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1
de Oliveira Filho, Ítalo Teles, Paulo Cesar Romero, Emílio Afonso França Fontoura, Saul Dalla de Oliveira, and Ricardo Vieira Botelho. "Symptomatic foramen of Magendie arachnoid cyst in an elderly patient: The second case report in the literature." Surgical Neurology International 10 (September 27, 2019): 189. http://dx.doi.org/10.25259/sni_380_2019.
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Background: Arachnoid cysts are benign extra-axial lesions corresponding to 1% of intracranial expansive lesions. They are usually incidental findings in asymptomatic patients. Most cases are congenital, and when symptomatic are diagnosed in childhood or adolescence. Symptomatic arachnoids cyst in elderly patients is very rare. This report documents the second case in the literature of a symptomatic elderly patient with an arachnoid cyst located in the foramen of Magendie. Case Description: A 68-year-old male had weakness in the lower limbs, imbalance, and gait disturbance for 3 years, associated with frequent falls. The patient complained of paresthesia in the upper right limb and right hemiface. An magnetic resonance imaging showed a massive cystic lesion in the posterior fossa in the foramen of Magendie. A median suboccipital craniectomy was performed, and the cyst was removed. Conclusion: This case report adds to the literature the second case of a patient with a symptomatic arachnoid cyst in the posterior fossa successfully treated by surgery.
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FRYDAY, Alan M., Damien ERTZ, and Per Magnus JØRGENSEN. "Insights into the genus Austrella (Pannariaceae, Peltigerales), including a new species from the Falkland Islands." Lichenologist 49, no. 1 (January 2017): 57–65. http://dx.doi.org/10.1017/s0024282916000621.
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AbstractThe new species Austrella isidioidea, which is unique in the genus in having isidioid structures on the thallus lobe ends as well as apothecia lacking a thalline margin, is described from the Falkland Islands. A collection with an identical mtSSU rDNA sequence to A. arachnoidea but with significant morphological differences (viz. a variable apothecial margin ranging from an arachnoid hyphal weft to a corticated regular margin) is reported from Îles Kerguelen. The phylogenetic and biogeographical implications of these new records are discussed.
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Verma, Siddharth. "Spinal Extradural Arachnoid cyst: Review of Literature." Journal of Surgical Case Reports and Images 3, no. 2 (February 27, 2020): 01–03. http://dx.doi.org/10.31579/2690-1897/020.
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Spinal arachnoid cysts are mostly intradural. Spinal extradural arachnoid cyst (SEAC) is very rare condition accounting for only 1% cases of spinal tumors. [1,2,3] SEAC is mostly found in males in their second to fifth decades. Most common location of SEAC is thoracic spine
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Haybaeck, Johannes, Rene Silye, and Dov Soffer. "Dural arachnoid granulations and “giant” arachnoid granulations." Surgical and Radiologic Anatomy 30, no. 5 (April 8, 2008): 417–21. http://dx.doi.org/10.1007/s00276-008-0345-2.
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Deutsch, Harel. "Thoracic arachnoid cyst resection." Neurosurgical Focus 37, v2supplement (September 2014): Video4. http://dx.doi.org/10.3171/2014.v3.focus14262.
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Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst.The video can be found here: http://youtu.be/pgUrl9xvsD0.
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Hande, Ashok Mahade, and Anil Pandurang Karapurkar. "Hemorrhage into an intradiploic arachnoid cyst." Journal of Neurosurgery 75, no. 6 (December 1991): 969–71. http://dx.doi.org/10.3171/jns.1991.75.6.0969.
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✓ Intracranial arachnoid cysts are relatively rare; it is believed that they account for only 1% of all intracranial space-occupying lesions. When they occur in the intracranial cavity, they usually develop in relation to an arachnoid cistern as a pocket of cerebrospinal fluid within two layers of arachnoid membrane. Five cases of intradiploic arachnoid cysts have been reported, but an arachnoid cyst presenting as an extradural mass has not been described before. The authors present an unusual case of hemorrhage into a massive intracranial extradural arachnoid cyst with no intradural communication.
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Sivakumaran, Rajitha. "The relationship between age and arachnoid depressions in humans." COMPASS 2, no. 1 (October 30, 2017): 10–23. http://dx.doi.org/10.29173/comp46.
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The human skeletal collection housed in the Department of Anthropolog y at the University of Alberta was used to determine the relationship between age and the occurrence of arachnoid depressions on the endocranial aspect of the skull. There were significant differences between the total number of arachnoid depressions found on the vaults of juveniles, adolescents, and adults. When mean ages were compared with total number of arachnoid depressions on the vault, a significant relationship did not emerge. When age was grouped into nine-year intervals to counteract the effect of idiosyncratic variation, the mean number of depressions increased with age, as did the maximum number of arachnoid depressions. The frequency of older individuals without arachnoid depressions waslow. Older individuals were more likely to have larger and deeper arachnoid depressions. There were no sex-based differences in the expression of arachnoid depressions. There were no significant differences between archaeological, historic, and modern samples or between pathological and healthy individuals. Although this study verifies the association between arachnoid depressions and senescence, the presence of arachnoid depressions is highly variable andcannot be used reliably as an indicator of chronological age or even as a sign of senescence.
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Benek, Huseyin Berk, and Emrah Akcay. "Concomitant chronic subdural hematomas and arachnoid cysts in young adults." F1000Research 10 (May 26, 2021): 421. http://dx.doi.org/10.12688/f1000research.53210.1.
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Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5–60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.
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Go, K. Gwan, Hendrik-Jan Houthoff, Johannes Hartsuiker, Engbert H. Blaauw, and Piet Havinga. "Fluid secretion in arachnoid cysts as a clue to cerebro-spinal fluid absorption at the arachnoid granulation." Journal of Neurosurgery 65, no. 5 (November 1986): 642–48. http://dx.doi.org/10.3171/jns.1986.65.5.0642.
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✓ The morphological similarity of the lining of arachnoid cysts to subdural neurothelium and the mesothelium of arachnoid granulations suggested that the latter tissues might be the origin of arachnoid cysts. Transport Na+-K+-adenosine triphosphatase was shown by enzyme ultracytochemistry to be an indication of secretory activity in the lining of arachnoid cysts and in the endothelial lining of arachnoid granulations. This secretory activity suggests the existence of a biochemical mechanism for cerebrospinal fluid absorption at these granulations separate from the mechanisms already demonstrated.
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Millichap, J. Gordon. "Arachnoid Cysts." Pediatric Neurology Briefs 5, no. 10 (October 1, 1991): 80. http://dx.doi.org/10.15844/pedneurbriefs-5-10-10.
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Dmytriw, Adam A. "Arachnoid Mater." Medical Humanities 43, no. 3 (March 8, 2017): e23-e23. http://dx.doi.org/10.1136/medhum-2017-011204.
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Valluru, Balakrishna, and Ray Raj. "Arachnoid Cyst." New England Journal of Medicine 373, no. 11 (September 10, 2015): e13-e13. http://dx.doi.org/10.1056/nejmicm1413067.
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Clary, Matthew S., Ryan Walker, Brian D. Nicholas, Joseph F. Goodman, Girish Kori, and Gregory J. Artz. "Arachnoid Cyst." Archives of Otolaryngology–Head & Neck Surgery 137, no. 4 (April 18, 2011): 398. http://dx.doi.org/10.1001/archoto.2011.31.
