Spontaneous development of a de novo suprasellar arachnoid cyst - Case report

Department of Neurological Surgery, University of Wisconsin–Madison, Madison, Wisconsin, United States
Journal of Neurosurgery (Impact Factor: 3.23). 07/2006; 104(6 Suppl):426-8. DOI: 10.3171/ped.2006.104.6.426
Source: PubMed

ABSTRACT Arachnoid cysts are commonly thought to arise from either congenital defects or trauma. In this article the authors report the spontaneous development of a suprasellar third ventricular arachnoid cyst whose origin was not clearly congenital or traumatic. At the age of 4 months, the patient presented with hypertonia, and a magnetic resonance (MR) imaging study showed no abnormalities. At the age of 2 years, the boy presented with headaches and projectile emesis, symptoms that prompted further imaging studies. An MR image of the brain revealed a suprasellar cyst and obstructive hydrocephalus. The cyst was endoscopically fenestrated, which led to long-term symptom resolution.

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    ABSTRACT: The aim of this study was to report the long-term outcomes of patients receiving endoscopic ventriculocystocisternostomy (VCC) for suprasellar arachnoid cysts (SACs), and to analyze all published reports on outcomes of ventriculocystostomy (VC) versus VCC to compare the effectiveness of the 2 techniques. Eleven consecutive patients with previously untreated SACs were surgically treated using endoscopic VCC. Another 2 patients were treated with VCC following ventriculoperitoneal shunt placement. Clinical imaging data were recorded. An analysis was performed of all published patient outcomes following endoscopic VC or VCC for an SAC. Developmental delay and progressive macrocephaly were the most common preoperative symptoms. At a mean clinical follow-up interval of 63 months, 10 of 11 patients undergoing primary VCC did not require reoperation. An analysis of the literature suggests that VCC may be more effective than VC. Of the 44 reported patients that underwent VC as a first treatment, 7 (16%) required reoperation, and 7 (8%) of 86 patients who underwent VCC as a first treatment required reoperation. When VC or VCC was performed following a prior surgical procedure, 4 of 11 patients undergoing VC had a treatment failure requiring reoperation. In contrast, only 2 of the 17 reported cases of VCC following a prior procedure required further treatment. The difference in reoperation rates following either primary or secondary VC was significantly higher than following primary or secondary VCC (p = 0.04). The authors conclude that VCC is an effective and durable treatment for symptomatic SACs in most cases.
    Journal of Neurosurgery Pediatrics 01/2011; 7(1):64-72. DOI:10.3171/2010.10.PEDS10356 · 1.37 Impact Factor
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    ABSTRACT: Object Arachnoid cysts are a frequent finding on intracranial imaging. The prevalence and natural history of these cysts in adults are not well defined. Methods We retrospectively reviewed the electronic medical records of a consecutive series of adults who underwent brain MRI over a 12-year interval to identify those with arachnoid cysts. The MRI studies were reviewed to confirm the diagnosis. For those patients with arachnoid cysts, we evaluated presenting symptoms, cyst size, and cyst location. Patients with more than 6 months' clinical and imaging follow-up were included in a natural history analysis. Results A total of 48,417 patients underwent brain MRI over the study period. Arachnoid cysts were identified in 661 patients (1.4%). Men had a higher prevalence than women (p < 0.0001). Multiple arachnoid cysts occurred in 30 patients. The most common locations were middle fossa (34%), retrocerebellar (33%), and convexity (14%). Middle fossa cysts were predominantly left-sided (70%, p < 0.001). Thirty-five patients were considered symptomatic and 24 underwent surgical treatment. Sellar and suprasellar cysts were more likely to be considered symptomatic (p < 0.0001). Middle fossa cysts were less likely to be considered symptomatic (p = 0.01. The criteria for natural history analysis were met in 203 patients with a total of 213 cysts. After a mean follow-up of 3.8 ± 2.8 years (for this subgroup), 5 cysts (2.3%) increased in size and 2 cysts decreased in size (0.9%). Only 2 patients developed new or worsening symptoms over the follow-up period. Conclusions Arachnoid cysts are a common incidental finding on intracranial imaging in all age groups. Although arachnoid cysts are symptomatic in a small number of patients, they are associated with a benign natural history for those presenting without symptoms.
    Journal of Neurosurgery 11/2012; 118(2). DOI:10.3171/2012.10.JNS12548 · 3.15 Impact Factor
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    ABSTRACT: Arachnoid cysts occupying the suprasellar region comprise 10-15% of intracranial distribution. Unlike large suprasellar cysts, pure interpeduncular cysts (IPCs) are rare, and their natural history is unknown. We describe a small series of children diagnosed with IPC and their long-term natural history. A retrospective review was conducted of interpeduncular arachnoid cysts diagnosed over the years 2000-2010 at our center. Patients with clearly suprasellar cysts were excluded. Serial magnetic resonance imaging and long-term follow-up examinations were analyzed. Additionally, we conducted an extensive literature review focusing on the differences between suprasellar cysts and IPCs. We identified three pediatric patients with "pure" IPC; all of these had a follow-up of more than 5 years, and none was operated. Only six additional cases were identified in the literature. In both our experience and in the literature review, IPCs proved stable over the course of time, both radiologically as well as clinically. The clinical and radiological features of IPCs are not well defined. Variations in the relationship of arachnoid cysts in this area to Liliequist's membrane may explain the different subgroups that have been identified as well as the confusing nomenclature. IPCs are usually diagnosed as incidental findings or present with mild endocrine disorders. Associated findings of hydrocephalus, mass effect, and compression of neighboring structures, such as the chiasm, are not as frequent as with suprasellar cysts. Given the high likelihood of continuing stability, a conservative strategy of follow-up is recommended for pure IPCs that demonstrate preservation of the third ventricle.
    Child s Nervous System 03/2011; 27(3):429-38. DOI:10.1007/s00381-010-1265-0 · 1.16 Impact Factor