Arachnoid cysts of the Sylvian fissure

Kito, Go; Houthoff, H. J.; Blaauw, Eh; Hartsuiker, J

doi:10.3171/jns.1984.60.4.0803

Cited by 201 publications

(66 citation statements)

References 51 publications

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“…24 Finally, data from some studies have shown that the membranes of arachnoid cysts harbor secretory properties that may be partially responsible for their potential to expand. 9 In any case, progressive growth of arachnoid cysts may cause secondary regional effects such as hypoplasia of the temporal lobe as well as manifest as symptoms such as seizures, developmental delay, visual loss, or motor deficits. 6,7,22,29 Patients with arachnoid cysts may also present with hemorrhagic events, especially following head trauma.…”

Section: Discussionmentioning

confidence: 99%

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Zada

Krieger²,

McNatt³

et al. 2007

FOC

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Object Arachnoid cysts can cause a variety of clinical signs and symptoms in infants. The authors sought to determine whether the clinical presentation of pediatric patients younger than 2 years old and harboring arachnoid cysts influenced the type of intervention that would be required. Methods A retrospective chart review was conducted for all patients younger than 2 years of age who had undergone craniotomy for fenestration of an arachnoid cyst at the Childrens Hospital Los Angeles between 1995 and 2006. Forty-two patients were included in the study. The mean age was 10.4 months. The median follow-up time was 33 months. Clinical presentations were as follows: macrocephaly without ventriculomegaly (21 patients, 50%), hydrocephalus (six patients, 14%), and other symptoms (15 patients, 36%). After fenestration of the arachnoid cyst, 12 of 21 patients (57%) presenting with nonspecific macrocephaly required placement of a cystoperitoneal or ventriculoperitoneal shunt, compared with 1 of 15 patients (7%) presenting with other symptoms (p value = 0.0039). Five of six patients with hydrocephalus (83%) were shunt dependent following fenestration. Overall, 18 of 42 patients (43%) were shunt dependent after fenestration. Ten of these patients (55%) required revisions during the follow-up period. Conclusions Patients younger than 2 years of age and harboring an arachnoid cyst commonly present with macrocephaly. These patients are more likely to require shunts than are those presenting with other findings, such as seizu

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Section: Discussionmentioning

confidence: 99%

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Zada

Krieger²,

McNatt³

et al. 2007

FOC

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“…Several mechanisms have been proposed, including active fluid secretion by cells in the cyst wall, expansion after formation of an osmotic gradient, and unidirectional valve mechanisms. 4,7,16,19 Cyst growth can lead to clinically important symptoms through increased intracranial pressure and/or compression of surrounding brain structures, including a CSF flow pathway. Symptoms can also arise suddenly after cyst rupture or hemorrhage into a cyst, and for both cases (cyst growth and cyst rupture/ hemorrhage), symptom type and severity tend to depend on cyst location.…”

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confidence: 99%

Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients

Ali

Bennardo²,

Almenawer³

et al. 2015

PED

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OBJECT Although intracranial arachnoid cysts are a common incidental finding on pediatric brain imaging, only a subset of patients require surgery for them. For the minority who undergo surgery, the comparative effectiveness of various surgical approaches is debated. The authors explored predictors of surgery and compared operative techniques for pediatric patients with an intracranial arachnoid cyst seen at a tertiary care center. METHODS The authors reviewed records of pediatric patients with an intracranial arachnoid cyst. For each patient, data on baseline characteristics, the method of intervention, and surgical outcomes for the initial surgery were extracted, and cyst size at diagnosis was calculated (anteroposterior × craniocaudal × mediolateral). Baseline variables were analyzed as predictors of surgery by using logistic regression modeling, excluding patients whose surgery was not related to cyst size (i.e., those with obstructive hydrocephalus secondary to the cyst compressing a narrow CSF flow pathway or cyst rupture/hemorrhage). Data collected regarding surgical outcomes were analyzed descriptively. RESULTS Among 83 pediatric patients with an intracranial arachnoid cyst seen over a 25-year period (1989–2013), 27 (33%) underwent surgery; all had at least 1 cyst-attributed symptom/finding. In the multivariate model, age at presentation and cyst size at diagnosis were independent predictors of surgery. Cyst size had greater predictive value; specifically, the area under the curve for the receiver-operating-characteristic curve was 0.89 (95% CI 0.82–0.97), with an ideal cutoff point of ≥ 68 cm3. This cutoff point had 100% sensitivity (95% CI 79%–100%), 75% specificity (95% CI 61%–85%), a 53% positive predictive value (95% CI 36%–70%), and a 100% negative predictive value (95% CI 91%–100%); the positive likelihood ratio was 4.0 (95% CI 2.5–6.3), and the negative likelihood ratio was 0 (95% CI 0–0.3). Although the multivariate model excluded 7 patients who underwent surgery (based on prespecified criteria), excluding these 7 cases did not change the overall findings, as shown in a sensitivity analysis that included all the cases. Descriptive results regarding surgical outcomes did not indicate any salient differences among the surgical techniques (endoscopic fenestration, cystoperitoneal shunting, or craniotomy-based procedures) in terms of symptom resolution within 6 months, need for reoperation to date, cyst-size change from before the operation, morbidity, or mortality. CONCLUSIONS The results of these exploratory analyses suggest that pediatric patients with an intracranial arachnoid cyst are more likely to undergo surgery if the cyst is large, compresses a narrow CSF flow pathway to cause hydrocephalus, or has ruptured/hemorrhaged. There were no salient differences among the 3 surgical techniques for several clinically important outcomes. A prospective multicenter study is required to enable more robust analyses, which could ultimately provide a decision-making framework for surgical indications and clarify any differences in the comparative effectiveness of surgical approaches to treating pediatric intracranial arachnoid cysts.