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Kida, Shinya, Tetsumori Yamashima, Toshihiko Kubota, Haruhide Ito, and Shinjiro Yamamoto. "A light and electron microscopic and immunohistochemical study of human arachnoid villi." Journal of Neurosurgery 69, no. 3 (September 1988): 429–35. http://dx.doi.org/10.3171/jns.1988.69.3.0429.
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✓ The structure of human arachnoid villi was investigated by light and electron microscopy with the aid of immunohistochemical techniques. The human arachnoid villi examined were basically composed of four portions: a fibrous capsule, an arachnoid cell layer, a cap cell cluster, and a central core. The arachnoid cell layer encompassing the central core was mostly covered by the thin fibrous capsule with an endothelial investment. However, the fibrous capsule was often absent at the apical portion of the villus and a factor VIII-related antigen stain failed to confirm the investment of endothelial cells. Instead, the arachnoid cell layer abutted directly upon the lumen of a lateral lacuna or the sinus. The arachnoid cell layer was thickened in places, forming cap cell clusters; it usually consisted of outer and inner zones. On vimentin staining, the former was slightly positive while the latter was strongly positive. The central core contained a network of arachnoid cells intermingled with connective tissue fibers and was in continuity with the cranial subarachnoid space. Electron microscopy showed that the arachnoid cells contained a larger number of intermediate filaments in the inner zone than the outer zone. Ultrastructural immunohistochemical localization showed that vimentin was localized at the intermediate filaments and desmosomal plaques of the arachnoid cells. The arachnoid cells showed a marked variety in both the cell forms and the number of intermediate filaments or desmosomes, depending on their location.
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Souweidane, Mark M., Peter F. Morgenstern, Paul J. Christos, Mark A. Edgar, Yasmin Khakoo, James T. Rutka, and Ira J. Dunkel. "INTRAOPERATIVE ARACHNOID AND CEREBROSPINAL FLUID SAMPLING IN CHILDREN WITH POSTERIOR FOSSA BRAIN TUMORS." Neurosurgery 65, no. 1 (July 1, 2009): 72–78. http://dx.doi.org/10.1227/01.neu.0000348011.98625.43.
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ABSTRACT OBJECTIVE This study was conducted to determine whether arachnoid tissue or cerebrospinal fluid (CSF) sampling is valuable for risk stratification in children with posterior fossa brain tumors. METHODS Arachnoid tissue and CSF from the cisterna magna (CSFCM) was sampled at the time of primary tumor resection. Results were compared with conventional staging methods (M stage) and correlated with patient outcome. RESULTS Eighty-three patients were enrolled in the study. Arachnoid infiltration was identified in 11 of 80 (13.8%) and CSFCM was positive in 20 of 77 (26.0%) specimens. Arachnoid infiltration and CSF cytology were found in 20.0% and 44.8%, respectively, for medulloblastoma/pineoblastoma (primitive neuroectodermal tumor), 6.9% and 3.6% for pilocytic astrocytoma, and 0.0% and 33.3% for ependymoma. The 3-year event-free survival (EFS) was negatively influenced by either arachnoid infiltration (40.9% arachnoid positive versus 65.4% arachnoid negative; P = 0.23) or CSFCM positivity (52.6% CSFCM positive versus 67.1% CSFCM negative; P = 0.03). The 3-year EFS for patients with primitive neuroectodermal tumor who had positive arachnoid sampling was 33.3%, compared with 67.3% in patients who had no evidence of arachnoid infiltration (P = 0.26). The 3-year EFS for patients with primitive neuroectodermal tumor who had positive CSFCM was 50.0% compared with 67.5% in patients who had negative cytological analysis of CSFCM (P = 0.07). Arachnoid infiltration and CSF sampling were congruous with M stage in 73.3% and 86.2% of patients, respectively. CONCLUSION Intraoperative evidence of arachnoid infiltration or CSFCM dissemination in patients with posterior fossa brain tumors occurs at a variable frequency that is dependent on tumor type, correlates with conventional M stage, and may be predictive of outcome.
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Isu, Toyohiko, Takashi Iizuka, Yoshinobu Iwasaki, Masafumi Nagashima, Minoru Akino, and Hiroshi Abe. "Spinal Cord Herniation Associated with an Intradural Spinal Arachnoid Cyst Diagnosed by Magnetic Resonance Imaging." Neurosurgery 29, no. 1 (July 1, 1991): 137–39. http://dx.doi.org/10.1227/00006123-199107000-00027.
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Abstract Two rare cases of spinal cord herniation associated with intradural spinal arachnoid cyst are reported. A preoperative magnetic resonance imaging scan demonstrated the presence of spinal cord herniation, identified as a protrusion continuous with the spinal cord. Surgery upon the intradural spinal arachnoid cyst improved progressive neurological dysfunction. The authors postulate that spinal cord herniation occurred for the following reason: The pressure of the intradural arachnoid cyst on the dorsal aspect of the spinal cord caused thinning of the dura, leading to a tear and, thus, the development of an extradural arachnoid cyst. Along with the enlargement of intradural arachnoid cyst, the spinal cord herniated through the tear in the dura into the extradural arachnoid cyst. (Neurosurgery 29:137-139, 1991)
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Li, L., F. Begbie, N. Grimmond, and G. Kontorinis. "Arachnoid cysts on magnetic resonance imaging: just an incidental finding?" Journal of Laryngology & Otology 134, no. 5 (April 17, 2020): 424–30. http://dx.doi.org/10.1017/s0022215120000808.
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AbstractObjectiveTo determine the clinical significance of arachnoid cysts.MethodsThe scans of 6978 patients undergoing magnetic resonance imaging of the internal acoustic meatus for unilateral cochleovestibular symptoms were retrospectively reviewed. We identified the scans with arachnoid cysts, and assessed the statistical associations between the laterality, location and size of the arachnoid cyst, the laterality of symptoms, the patients’ age and gender.ResultsIn a total of 37 arachnoid cysts identified in 36 patients (0.5 per cent), no associations were identified between the laterality of symptoms and the laterality of the arachnoid cyst, regardless of its size or location. There were no significant associations between the location of the arachnoid cyst and the age (p = 0.99) or gender of the patient (p = 0.13), or size (p = 0.656) or side of the cyst (p = 0.61). None of the cysts with repeat imaging scans (17 cysts) demonstrated growth.ConclusionOur results suggest that most, if not all, arachnoid cysts are of no clinical significance. Given their indolent behaviour, even serial imaging is not essential.
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Kohno, Michihiro, Hiroaki Sato, Shigeo Sora, Hiroshi Miwa, and Munehiro Yokoyama. "Is an Acoustic Neuroma an Epiarachnoid or Subarachnoid Tumor?" Neurosurgery 68, no. 4 (April 1, 2011): 1006–17. http://dx.doi.org/10.1227/neu.0b013e318208f37f.
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Abstract BACKGROUND: There are arguments about whether acoustic neuromas are epiarachnoid or subarachnoid tumors. OBJECTIVE: To retrospectively examine 118 consecutively operated-on patients with acoustic neuromas to clarify this point. METHODS: Epiarachnoid tumors are defined by the absence of an arachnoid membrane on the tumor surface after moving the arachnoid fold (double layers of the arachnoid membrane) toward the brainstem. In contrast, subarachnoid tumors are characterized by the arachnoid membrane remaining on the tumor surface after moving the arachnoid fold. Based on this hypothesis, we used intraoperative views and light and electron microscopy to confirm the existence of an arachnoid membrane after the arachnoid fold had been moved. RESULTS: The tumors were clearly judged to be subarachnoid tumors in 86 of 118 patients (73%), an epiarachnoid tumor in 2 patients (2%), whereas a clear judgment was difficult to make in the remaining 30 patients (25%). CONCLUSION: The majority of acoustic neuromas are subarachnoid tumors, with epiarachnoid tumors being considerably less common.
