Delayed Recurrent Arachnoid Cyst of the Occipital Convexity in an Elderly Woman -Case Report-

Abstract

A 62-year-old woman presented with a symptomatic arachnoid cyst of the right occipital convexity manifesting as visual disturbances and headache. She underwent craniotomy with membranectomy and fenestration to the subarachnoid space. Postoperatively, her complaints disappeared and brain magnetic resonance (MR) imaging showed cyst shrinkage. During the first 1 year after surgery, she made a good recovery without clinical symptoms or cyst enlargement. However, she complained of visual disturbances after 6 years. Brain MR imaging revealed cyst enlargement and Goldmann perimetry detected left lower quadrantanopia. The diagnosis was recurrent arachnoid cyst. A second surgical procedure was performed including membranectomy for histological examination of the cyst membrane, and an Ommaya reservoir was inserted into the cyst cavity to prevent further cyst enlargement. The histological findings were compatible with arachnoid cyst, similar to the results seen at the first surgery. She was discharged 3 weeks after the second operation with no complications, and follow up continues as an outpatient. Patients with symptomatic arachnoid cysts typically have good progress after surgery, but the present case shows that follow up should continue for at least 6 years after surgery, even if cyst volume reduction was initially favorable.

Intracranial arachnoid cysts in a chimpanzee (Pan troglodytes)

“…In humans, occipital convexity arachnoid cysts are rare, but two case reports have documented symptomatic arachnoid cysts in elderly women (Tucker et al 2006;Suzuki et al 2009). The cyst volume slowly increased over time in one case; the cyst was located close to the patient's posterior horn of the right lateral ventricle, which may have been related to the cystic growth (Suzuki et al 2009). The other woman with a cystic lesion in the right occipital convexity presented with a visual field defect and headache.…”

“…A visual field examination showed left lower quadrantanopia. Surgical treatment was performed and her headache and visual field defect improved (Suzuki et al 2009).…”