Cerebral Arachnoid Cysts in Adults – Retrospective Analysis of the Results of Surgical Treatment

Česká verzia

Authors: V. Vybíhal ¹ ; V. Smrčka ¹; M. Smrčka ¹; M. Keřkovský ²
Authors place of work: LF MU a FN Brno Neurochirurgická klinika ¹; LF MU a FN Brno Radiologická klinika ²
Published in the journal: Cesk Slov Neurol N 2012; 75/108(4): 480-484
Category: Short Communication

Summary

Cerebral arachnoid cysts represent about 1% of all intracranial expansive processes. The authors of the article present a group of 64 patients treated surgically during a 20-year period. Patients with symptomatic arachnoid cysts were treated surgically. The most common clinical manifestation was headache, epileptic seizures, vertigo, nausea, cerebellar symptoms, visual disturbances, etc. The patients were treated by endoscopy technique (16 pts, i.e. 25.0%), cystoperitoneal shunt implantation (22 pts, i.e. 34.4%), open craniotomy and marsupialization (21 pts, i.e. 32.8%) and puncture of arachnoid cysts (5 pts, i.e. 7.8%). According to the authors, endoscopic techniques are a preferred method for their minimal invasiveness, low complication rate, and independence from the implant, such as with cystoperitoneal shunts. Their implantation is simple and universal but they are a subject to risk of possible revisions due to failure. Craniotomy with a resection of the cyst wall and establishment of communication with the surrounding tissues is another alternative. The method provides a good view of and orientation in the surgical field, an opportunity to treat associated lesions and solution of eventual intraoperative complications. Even though there is no dependence on the implant, this method is more invasive than the other. The puncture of arachnoid cysts is used least frequently. This is a simple, minimally invasive but the least effective method. It is reserved primarily for older polymorbid patients.

Key words:
cerebral arachnoid cysts – cystoperitoneal shunt – endoscopy – craniotomy – marsupialization – puncture

Zdroje

1. Vega-Sosa A, de Obieta-Cruz E, Hernández-Rojas MA. Intracranial arachnoid cyst. Cir Cir 2010; 78(6): 551–556.

2. Rengachary SS, Kennedy JD. Intracranial arachnoid cysts and ependymal cysts. In: Wilkins RH, Rengachary SS (eds). Neurosurgery. 2^nd ed. New York: McGraw-

-Hill 1996: 3709–3728.

3. Choi JU, Kim DS. Pathogenesis of arachnoid cyst: congenital or traumatic? Pediatr Neurosurg 1998; 29(5): 260–266.

4. Di Rocco C. Arachnoid cysts. In: Youmans JR (ed). Youmans Neurological Surgery. 4^th ed. Philadelphia: WB Saunders 1997: 967–994.

5. Robinson RG. The temporal lobe agenesis syndrome. Brain 1964; 87: 87–106.

6. Santamarta D, Aguas J, Ferrer E. The natural history of arachnoid cyst: endoscopic and cine-mode MRI evidence of a slit-valve mechanism. Minim Invasive Neurosurg 1995; 38(4): 133–137.

7. Go KG, Houthoff HF, Blaauw EH, Havinga P, Hartsuiker J. Arachnoid cysts of the sylvian fissure. Evidence of fluid secretion. J Neurosurg 1984; 60(4): 803–813.

8. Sandberg DI, McComb JE, Krieger MD. Chemical analysis of fluid obtained from intracranial arachnoid cysts in pediatric patients. J Neurosurg 2005;

103 (Suppl 5): 427–432.

9. Galassi E, Tognetti F, Gaist G, Fagioli L, Frank F, Frank G. CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: classification and pathophysiological aspects. Surg Neurol 1982; 17(5): 363–369.

10. Arai H, Sato K. Posterior fossa cysts: clinical,

neuroradiological and surgical features. Childs Nerv Syst 1991; 7(3): 156–164.

11. Helland CA, Wester K. Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome. J Neurol Neurosurg Psychiatry 2007; 78(6): 620–623.

12. Raeder MB, Helland CA, Hugdahl K, Wester K. Arachnoid cysts cause cognitive deficits that improve after surgery. Neurology 2005; 64(1): 160–162.

13. Lang W, Lang M, Kornhuber A, Gallwitz A, Kriebel J. Neuropsychological and neuroendocrinological disturbances associated with extracerebral cysts of the anterior and middle cranial fossa. Eur Arch Psychiatry Neurol Sci 1985; 235(1): 38–41.

14. Sgouros S, Chapman S. Congenital middle fossa arachnoid cysts may cause global brain ischaemia: a study with 99Tc-hexamethylpropyleneamineoxime single photon emission computerized tomography scans. Pediatr Neurosurg 2001; 35(4): 188–194.

15. Mori K, Yamamoto T, Horinaka N, Maeda M. Arachnoid cyst is a risk factor for chronic subdural hematoma in juveniles: twelve cases of chronic subdural hematoma associated with arachnoid cyst. J Neurotrauma 2002; 19(9): 1017–1027.

16. Poirrier AL, Ngosso-Tetanye I, Mouchamps M, Misson JP. Spontaneous arachnoid cyst rupture in a previously asymptomatic child: a case report. Eur J

Paediatr Neurol 2004; 8(5): 247–251.

17. Beltramello A, Mazza C. Spontaneuous disappearance of a large middle cranial fossa arachnoid cyst. Surg Neurol 1985; 24(2): 181–183.

18. Wester K. Arachnoid cysts in adults: experience with internal shunts to the subdural compartment. Surg Neurol 1996; 45(1): 15–24.

19. Karabatsou K, Hayhurst C, Buxton N, O’Brien DF, Mallucci CL. Endoscopic management of arachnoid cysts: an advancing technique. J Neurosurg 2007; 106 (Suppl 6): 455–462.

20. Mottolese C, Szathmari A, Simon E, Ginguene C,

Ricci-Franchi AC, Hermier M. The parallel use of endoscopic fenestration and a cystoperitoneal shunt with programmable valve to treat arachnoid cysts: experience and hypothesis. J Neurosurg Pediatrics 2010; 5(4): 408–414.

21. Levy ML, Wang M, Arayan HE, Yoo K, Meltzer H.

Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration. Neurosurgery 2003; 53(5): 1138–1145.

22. Wang JC, Heier L, Souweidane MM. Advances in the endoscopic management of suprasellar cysts in children. J Neurosurg 2004; 100 (Suppl 5): 418–426.

23. Helland CA, Wester K. A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry 2007; 78(10): 1129–1135.

24. Häckel M, Homolková H. Mozkové arachnoidální cysty. Výsledky chirurgické léčby 9 nemocných v letech 2000–2003. Cesk Slov Neurol N 2005; 68/101(5): 316–322.

25. Fewel ME, Levy ML, McComb JG. Surgical treatment of 95 children with 102 intracranial arachnoid cysts. Pediatr Neurosurg 1996; 25(4): 165–173.