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Zhan, Chaohong, Gelei Xiao, Xiangyang Zhang, Xiaoyu Chen, Zhiping Zhang, and Jingping Liu. "Decreased MiR-30a promotes TGF-β1-mediated arachnoid fibrosis in post-hemorrhagic hydrocephalus." Translational Neuroscience 11, no. 1 (May 26, 2020): 60–74. http://dx.doi.org/10.1515/tnsci-2020-0010.
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AbstractBackgroundFibrosis in the ventricular system is closely associated with post-hemorrhagic hydrocephalus (PHH). It is characterized by an expansion of the cerebral ventricles due to CSF accumulation following intraventricular hemorrhage (IVH). The activation of transforming growth factor-β1 (TGF-β1) may be involved in thrombin-induced arachnoid fibrosis.MethodsA rat model of PHH was established by injection of autologous non-anticoagulated blood from the right femoral artery into the lateral ventricles. Differential expression of miR-30a was detected in rat arachnoid cells by RNA sequencing. AP-1, c-Fos, and TRAF3IP2 were knocked down in primary arachnoid cells, and the degree of arachnoid fibrosis was assessed.ResultsDecreased expression of miR-30a and increased expression of TRAF3IP2, TGF-β1, and α-SMA were detected in the arachnoid cells of PHH rat. Besides, overexpression of miR-30a targets TRAF3IP2 mRNA 3′UTR and inhibits the expression of TRAF3IP2, TGF-β1, and α-SMA in the primary arachnoid cells. Furthermore, TRAF3IP2 activates AP-1 to promote arachnoid fibrosis. The content of type I collagen in the primary arachnoid cells was reduced after the silencing of AP-1 and TRAF3IP2.ConclusionsThis study identified a miR-30a-regulated mechanism of arachnoid fibrosis, suggesting a previously unrecognized contribution of miR-30a to the pathogenesis of fibrosis in the ventricular system. These results might provide a new target for the clinical diagnosis and treatment of PHH.
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Rabiei, Katrin, Per Hellström, Mats Högfeldt-Johansson, and Magnus Tisell. "Does subjective improvement in adults with intracranial arachnoid cysts justify surgical treatment?" Journal of Neurosurgery 128, no. 1 (January 2018): 250–57. http://dx.doi.org/10.3171/2016.9.jns161139.
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OBJECTIVESubjective improvement of patients who have undergone surgery for intracranial arachnoid cysts has justified surgical treatment. The current study aimed to evaluate the outcome of surgical treatment for arachnoid cysts using standardized interviews and assessments of neuropsychological function and balance. The relationship between arachnoid cyst location, postoperative improvement, and arachnoid cyst volume was also examined.METHODSThe authors performed a prospective, population-based study. One hundred nine patients underwent neurological, neuropsychological, and physiotherapeutic examinations. The arachnoid cysts were considered symptomatic in 75 patients, 53 of whom agreed to undergo surgery. In 32 patients, results of the differential diagnosis revealed that the symptoms were due to a different underlying condition and were unrelated to an arachnoid cyst. Neuropsychological testing included target reaction time, Grooved Pegboard, Rey Auditory Verbal Learning, Rey Osterrieth complex figure, and Stroop tests. Balance tests included the extended Falls Efficacy Scale, Romberg, and sharpened Romberg with open and closed eyes. The tests were repeated 5 months postoperatively. Cyst volume was pre- and postoperatively measured using OsiriX software.RESULTSPatients who underwent surgery did not have results on balance and neuropsychological tests that were different from patients who declined or had symptoms unrelated to the arachnoid cyst. Patients with a temporal arachnoid cyst performed within the normal range on the neuropsychological tests. Seventy-seven percent of the patients who underwent surgery reported improvement, yet there were no differences in test results before and after surgery. Arachnoid cysts in the temporal region and posterior fossa did not influence the preoperative results of neuropsychological and motor tests. The arachnoid cyst volume decreased postoperatively (p < 0.0001), but there was no relationship between volume reduction and clinical improvement.CONCLUSIONSThe results of this study speak against objectively verifiable improvement following surgical treatment in adults with intracranial arachnoid cysts.
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Asimakopoulos, George, Panagiotis Antsaklis, Mariana Theodora, Michael Sindos, Alexandros Rodolakis, Dimitrios Loutradis, and George Daskalakis. "Prenatal diagnosis of a large suprasellar arachnoid cyst." Hellenic Journal of Obstetrics and Gynecology 19, no. 1 (January 3, 2020): 51–58. http://dx.doi.org/10.33574/hjog.1937.
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Arachnoid cysts represent 1% of all intracranial lesions and appear on the arachnoid membrane (subarachnoid space). The etiology and pathogenesis of arachnoid cysts remain unclear and in their majority they are asymptomatic. Due to the developmental origin of arachnoid cysts, these formations can be identified on prenatal fetal imaging. In this report we presented a case of an enlarged suprasellar arachnoid cyst detected incidentally during a routine fetal sonographic examination at 33 weeks of gestation. The cyst remained stable in size prenatally and postnatally without compressive symptoms and signs and the patient has been set under expectant management with serial clinical evaluation and serial imaging of the cyst.
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Gupta, Pankaj, Nityanand Gopal, and Varsha Kumar. "Long segment dorsolumbar spinal arachnoid cyst: a case report." Romanian Neurosurgery 21, no. 1 (March 1, 2014): 85–87. http://dx.doi.org/10.2478/romneu-2014-0009.
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Abstract Congenital spinal intradural arachnoid cyst involving almost the entire spine is very rare. We report a case of 15 years old boy, who presented with progressive spastic paraparesis with gait instability for last 4 months. MRI spine revealed thoracolumbar arachnoid cyst extending from D4 to L3 segment. Complete surgical excision of arachnoid cyst and laminoplasty was done. Patient recovered completely and histopathological examination of specimen confirmed the diagnosis of arachnoid cyst.
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McCormick, Paul C. "Dorsal arachnoid web." Neurosurgical Focus 37, v2supplement (September 2014): Video8. http://dx.doi.org/10.3171/2014.v3.focus14273.
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Dorsal thoracic arachnoid web is a rare but often overlooked cause of progressive myelopathy. Syringomyelia, either above or below the compressive arachnoid band, may also be present. Dorsal arachnoid cyst and ventral spinal cord herniation may be mistaken for this condition. This video demonstrates the microsurgical identification and techniques of resection of a dorsal arachnoid band producing a progressive myelopathy in a 63-year-old man.The video can be found here: http://youtu.be/KDNTqiyW6yo.
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Yamaguchi, Satoshi, Kazutoshi Hida, Masaaki Takeda, Takafumi Mitsuhara, Mizuki Morishige, Naoto Yamada, and Kaoru Kurisu. "Visualization of regional cerebrospinal fluid flow with a dye injection technique in focal arachnoid pathologies." Journal of Neurosurgery: Spine 22, no. 5 (May 2015): 554–57. http://dx.doi.org/10.3171/2014.10.spine1446.
