Development of Intracranial Hypertension After Surgical Management of Intracranial Arachnoid Cyst: Report of Three Cases and Review of the Literature

Kaliaperumal, Chandrasekaran; O'Connor, Brendan; Marks, Charles

doi:10.1016/j.wneu.2012.11.002

Cited by 9 publications

(12 citation statements)

References 8 publications

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“…after a successful cyst fenestration; 9,11,12,15 however, there is no clear explanation for the pathogenesis of subsequent intracranial hypertension and the risk factors for shunt placement after fenestration. The middle cranial fossa is the most common location for intracranial arachnoid cysts, and obstructive hydrocephalus is uncommon.…”

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confidence: 99%

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

Kimiwada

Hayashi

Shirane

et al. 2015

PED

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OBJECT Some pediatric patients with middle cranial fossa arachnoid cysts present with symptoms of increased intracranial pressure (ICP) and require shunt placement after a cyst fenestration. However, factors concerning increased ICP after fenestration followed by shunt placement have not been elucidated. This study evaluated factors that are associated with shunt placement following cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. METHODS Twenty-six pediatric patients with middle cranial fossa arachnoid cysts who were surgically treated at a single institution between 2004 and 2013 were retrospectively identified. The surgical indications for middle cranial fossa arachnoid cysts were as follows: 1) arachnoid cysts associated with symptoms such as headache and abnormally enlarging head circumference; 2) progressively expanding arachnoid cysts; and 3) large arachnoid cysts such as Galassi Type III. A cyst fenestration was performed as a first-line treatment, and shunt placement was required if symptoms associated with increased ICP were found following fenestration. The risk factors evaluated included age, sex, presenting symptoms, the presence of head enlargement, progressive cyst expansion, and subdural hematoma/hygroma. RESULTS Four patients (15.4%) required shunt placement after cyst fenestration. Younger age, abnormal head enlargement, and progressive cyst expansion before fenestration were significantly associated with the need for shunt placement following fenestration. Arachnoid cysts decreased in size in 22 patients (84.6%) after fenestration and/or shunt placement. The presence of symptoms was not associated with postoperative cyst size in this study. CONCLUSIONS In this study, younger age, abnormal head enlargement, and progressive cyst expansion were risk factors for shunt placement after cyst fenestration in pediatric patients with middle cranial fossa arachnoid cysts. It is important to consider that cyst fenestration may not be effective because of a latent derangement of CSF circulation in patients with these risk factors.

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confidence: 99%

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

Kimiwada

Hayashi

Shirane

et al. 2015

PED

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“…[ 5 ] Only a few cases of visual impairment after CP shunt placement have been reported. [ 2 , 11 , 14 ] Hence, it seems that visual impairment seems to be a rare symptom. It is universally accepted that clinicians should exercise caution when ascribing any nonspecific symptoms such as headaches, behavioral disturbances, or epilepsy to the presence of an AC.…”

Section: Discussionmentioning

confidence: 99%

Impaired visual acuity as an only symptom of shunt malfunction, long time after initial cyst-peritoneal shunting for arachnoid cyst: A case report

Ono

Mukae

Nishimura

et al. 2022

Surgical Neurology International

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Background: Long-term outcomes after surgical treatment of arachnoid cysts (ACs) have not been reported adequately. Impaired visual acuity is not a common symptom of shunt dependency syndrome due to cyst-peritoneal (CP) shunt malfunction for ACs. We report a case of CP shunt malfunction, who presented only impaired visual acuity as a symptom, long after the initial surgical treatment. Case Description: A 16-year-old boy was surgically treated for the left frontal AC with CP shunting at 2 years of age. Extension of the peritoneal shunt catheter was performed at 15 years of age. A year later, he started experiencing impairment of visual acuity without headaches, which worsened to bilateral light perception. The presence of bilateral optic atrophy was confirmed. The AC in the left frontal lobe had enlarged very slightly, with shortening of the intracystic catheter, and the cerebrospinal fluid pressure was elevated to 30 cmH2O. He was treated with lumboperitoneal shunting. The visual acuity showed limited improvement. Conclusion: The possibility of CP shunt malfunction and shunt dependency syndrome should be considered, even if the patient presented only impaired visual acuity and no significant changes in the size of the ACs are observed.

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“…Few reports in the literature have reported IIH developing after successful treatment of intracranial cyst (IAC), in some cases after up to several years [ 1 , 2 , 3 , 4 ]. One paper reported a series of three cases in which the IIH symptoms became clinically apparent or evolved after the surgical treatment of arachnoid cyst [ 2 ]. Similarly, another paper based on the clinical presentation and treatment of three arachnoid cyst patients, and later IIH, described a mechanism explaining arachnoid cyst formation and elevation of ICPs [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…They proposed a disequilibrium of cerebrospinal fluid (CSF) hydrodynamics as a probable basis of onset or exacerbation of IIH after IAC treatment. Diversion of cystic and subdural CSF into basal cisterns decompensating a tenuous CSF circulatory mechanism has been proposed [ 2 , 5 ]. The possibility of cyst fluid secreted by cyst lining cells being different than CSF, potentially leading to problems in CSF dynamics or circulation, has also been raised as possible mechanism of developing IIH [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

et al. 2021

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We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

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Development of Intracranial Hypertension After Surgical Management of Intracranial Arachnoid Cyst: Report of Three Cases and Review of the Literature

Cited by 9 publications

References 8 publications

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

Shunt placement after cyst fenestration for middle cranial fossa arachnoid cysts in children

Impaired visual acuity as an only symptom of shunt malfunction, long time after initial cyst-peritoneal shunting for arachnoid cyst: A case report

Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

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