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“…The cyst enlargement seems to be the result of secretory activity of the arachnoid cells lining the cyst, 19 but other mechanisms such as infiltration across osmotic gradient and unidirectional flow through a ball-valve arrangement have also been considered. 20 The clinical manifestations of arachnoid cysts are variable and often unspecific. 14,[21][22][23][24][25][26] The most common presenting symptoms and signs are those of raised intracranial pressure, craniomegaly, and developmental delay.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Arachnoid Cysts: Treatment Alternatives and Outcome in A Series of 25 Patients

Jamjoom

1997

Ann Saudi Med

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A series of 25 patients with intracranial arachnoid cysts is analyzed retrospectively. There were 14 males and 11 females ranging in age between a few days and 58 (mean 10) years. Seventy-six percent of patients were children below the age of 15 years. Most of the patients presented with symptoms and signs of long-standing raised intracranial pressure, while localizing signs were rather uncommon. The clinical manifestations were often mild relative to the large size of the cyst. Associated hydrocephalus was present in three patients: one with suprasellar cyst and two with posterior fossa cysts. Seven patients with mild symptoms and small cysts were treated conservatively, while the remaining 18 patients underwent surgical treatment. The initial surgical procedure consisted of craniotomy and fenestration of the cyst in three patients, and cystoperitoneal shunting in the other 15. Of the three patients who underwent craniotomy, one improved postoperatively, while the remaining two developed complications consisting of wound infection and postoperative epilepsy in one and permanent severe neurological deficit in the other. In contrast, six of the 15 cysts treated by shunting resolved completely, eight were smaller, and one remained unchanged. Radiological regression of the cyst after shunting was associated with various degrees of clinical improvement in 13 patients (87%). Two (13%) of 15 shunted patients developed complications in the early postoperative period, consisting of wound infection in one and early shunt failure in the other. Three patients (20%) with shunts had late complications during the follow-up period, consisting of recurrent shunt failure in the first, subdural hematoma in the second, and perforation of the peritoneal catheter into the hepatic bile ducts in the third. These findings, as well as recent data from the literature, suggest that in the management of intracranial arachnoid cysts, cystoperitoneal shunting was more effective and had fewer serious complications than craniotomy and cyst fenestration, and therefore, it is recommended as the treatment of first choice. Ann Saudi Med 1997; 17(3) Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1% of all intracranial space-occupying lesions.1 They may develop thoughout the cerebrospinal axis, with a predominance in the sylvian region.2,3 Because of their benign nature and slow expansion, arachnoid cysts may remain symptomatic or produce only subtle symptoms and signs. On the other hand, they sometimes give rise to focal neurological deficits, raised intracranial pressure, and/or epileptic seizures. The question of when these lesions should be operated upon is, therefore, not always easy to answer. Moreover, the choice of the most appropriate surgical approach is still debated. 2,[4][5][6][7][8] In the following report, the author describes the clinical and radiological findings in 25 patients with intracranial arachnoid cysts. In addition, the treatment results are analyzed and compared with those publish...

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Arachnoid cysts of the Sylvian fissure

Cited by 201 publications

References 51 publications

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Pathogenesis and treatment of intracranial arachnoid cysts in pediatric patients younger than 2 years of age

Exploring predictors of surgery and comparing operative treatment approaches for pediatric intracranial arachnoid cysts: a case series of 83 patients

Intracranial Arachnoid Cysts: Treatment Alternatives and Outcome in A Series of 25 Patients

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