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Surgical lysis of the thickened arachnoid membrane is the first choice of treatment in spinal arachnoid pathologies that cause flow disturbances or blockage of CSF. However, it is important to consider that while extensive lysis of the arachnoid may temporarily provide a wide pathway for CSF, an extensive lytic procedure may later cause secondary adhesion. Thus, it is ideal for the proper extent of the arachnoid lysis to be determined after careful analysis of regional CSF flow. The authors report their limited experience with intraoperative visualization of CSF flow in spinal arachnoid pathologies. Two patients with a dorsal arachnoid web (DAW) with cervical syringomyelia and 1 patient with focal adhesive arachnoiditis causing edema of the spinal cord were surgically treated at the authors' institution between 2007 and 2013. In all cases, the presence of a DAW or focal adhesive arachnoiditis was suspected from the findings on MRI, namely 1) an indentation on the upper thoracic spinal cord and 2) syringomyelia and/or edema of the spinal cord above the indentation. Exploratory surgery disclosed a transversely thickened arachnoid septum on the dorsal side of the indented cord. To prove blockage of the CSF by the septum and to decide on the extent of arachnoid lysis, regional CSF flow around the arachnoid septum was visualized by subarachnoid injection of gentian violet solution close to the web. Injected dye stagnated just close to the arachnoid septum in all cases, and these findings documented CSF blockage by the septum. In 2 cases, a 2-minute observation showed that the injected dye stayed close to the web without diffusion. The authors performed not only resection of the web itself but also lysis of the thickened arachnoid on both sides of the spinal cord to make a CSF pathway on the ventral side. In the third case, the dye stagnated close to the web at first but then diffused through the nerve root to the ventral CSF space. The lysis procedure was completed after exclusive removal of the dorsal web. Postoperative MR images confirmed reduction of the syrinx and/or improvement of the edema in all cases, suggesting that the extent of arachnoid lysis was optimal in each case. No adverse effect was observed after subarachnoid injection of gentian violet. The authors believe that their technique of visualizing regional CSF flow will be helpful to decide the optimal extent of lysis in some local arachnoid pathologies.
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Domenicucci, Maurizio, Natale Russo, Elisabetta Giugni, and Alberto Pierallini. "Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment." Journal of Neurosurgery 110, no. 6 (June 2009): 1250–55. http://dx.doi.org/10.3171/2008.4.17509.
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Object Arachnoid cysts are relatively common congenital intracranial mass lesions that arise during the development of the meninges. They can be complicated by the formation of an ipsilateral chronic subdural hematoma (CSDH) after minor cranial trauma. Treatment of these coexisting conditions remains controversial. In this study the authors describe the anatomical, clinical, and neuroradiological features and outcome in a series of patients whose CSDH associated with arachnoid cysts were managed surgically by draining the hematoma alone and leaving the cyst intact. The authors based this surgical management on histological and neuroradiological observations concerning these associated medical conditions. Methods A series of 8 patients with CSDHs associated with arachnoid cysts underwent surgery to drain the hematoma though a bur hole. The arachnoid cyst was left intact. Postoperative follow-up included CT scanning and T1- and T2-weighted MR imaging. Results Clinical, anatomical, and radiological observations suggest that because separate membranes cover arachnoid cysts and the related hematoma, arachnoid cysts remain unaffected by the subdural bleeding. In the present study, these observations received support from the neuroimaging appearances, suggesting that arachnoid cysts related to hematoma contained only blood breakdown products from the hematoma that had filtered through the reciprocal dividing membranes. Conclusions Arachnoid cysts associated with SDH are anatomically separate conditions whose neurological symptoms respond to surgical drainage of the CSDH alone.
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Lü, Jian, and Xianli Zhu. "Microsurgical anatomy of the interpeduncular cistern and related arachnoid membranes." Journal of Neurosurgery 103, no. 2 (August 2005): 337–41. http://dx.doi.org/10.3171/jns.2005.103.2.0337.
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Object. The goal of this study was to investigate the microsurgical anatomy of the interpeduncular cistern and related arachnoid membranes. Methods. The interpeduncular cistern and related arachnoid membranes were studied in eight Han Chinese adult human cadaveric brains with the aid of an operating microscope. The interpeduncular cistern is one area in the cranial cavity in which the arachnoid membranes and trabeculae are extremely luxuriant and complicated. The Liliequist membrane, the medial pontomesencephalic membrane, and the lateral pontomesencephalic membranes form the walls of the interpeduncular cisterns. The basilar artery (BA) bifurcation membrane, posterior perforated membrane, and arachnoid trabeculae fill the cistern. These arachnoid membranes and trabeculae adhere to the hypothalamus, brainstem, and oculomotor nerves, and bind the bifurcation of the BA, posterior cerebral arteries, superior cerebellar arteries, posterior communicating arteries, and their perforating branches. Conclusions. Arachnoid membranes and trabeculae complicate the exposure and dissection of lesions within the interpeduncular cistern. All arachnoid membranes and trabeculae should be dissected and incised sharply during surgical procedures. The BA bifurcation membrane and the posterior perforated membrane must be incised after opening the Liliequist membrane for sufficient exposure of deep structures within the interpeduncular cistern.
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Chang, Han Soo, Atsushi Nagai, Soichi Oya, and Toru Matsui. "Dorsal spinal arachnoid web diagnosed with the quantitative measurement of cerebrospinal fluid flow on magnetic resonance imaging." Journal of Neurosurgery: Spine 20, no. 2 (February 2014): 227–33. http://dx.doi.org/10.3171/2013.10.spine13395.
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An arachnoid web is an abnormal formation of the arachnoid membrane in the spinal subarachnoid space that blocks CSF flow and causes syringomyelia. Although the precise mechanism of syrinx formation is unknown, dissection of the arachnoid web shrinks the syrinx and improves symptoms. Precisely determining the location of the arachnoid web is difficult preoperatively, however, because the fine structure generally cannot be visualized in usual MRI sequences. In this report the authors describe 2 cases of arachnoid web in which the web was preoperatively identified using quantitative CSF flow analysis of MRI. By analyzing cardiac-gated phase-contrast cine-mode MRI in multiple axial planes, the authors precisely localized the obstruction of CSF flow on the dorsal side of the spinal cord in both patients. This technique also revealed a 1-way valve-like function of the arachnoid webs. Imaging led to the early diagnosis of myelopathy related to the derangement of CSF flow and allowed the authors to successfully excise the webs through limited surgical exposure.
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Olaya, Joffre E., Michelle Ghostine, Mark Rowe, and Alexander Zouros. "Endoscopic fenestration of a cerebellopontine angle arachnoid cyst resulting in complete recovery from sensorineural hearing loss and facial nerve palsy." Journal of Neurosurgery: Pediatrics 7, no. 2 (February 2011): 157–60. http://dx.doi.org/10.3171/2010.11.peds10281.
