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intracranial_arachnoid_cyst

Intracranial arachnoid cyst

Intracranial arachnoid cysts are fluid-filled cavities that arise within the cranial arachnoid.

These cystic lesions are congenital.

Epidemiology

Arachnoid cysts account for only 1% of all intracranial space-occupying lesions.

Intracranial arachnoid cysts have a predilection for the temporal fossa.

Classification

Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch) 1).

50-66% occurring within the middle cranial fossa in most series. Ten percent occur in the suprasellar and quadrigeminal regions and approximately 5% each in the posterior fossa and over the frontal convexities

Supratentorial are divided into:

Sylvian fissure arachnoid cyst

Cerebral convexity

Interhemispheric arachnoid cyst

Sellar region

Intrasellar arachnoid cyst

Retrosellar arachnoid cyst

Suprasellar arachnoid cyst

Intraventricular.

Quadrigeminal plate cistern


see Posterior fossa arachnoid cyst.

see Middle fossa arachnoid cyst.

Etiology

Many theories have been postulated for etiopathogenesis of arachnoid cysts. Various hypotheses are: entrapment of CSF in a diverticulum; CSF flow changes leading to arachnoid cell layer tears during the formation of various cisternae; during embryological separation (at around 15th week of gestation) of arachnoid from the dura mater 2).

Clinical features

Treatment

Complications

Spontaneous intracystic hemorrhage in an arachnoid cyst is a rare complication (although hemorrhagic arachnoid cyst is well known in the clinical setting of trauma), which may present with symptoms of raised intracranial pressure (headache, vomiting, altered sensorium) or focal neurological deficits depending on the location and is an indication for surgery 3) 4).

Although complications such as intracystic, subdural, and extradural hematomas are well known after a trauma, spontaneous hemorrhage in an arachnoid cyst is a rare and serious complication with atypical imaging features on cross-sectional imaging and only less than ten cases are documented in the literature 5).

Outcome

Surgery can be performed with a fairly low risk of complications and yields significant improvement in quality of life correlated to postoperative improvement in headache and dizziness. These findings may justify a more liberal approach to surgical treatment 6).

Sports participation with arachnoid cysts

There is currently no consensus on the safety of sports participation for patients with an intracranial arachnoid cyst (AC).

A survey was prospectively administered to 185 patients with ACs during a 46-month period at a single institution. Cyst size and location, treatment, sports participation, and any injuries were recorded. Eighty patients completed at least 1 subsequent survey following their initial entry into the registry, and these patients were included in a prospective registry with a mean prospective follow-up interval of 15.9 ± 8.8 months.

A total 112 patients with ACs participated in 261 sports for a cumulative duration of 4410 months or 1470 seasons. Of these, 94 patients participated in 190 contact sports for a cumulative duration of 2818 months or 939 seasons. There were no serious or catastrophic neurological injuries. Two patients presented with symptomatic subdural hygromas following minor sports injuries. In the prospective cohort, there were no neurological injuries

Permanent or catastrophic neurological injuries are very unusual in AC patients who participate in athletic activities. In most cases, sports participation by these patients is safe 7).

Case series

Case reports

1)
Candela S, Puerta P, Alamar M, Barcik U, Guillén A, Muchart J, García-Fructuoso G, Ferrer-Rodríguez E. [Epidemiology and classification of arachnoid cysts in children]. Neurocirugia (Astur). 2015 Sep-Oct;26(5):234-40. doi: 10.1016/j.neucir.2015.02.007. Epub 2015 Apr 2. Spanish. PubMed PMID: 25843209.
2) , 4)
Gunduz B, Yassa MIK, Ofluoglu E, et al. Two cases of arachnoid cyst complicated by spontaneous intracystic hemorrhage. Neurology India. 2010;58:312–15.
3)
Ide C, Coene BD, Gilliard C, et al. Hemorrhagic arachnoid cyst with third nerve paresis: CT and MR findings. Am J Neuroradiol. 1997;18:1407–10.
5)
Arora R, Puligopu AK, Uppin MS, Purohit AK. Suprasellar Arachnoid Cyst with Spontaneous Intracystic Hemorrhage: A Rare Complication - Role of MR and Illustration of a Case. Pol J Radiol. 2014 Nov 18;79:422-5. doi: 10.12659/PJR.890992. eCollection 2014. PubMed PMID: 25422677; PubMed Central PMCID: PMC4238756.
6)
Mørkve SH, Helland CA, Amus J, Lund-Johansen M, Wester KG. Surgical Decompression of Arachnoid Cysts Leads to Improved Quality of Life: A Prospective Study. Neurosurgery. 2015 Nov 4. [Epub ahead of print] PubMed PMID: 26540351.
7)
Strahle J, Selzer BJ, Geh N, Srinivasan D, Strahle M, Martinez-Sosa M, Muraszko KM, Garton HJ, Maher CO. Sports participation with arachnoid cysts. J Neurosurg Pediatr. 2016 Apr;17(4):410-7. doi: 10.3171/2015.7.PEDS15189. Epub 2015 Dec 4. PubMed PMID: 26636254.
intracranial_arachnoid_cyst.txt · Last modified: 2018/09/18 08:50 by administrador