural and extralesional, or occur between the lesion and the brain. The type of cyst is important to recognize preoperatively, so that adequate precautions can be taken during the excision of these lesions.


Assuntos
Encefalopatias/classificação , Encefalopatias/etiologia , Cistos do Sistema Nervoso Central/classificação , Cistos do Sistema Nervoso Central/etiologia , Tuberculoma Intracraniano/classificação , Tuberculoma Intracraniano/etiologia , Adulto , Encefalopatias/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Córtex Cerebral/cirurgia , Humanos , Masculino , Tuberculoma Intracraniano/cirurgia
12.
Acta Radiol ; 45(2): 204-8, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15191107

RESUMO

PURPOSE: To investigate the role of the CISS (constructive interference in steady state) sequence in sacral meningeal cysts. MATERIAL AND METHODS: Fourteen patients with sacral meningeal cysts were included. Conventional T1W and T2W sequences and the CISS sequence (TR/TE = 12.25/5.90) were obtained at 1.5-T. The 1-mm-thick base images and multiplanar reformatted images of the CISS sequence were studied. The sacral meningeal cysts were classified by the CISS sequence in accordance with the previously described surgical and histopathological criteria. RESULTS: A total of 25 sacral meningeal cysts were identified in the 14 patients. The cysts and their contents were visualized by the CISS sequence, and the CISS sequence was superior to the T1W and T2W images. Fifteen of the cysts were consistent with type I lesions (extradural meningeal cysts without nerve fibers inside) and 10 cysts with type II lesions (extradural meningeal cysts with nerve fibers inside). There were no type III lesions (intradural meningeal cysts) in the sacral region. CONCLUSION: Previous studies have indicated that conventional MRI as well as magnetic resonance myelography are inconsistent for a classification of sacral meningeal cysts. The CISS sequence with its capability to obtain T2W thin slice acquisitions is superior in showing the nerve root fibers contained in the cysts, which is essential in the differentiation of type I and II cysts. Application of the CISS sequence is recommended in the diagnosis of sacral meningeal cysts.


Assuntos
Cistos do Sistema Nervoso Central/classificação , Imagem por Ressonância Magnética/métodos , Meninges , Adulto , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Região Lombossacral , Masculino , Pessoa de Meia-Idade
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