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Cerebellopontine angle arachnoid cysts are usually asymptomatic, but are frequently found incidentally because of increased use of neuroimaging. Nevertheless, as these cysts enlarge, they may compress surrounding structures and cause neurological symptoms. Patients may present with vague, nonspecific symptoms such as headache, nausea, vomiting, and vertigo. Cranial nerve palsies, including sensorineural hearing loss and facial weakness, although rare, have also been reported in association with posterior fossa arachnoid cysts. Although surgery for these entities is controversial, arachnoid cysts can be treated surgically with open craniotomy for cyst removal, fenestration into adjacent arachnoid spaces, shunting of cyst contents, or endoscopic fenestration. Reversal of sensorineural hearing loss following open craniotomy treatment has been described in the literature in only 1 adult and 1 pediatric case. Improvement in facial weakness has also been reported after open craniotomy and arachnoid cyst fenestration. The authors report the first case of complete recovery from sensorineural hearing loss and facial weakness following endoscopic fenestration in a patient with a cerebellopontine angle arachnoid cyst.
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Paramore, Christopher G. "Dorsal arachnoid web with spinal cord compression: variant of an arachnoid cyst?" Journal of Neurosurgery: Spine 93, no. 2 (October 2000): 287–90. http://dx.doi.org/10.3171/spi.2000.93.2.0287.
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✓ Spinal arachnoid cysts are diverticula of the subarachnoid space that may compress the spinal cord; these lesions are most commonly found in the thoracic spine. Two patients who presented with thoracic myelopathy were noted on magnetic resonance imaging to have focal indentation of the dorsal thoracic cord, with syringomyelia inferior to the site of compression. Both patients were found at operation to have discrete arachnoid “webs” tenaciously attached to the dura mater and pia mater. These webs were not true arachnoid cysts, yet they blocked the flow of cerebrospinal fluid (CSF) and caused focal compression of the spinal cord. The mass effect appeared to be the result of a pressure gradient created by the obstruction of CSF flow in the dorsal aspect of the subarachnoid space. Both patients responded well to resection of the arachnoid web. Arachnoid webs appear to be rare variants of arachnoid cysts and should be suspected in patients with focal compression of the thoracic spinal cord.
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Dauleac, Corentin, Timothée Jacquesson, and Patrick Mertens. "Anatomy of the human spinal cord arachnoid cisterns: applications for spinal cord surgery." Journal of Neurosurgery: Spine 31, no. 5 (November 2019): 756–63. http://dx.doi.org/10.3171/2019.4.spine19404.
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OBJECTIVEThe goal in this study was to describe the overall organization of the spinal arachnoid mater and spinal subarachnoid space (SSAS) as well as its relationship with surrounding structures, in order to highlight spinal cord arachnoid cisterns.METHODSFifteen spinal cords were extracted from embalmed adult cadavers. The organization of the spinal cord arachnoid and SSAS was described via macroscopic observations, optical microscopic views, and scanning electron microscope (SEM) studies. Gelatin injections were also performed to study separated dorsal subarachnoid compartments.RESULTSCompartmentalization of SSAS was studied on 3 levels of axial sections. On an axial section passing through the tips of the denticulate ligament anchored to the dura, 3 subarachnoid cisterns were observed: 2 dorsolateral and 1 ventral. On an axial section passing through dural exit/entrance of rootlets, 5 subarachnoid cisterns were observed: 2 dorsolateral, 2 lateral formed by dorsal and ventral rootlets, and 1 ventral. On an axial section passing between the two previous ones, only 1 subarachnoid cistern was observed around the spinal cord. This compartmentalization resulted in the anatomical description of 3 elements: the median dorsal septum, the arachnoid anchorage to the tip of the denticulate ligament, and the arachnoid anchorage to the dural exit/entrance of rootlets. The median dorsal septum already separated dorsal left and right subarachnoid spaces and was described from C1 level to 3 cm above the conus medullaris. This septum was anchored to the dorsal septal vein. No discontinuation was observed in the median dorsal arachnoid septum. At the entrance point of dorsal rootlets in the spinal cord, arachnoid trabeculations were described. Using the SEM, numerous arachnoid adhesions between the ventral surface of the dorsal rootlets and the pia mater over the spinal cord were observed. At the ventral part of the SSAS, no septum was found, but some arachnoid trabeculations between the arachnoid and the pia mater were present and more frequent than in the dorsal part. Laterally, arachnoid was firmly anchored to the denticulate ligaments’ fixation at dural points, and dural exit/entrance of rootlets made a fibrous ring of arachnoidodural adhesions. At the level of the cauda equina, the arachnoid mater surrounded all rootlets together—as a sac and not individually.CONCLUSIONSArachnoid cisterns are organized on each side of a median dorsal septum and compartmentalized in relation with the attachments of denticulate ligament and exit/entrance of rootlets.
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Nottmeier, Eric W., Robert E. Wharen, and Naresh P. Patel. "Iatrogenic intradural spinal arachnoid cyst as a complication of lumbar spine surgery." Journal of Neurosurgery: Spine 11, no. 3 (September 2009): 344–46. http://dx.doi.org/10.3171/2009.3.spine08844.
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Iatrogenic spinal arachnoid cysts are rare, but have been described as a complication of spinal injection and lumbar puncture procedures. The authors describe 2 cases of iatrogenic spinal arachnoid cyst formation that occurred after incidental durotomy during lumbar spine surgery. In both cases, postoperative MR imaging revealed compression of the cauda equina by an intradural arachnoid cyst. Intradural exploration and fenestration of the arachnoid cyst was accomplished in each case. This entity should be considered in the differential diagnosis of a patient experiencing symptoms of neurological compression after a lumbar surgery complicated by incidental durotomy.
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Goyal, Ashish, Anil K. Singh, Daljit Singh, Vikas Gupta, Medha Tatke, Sanjiv Sinha, and Sushil Kumar. "Intramedullary arachnoid cyst." Journal of Neurosurgery: Spine 96, no. 1 (January 2002): 104–6. http://dx.doi.org/10.3171/spi.2002.96.1.0104.
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✓ The authors present an unusual case of intramedullary arachnoid cyst diagnosed in a patient after the lesion was resected. A wide decompressive surgery was performed and the lesion removed. Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively the patient exhibited marked improvement in neurological status. To the best of the authors' knowledge, there is no case report of intramedullary arachnoid cyst reported in the literature. With the advent of newer neuroimaging modalities such as magnetic resonance imaging the number of cases of intramedullary arachnoid cysts encountered in the future may increase.
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Sasaji, Tatsuro, Kiyoshi Horaguchi, Noboru Yamada, and Kazuo Iwai. "The Specific Sagittal Magnetic Resonance Imaging of Intradural Extra-Arachnoid Lumbar Disc Herniation." Case Reports in Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/383451.
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Intradural extra-arachnoid lumbar disc herniation is a rare disease. Few MRI findings have been reported. We experienced an intradural extra-arachnoid lumbar disc herniation. We reviewed the preoperative MRI findings. Lumbar spine T2-weighted sagittal MRI showed that one line of the ventral dura was divided into two by a disc herniation. We speculated that the two lines comprised the dura and arachnoid and that a disc herniation existed between them. We believe that division of the ventral dural line on T2-weighted sagittal images is a characteristic finding of intradural extra-arachnoid lumbar disc herniation. The division of ventral dural line seemed to be a “Y,” and, thus, we called it the “Y sign.” The “Y sign” may be useful for diagnosing intradural extra-arachnoid lumbar disc herniation.
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Panwar, Naresh, Devendra Kumar Purohit, Somnath Sharma, and Sanjeev Chopra. "Symptomatic Thoracic Intramedullary Arachnoid Cyst: “A Rare Entity” Report of Two Cases with Short Review of Literature." Journal of Neurosciences in Rural Practice 10, no. 02 (April 2019): 306–11. http://dx.doi.org/10.4103/jnrp.jnrp_246_18.
