Natural History of Intracranial Arachnoid Cysts

Hall, Samuel; Smedley, Alexander; Sparrow, Owen; Mathad, Nijuguna; Waters, Ryan; Chakraborty, Aabir; Tsitouras, Vassilios

doi:10.1016/j.wneu.2019.03.087

Cited by 62 publications

(59 citation statements)

References 22 publications

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“…Finally, the underlying mechanisms in which IACs can provoke an epileptic insult still remain unknown [15]. Many pathogenic mechanisms have been described, such as cystic compression of surrounding cerebral cortex, active cyst wall secretion, an increase in an osmotic gradient over the cyst wall, and an underlying valve mechanism [9,12,15,17,24]. In our patient, cortical compression due to a gradual increase in cyst volume caused by an underlying valve mechanism probably has led to cortical irritation.…”

Section: Iacs and Epilepsymentioning

confidence: 77%

“…We developed a flowchart including these characteristics in order to guide clinicians in the appropriate approach of these patients, based on both institutional experience and previously published literature (Fig. 3) [9,12,17,23].…”

Section: The Role Of Surgery In the Treatment Of Iacmentioning

confidence: 99%

“…Intracranial arachnoid cysts (IACs) are benign, intraarachnoidal developmental anomalies containing a substance resembling cerebrospinal fluid [2,5,6,9,12,15,17,[23][24][25]. In adults, they account for about 1.5-2.3% of all intracranial masses [1,9,17,18,24] and are most commonly encountered in the middle cranial fossa, in accordance with the Sylvian and choroidal fissure [2,6,17]. Most IACs are congenital, although underlying causal events have been described of which infection, trauma, increased intracranial pressure, and surgery are the most commonly mentioned [2,6,9,17,25].…”

Section: Introductionmentioning

confidence: 99%

“…In 4-14% of cases, IACs are accompanied by seizures [6,9,17]. Since most cysts do not cause any symptoms, many lesions remain clinically silent and are found incidentally [2,6,12,14,15,17,25].…”

Section: Introductionmentioning

confidence: 99%

“…Since most cysts do not cause any symptoms, many lesions remain clinically silent and are found incidentally [2,6,12,14,15,17,25]. As these lesions can be slow-growing, they can become symptomatic over time and may even give rise to epileptic seizures [1,6,9,10,15,17,[23][24][25][26]. However, since IAC localization and seizure focus do not always coincide, a unifying theory between IACs and epileptogenesis is still lacking.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Exploring the Controversial Association Between Intracranial Arachnoid Cysts and Epileptogenesis: a Case Report and Review of the Literature

Broekx

Vandevenne

Weyns

2020

SN Compr. Clin. Med.

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Intracranial arachnoid cysts (IACs) are benign, slow-growing developmental anomalies. In 4-14% of cases, IACs are accompanied by seizures. Since most cysts do not cause any symptoms, many lesions remain clinically silent and are found incidentally. As these lesions are slow-growing, they can become symptomatic over time and may give rise to epileptic seizures. Since IAC localization and seizure focus do not always coincide, a unifying theory between IACs and epileptogenesis is still lacking. We present a case of a 49-year old man who presented himself as a result of a first tonic-clonic insult. No major risk factors nor antecedents in his medical history were present. MRI confirmed a voluminous cystic lesion at the transition of motor cortex and supplementary motor area. Due to the large volume (with risk of cyst rupture) and compatible clinical, radiographic, and electroencephalographic features, cyst fenestration through craniotomy was performed. Epileptic seizures were resolved completely after this procedure. IACs are not uncommon and are frequently encountered incidentally in patients who present with epilepsy. Some authors have been classifying this association as rather exceptional. However, we illustrated a case in which excellent surgical results were obtained in a patient with focal epilepsy in which both clinical and electroencephalographic features were compatible with arachnoid cyst localization. Therefore, in patients with no other identifiable causes for epilepsy, thorough evaluation should be performed and surgical intervention should be considered. We developed a flowchart in order to guide clinicians in the appropriate approach of these patients. Therefore, this summary could serve as a scaffold for future highquality studies concerning this topic.

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