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ABSTRACTSpinal arachnoid cysts are uncommon benign lesions of spine axis and most commonly present as compressive myelopathy. Intramedullary arachnoid cyst is uncommonly seen, hence, not much discussed in literature. Due to rarity of this entity, many questions are yet to be answered and should be addressed properly, particularly related to etiopathogenesis, accustomed course, behavior, differential diagnosis, and the best treatment modality. We report the clinicopathological profile of thoracic intramedullary arachnoid cysts in two adult patients, and present a detailed review of available literature on the spinal intramedullary arachnoid cyst. Most of the literature concerning with intramedullary arachnoid cysts are in the form of case reports from pediatrics population. As far to the best of our knowledge, only a few cases excluding our two were found in both pediatrics and adult population.
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Klekamp, Jörg, Ulrich Batzdorf, Madjid Samii, and Hans Werner Bothe. "Treatment of syringomyelia associated with arachnoid scarring caused by arachnoiditis or trauma." Journal of Neurosurgery 86, no. 2 (February 1997): 233–40. http://dx.doi.org/10.3171/jns.1997.86.2.0233.
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✓ The authors conducted a retrospective study of 107 patients treated for syringomyelia associated with arachnoid scarring between 1976 and 1995 at the Departments of Neurosurgery at the Nordstadt Hospital in Hannover, Germany, and the University of California in Los Angeles, California. Twenty-nine patients have not been surgically treated to date because of their stable neurological status. Seventy-eight patients with progressive neurological deficits underwent a total of 121 surgical procedures and were followed for a mean period of 32 (±37) months. All patients demonstrated arachnoid scarring at a level close to the syrinx. In 52 patients the arachnoid scarring was related to spinal trauma, whereas 55 had no history of trauma and developed arachnoid scarring as a result of an inflammatory reaction. Of these, 15 patients had undergone intradural surgery, eight had suffered from spinal meningitis, three had undergone peridural anesthesia, and one each presented with a history of osteomyelitis, spondylodiscitis, and subarachnoid hemorrhage. No obvious cause for the inflammatory reaction resulting in arachnoid scarring could be ascertained for the remaining 26 patients. The postoperative neurological outcome correlated with the severity of arachnoid pathology and the type of surgery performed. Shunting of the syrinx to the subarachnoid, pleural, or peritoneal cavity was associated with recurrence rates of 92% and 100% for focal and extensive scarring, respectively. Successful long-term management of the syrinx required microsurgical dissection of the arachnoid scar and decompression of the subarachnoid space with a fascia lata graft. This operation stabilized the preoperative progressive neurological course in 83% of patients with a focal arachnoid scar. For patients with extensive arachnoid scarring over multiple spinal levels or after previous surgery, clinical stabilization was achieved in only 17% with this technique.
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Kimiwada, Tomomi, Toshiaki Hayashi, Ayumi Narisawa, Reizo Shirane, and Teiji Tominaga. "Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children." Journal of Neurosurgery: Pediatrics 16, no. 5 (November 2015): 533–39. http://dx.doi.org/10.3171/2015.3.peds14573.
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OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.
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Romero, Flávio Ramalho, Eduardo De Freitas Bertolini, Adalberto Sestari, Sérgio Soares Guerrero, Ramon Barbalho Guerreiro, and Modesto Cerione Júnior. "Endoscopic Management of Arachnoid Cysts." JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA 22, no. 4 (March 24, 2018): 164–68. http://dx.doi.org/10.22290/jbnc.v22i4.1039.
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Object: Arachnoid cysts are developmental space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid mater, with controversial etiology and natural history. Endoscopy has been successfully used for decades to treat a variety of pathologies within thecentral nervous system. Methods: Thirteen patients who underwent endoscopic fenestration for treatment of arachnoid cyst were selected for this study. The surgical indications and techniques were reviewed, and surgical success rates and patient outcomes were assessed. Results: Five patients had middle fossa cysts; 2 a posterior fossa cyst; 3 a quadrigeminal cistern arachnoid cyst and 3 a suprasellar arachnoid cyst. Endoscopic management consisted in a cystoventriculostomy in 8 patients and cystocisternotomy in 5 patients. There was neither mortality nor operative morbidity. Discussion: Arachnoid cysts are a relatively benign pathological entity that can be managed by performing endoscopically guided cyst wall fenestrations into the ventricular system or cerebrospinal fluid containing cisterns. Conclusion: Proper patient selection, preoperative planning of endoscope trajectory, use of frameless navigation, and advances in endoscope lens technology and light intensitycombine to make this a safe procedure with excellent outcomes.
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Nakahashi, Masahiro, Hiroshi Uei, and Yasuaki Tokuhashi. "Recurrence of a symptomatic spinal intradural arachnoid cyst 29 years after fenestration." Journal of International Medical Research 47, no. 9 (August 26, 2019): 4530–36. http://dx.doi.org/10.1177/0300060519870092.
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Symptomatic arachnoid cysts are relatively rare, and no case reports have described recurrence of such cysts almost 30 years after surgery. We herein report a case in which a symptomatic intradural arachnoid cyst recurred 29 years after fenestration of the primary lesion. The patient was a 64-year-old woman who presented with paralysis of the left lower limb. She had undergone surgical treatment for an intradural arachnoid cyst at the T12 level 29 years previously. Magnetic resonance imaging (MRI) revealed an intradural mass at the T12–L1 level. The mass was compressing the spinal cord and cauda equina. Its localization and shape on MRI were similar to those of the primary cyst 29 years previously. Partial resection was performed under a diagnosis of a recurrent intradural arachnoid cyst. After surgery, the patient’s left lower limb paralysis improved. The pathological findings were suggestive of an intradural arachnoid cyst. The MRI findings 29 years previously provided useful information. The possibility of very late recurrence should be considered in patients who undergo surgical removal of intradural arachnoid cysts.
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Christodoulides, Ioannis, Christoforos Syrris, Jose Pedro Lavrador, and Christopher Chandler. "Infection of a sylvian Galassi II arachnoid cyst after craniotomy for resection of a parasagittal meningioma." BMJ Case Reports 14, no. 8 (August 2021): e243405. http://dx.doi.org/10.1136/bcr-2021-243405.
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Arachnoid cysts are CSF-containing entities that rarely are symptomatic or warrant neurosurgical intervention. In addition, infection of these lesions is an even rarer event, with only four reports in the literature capturing this. In this report, we present the case of a 79-year-old man presenting with paraparesis, secondary to a right parasagittal meningioma, with an incidental asymptomatic right sylvian arachnoid cyst (Galassi type II). The initially planned surgery was postponed for 3 months, due to COVID-19 restrictions, and he was kept on high dose of steroids. Following tumour resection, the patient developed bilateral subdural empyemas with involvement of the arachnoid cyst, requiring bilateral craniotomies for evacuation of the empyemas and drainage of the arachnoid cyst. Suppuration of central nervous system arachnoid cysts is a very rare complication following cranial surgery with the main working hypotheses including direct inoculation from surrounding inflamed meninges or haematogenous spread secondary to systemic bacteraemia, potentiated by steroid-induced immunosuppression. Even though being a rarity, infection of arachnoid cysts should be considered in immunosuppressed patients in the presence of risk factors such as previous craniotomy.
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Holly, Langston T., and Ulrich Batzdorf. "Syringomyelia associated with intradural arachnoid cysts." Journal of Neurosurgery: Spine 5, no. 2 (August 2006): 111–16. http://dx.doi.org/10.3171/spi.2006.5.2.111.
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Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.
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Holly, Langston T., and Ulrich Batzdorf. "Syringomyelia associated with intradural arachnoid cysts." Neurosurgical Focus 22, no. 2 (February 2007): 111–16. http://dx.doi.org/10.3171/foc.2007.22.2.8.
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Object Intradural arachnoid cysts are relatively uncommon pouches of cerebrospinal fluid (CSF) found within the subarachnoid space. The authors present a series of eight symptomatic patients in whom syrinx cavities were associated with arachnoid cysts, and they discuss treatment strategies for this entity. Methods The population comprised eight men whose mean age was 50 years (range 35–81 years). All patients experienced gait difficulty, and it was the chief complaint in seven; arm pain was the primary complaint in one. No patient had a history of spinal trauma, meningitis, or previous spinal surgery at the level of the syrinx cavity or arachnoid cyst. In each patient imaging revealed a syrinx cavity affecting two to 10 vertebral levels. Posterior thoracic arachnoid cysts were found in proximity to the syrinx cavity in each case. There was no evidence of cavity enhancement, Chiari malformation, tethered cord, or hydrocephalus. All patients underwent thoracic laminectomy and resection of the arachnoid cyst wall, and postoperative neurological improvement was documented in each case. The mean follow-up duration was 19 months (range 4–37 months). Follow-up magnetic resonance imaging demonstrated the disappearance of the arachnoid cyst and a significant decrease in syrinx cavity size in each patient. Conclusions Spinal arachnoid cysts can be associated with syringomyelia, likely due to alterations in normal CSF dynamics. In symptomatic patients these cysts should be resected and the normal CSF flow restored. The results of the present series indicate that neurological improvement and reduction in syrinx cavity size can be achieved in patients with syringomyelia associated with intradural arachnoid cysts.
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Hayashi, Nakamasa, Shunro Endo, Eiji Tsukamoto, Shuji Hohnoki, Toru Masuoka, and Akira Takaku. "Endoscopic ventriculocystocisternostomy of a quadrigeminal cistern arachnoid cyst." Journal of Neurosurgery 90, no. 6 (June 1999): 1125–28. http://dx.doi.org/10.3171/jns.1999.90.6.1125.
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✓ The authors present the case of an elderly patient with a quadrigeminal arachnoid cyst who was successfully treated with endoscopic fenestration through the posterior wall of the third ventricle via the anterior horn of the lateral ventricle. This 71-year-old man suffered from progressive gait instability and disorientation. Radiological examination revealed hydrocephalus caused by a quadrigeminal arachnoid cyst. The patient underwent endoscopic fenestration of the quadrigeminal cistern arachnoid cyst and third ventriculostomy via one burr hole placed at the coronal suture. This method is less invasive and is effective for quadrigeminal cistern arachnoid cyst and accompanying hydrocephalus.
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Auschwitz, Tyler, Michael DeCuypere, Nickalus Khan, and Stephanie Einhaus. "Hemorrhagic infarction following open fenestration of a large intracranial arachnoid cyst in a pediatric patient." Journal of Neurosurgery: Pediatrics 15, no. 2 (February 2015): 203–6. http://dx.doi.org/10.3171/2014.9.peds14126.
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Intracranial arachnoid cysts are a rare condition thought to be congenital in nature. Treatment of intracranial arachnoid cysts remains controversial based on their variable presentation. Treatment options include CSF shunting, endoscopic fenestration, or craniotomy and open fenestration for larger cysts. The complications of these procedures can include hydrocephalus, subdural hematomas, hygromas, and—more rarely—intraparenchymal hemorrhage. The authors found very few reports of hemorrhagic infarction as a complication of arachnoid cyst fenestration in the literature. The authors report a case of an 18-year-old female patient who suffered an ipsilateral hemorrhagic infarction after craniotomy for open fenestration of an arachnoid cyst.
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Jayarao, Mayur, Anand K. Devaiah, and Lawrence S. Chin. "Recovery of sensorineural hearing loss following operative management of a posterior fossa arachnoid cyst." Journal of Neurosurgery: Pediatrics 4, no. 2 (August 2009): 121–24. http://dx.doi.org/10.3171/2009.3.peds08416.
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Arachnoid cysts are benign, intraarachnoid cysts filled with cerebrospinal fluid that are usually encountered in the middle cranial fossa. If present in the posterior fossa, they usually produce nonspecific signs and symptoms such as headaches, dizziness and vertigo. We report the rare presentation of a young girl with right-sided sensorineural hearing loss and tinnitus secondary to a right cerebellopontomedullary arachnoid cyst. The patient underwent a suboccipital retrosigmoid (retromastoid) craniectomy with fenestration of the arachnoid cyst. Subsequently, the patient experienced improvement in hearing with near-complete resolution of sensorineural hearing loss. To the authors' knowledge, postoperative near-complete resolution of hearing loss secondary to posterior fossa arachnoid cysts in a pediatric patient has not been previously reported. The authors also review the literature with respect to posterior fossa arachnoid cysts and discuss their clinical features, diagnosis, and management.
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Thinakara-Rajan, T., A. Janjua, and V. Srinivasan. "Posterior fossa arachnoid cyst presenting with isolated sensorineural hearing loss." Journal of Laryngology & Otology 120, no. 11 (July 19, 2006): 979–82. http://dx.doi.org/10.1017/s0022215106002337.
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Arachnoid cysts are benign cysts occurring in the intra-arachnoid space and containing cerebrospinal fluid. They constitute approximately 1 per cent of all intracranial masses. They are uncommon in the posterior cranial fossa. Common presenting symptoms include headaches, seizures, focal neurologic signs and vague dizziness. Magnetic resonance imaging is the preferred method of investigation, and the treatment for symptomatic cysts is generally surgical drainage.We report the unusual presentation of a young patient with a posterior fossa arachnoid cyst that manifested in the form of isolated unilateral sensorineural hearing loss. The patient underwent posterior fossa craniotomy and marsupialization of the cyst. To our knowledge, posterior fossa arachnoid cyst presenting with isolated hearing loss alone has not been reported in the English literature. A review of the literature pertaining to posterior fossa arachnoid cysts, including the clinical features, diagnosis and management, is also presented.
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Massicotte, Eric M., and Marc R. Del Bigio. "Human arachnoid villi response to subarachnoid hemorrhage: possible relationship to chronic hydrocephalus." Journal of Neurosurgery 91, no. 1 (July 1999): 80–84. http://dx.doi.org/10.3171/jns.1999.91.1.0080.
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Object. The origin of chronic communicating hydrocephalus following subarachnoid hemorrhage (SAH) is not well understood. Fibrosis of the arachnoid villi has been suggested as the cause for obstruction of cerebrospinal fluid (CSF) flow, but this is not well supported in the literature. The goal of this study was to determine the relationship between blood, inflammation, and cellular proliferation in arachnoid villi after SAH.Methods. Arachnoid villi from 50 adult patients were sampled at autopsy. All specimens were subjected to a variety of histochemical and immunohistochemical stains. The 23 cases of SAH consisted of patients in whom an autopsy was performed 12 hours to 34 years post-SAH. Fifteen cases were identified as moderate-to-severe SAH, with varying degrees of hydrocephalus. In comparison with 27 age-matched non-SAH controls, the authors observed blood and inflammation within the arachnoid villi during the 1st week after SAH. Greater mitotic activity was also noted among arachnoid cap cells. The patient with chronic SAH presented with ventriculomegaly 2 months post-SAH and exhibited remarkable arachnoid cap cell accumulation.Conclusions. The authors postulate that proliferation of arachnoidal cells, triggered by the inflammatory reaction or blood clotting products, could result in obstruction of CSF flow through arachnoid villi into the venous sinuses. This does not exclude the possibility that SAH causes generalized fibrosis in the subarachnoid space.
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Morioka, Motohiro, Jun-ichiro Hamada, Yuki Ohmori, Toshiro Kageshita, and Yukitaka Ushio. "Spinal Arachnoid Cyst Containing Nevus Cells in a Patient with a Large Congenital Melanocytic Nevus: Case Report." Neurosurgery 55, no. 4 (October 1, 2004): E1006—E1010. http://dx.doi.org/10.1227/01.neu.0000137280.84648.ce.
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Abstract OBJECTIVE AND IMPORTANCE: Spinal arachnoid cysts are rare, and their cause and pathogenesis remain controversial. We experienced a rare case with a large congenital melanocytic nevus in which a spinal arachnoid cyst contained nevus cells, suggesting the congenital nature of a spinal arachnoid cyst. CLINICAL PRESENTATION: A 37-year-old Japanese man had been born with a large melanocytic nevus on his back. He experienced intermittent pain radiating to both thighs and to the lower back and waist. A magnetic resonance imaging study disclosed the presence of a posterior intradural extramedullary arachnoid cyst extending from T10 through T12. His spinal cord was displaced anteriorly and flattened. INTERVENTION: An osteoplastic laminoplasty was performed, and the arachnoid cyst was totally removed. The cyst membrane exhibited many foci of brown deposits, and histological examination disclosed the presence of melanin-containing cells in the cyst membrane. Morphologically and immunohistochemically, the melanin-containing cells in the cyst membrane were similar to nevus cells in the dermis. CONCLUSION: The histological findings of our case suggest that the patient's spinal arachnoid cyst was formed at the same stage of development as the melanocytic nevus.
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Furtado, Leopoldo Mandic Ferreira, José Aloysio Costa Val Filho, Raquel Ida Ferreira, and Italo Guilherme Giarola de Freitas Mariano. "Intracranial arachnoid cyst rupture after mild TBI in children: have we underestimated this risk?" BMJ Case Reports 12, no. 4 (April 2019): e228790. http://dx.doi.org/10.1136/bcr-2018-228790.
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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.
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Zanini, Marco A., Antonio T. de Souza Faleiros, Gilberto Rondinelli, Roberto C. Gabarra, and Luiz A. de Lima Resende. "A FORM OF DYSPLASIA OR A FORTUITOUS ASSOCIATION? A CEREBRAL ANEURYSM INSIDE AN ARACHNOID CYST." Neurosurgery 61, no. 3 (September 1, 2007): E654—E655. http://dx.doi.org/10.1227/01.neu.0000290917.70717.39.
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Abstract OBJECTIVE Although arachnoid cysts and intracranial aneurysms are very common lesions, their association in the same patient is rare. We present a case of a middle cerebral artery aneurysm ruptured into an arachnoid cyst. We found only six cases with intracystic hemorrhage reported in the literature. The presence of an arachnoid cyst can mislead clinical presentation. The patient presented a paradoxically small temporal fossa and thickening of the temporal and sphenoid bone. The authors suggest that this uncommon association (arachnoid cyst, atypical cranial vault, and “mirror-like” cerebral aneurysm) could represent a form of dysplasia. CLINICAL PRESENTATION A 46-year-old patient presented with a 3-week history of slight headaches, which had worsened in the last 3 days before presentation. Computed tomographic scans showed a cystic lesion located in the middle cranial fossa and sylvian fissure with suspected aneurysm dilation inside. Magnetic resonance imaging scans showed an intracystic hemorrhage but not subarachnoid hemorrhage. Paradoxically, changes in the cranial vault around the cyst were noted. Digital subtraction angiography showed bilateral “mirror” middle cerebral artery aneurysms. INTERVENTION A large right pterional craniotomy was performed with full microsurgical removal of the arachnoid cyst walls and aneurysm clipping. The aneurysm was in the medial wall of the arachnoid cyst with its dome inside the cyst. The contralateral aneurysm was clipped 2 weeks later. The follow-up period was uneventful, and the patient returned to normal life. CONCLUSION Rupture of a cerebral aneurysm into an arachnoid cyst is rare. Clinical presentation may be unusual because the cyst can prevent subarachnoid hemorrhage. A middle fossa cranial arachnoid cyst in the presence of temporal bone depression, small middle fossa, and thickness of squamous temporal bone and the lesser wing of sphenoid is rare and suggests that congenital factors may play an important role in their development. The exceptional association between “mirror” aneurysms and arachnoid cyst with bone changes suggests a possible congenital form of dysplasia.
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Rangel-Castilla, Leonardo, Jaime Torres-Corzo, Roberto Rodriguez Della Vecchia, Aaron Mohanty, and Haring J. W. Nauta. "Coexistent intraventricular abnormalities in periventricular giant arachnoid cysts." Journal of Neurosurgery: Pediatrics 3, no. 3 (March 2009): 225–31. http://dx.doi.org/10.3171/2008.11.peds08106.
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Object Arachnoid cysts are congenital lesions that arise during development by splitting of the arachnoid membrane. Large cysts can be adjacent to CSF pathways causing a marked midline shift and hydrocephalus. The association between a large arachnoid cyst and hydrocephalus has been commonly described as being due to a mass effect, but these previous reports have not focused closely on any associated intraventricular abnormalities. Methods Seven patients who were previously treated with a cystoperitoneal shunt presented with shunt failure, hydrocephalus, and/or cyst expansion. All of these patients had giant arachnoid cysts extending to the periventricular region from the original site, which was the sylvian fissure in 4 patients, and the suprasellar cistern, quadrigeminal cistern, and interhemispheric fissure in 1 patient each. Endoscopic exploration of the ventricular system and cyst fenestration was then performed in all patients. Results The endoscopic findings were obstruction of the cerebral aqueduct by a membrane not related to the cyst in 5 patients, occlusion of the foramen of Monro in 6, septum pellucidum hypoplasia in 2, and occlusion of the cerebral aqueduct by a quadrigeminal arachnoid cyst in 1. Endoscopic procedures performed were septum pellucidum fenestration and/or foraminoplasty in 5 patients, aqueductoplasty in 2, endoscopic third ventriculostomy in 5, fenestration of the lamina terminalis in 1, and direct cystocisternostomy in 1. After the endoscopic procedure, signs and symptoms of increased intracranial pressure and hydrocephalus improved in all patients, with a reduction in size of the cyst and the ventricle. Conclusions Ventricular abnormalities contributing to hydrocephalus may be associated with arachnoid cysts. These abnormalities may more likely reflect a common origin than a casual relation. Foramen of Monro stenosis and cerebral aqueduct occlusion associated with an arachnoid cyst can be more frequent than has been previously believed. In cases of periventricular giant arachnoid cysts, endoscopic exploration is a good alternative for examining the ventricular system and identifying and treating CSF obstructions caused by and/or related to arachnoid cysts.