Neuroepithelial Cysts Presenting with Movement Disorders: Two Cases

Abstract

Background:The authors present two cases of movement disorders caused by neuroepithelial cysts and highlight their management. Neuroepithelial cysts are ependymal or epithelial lined fluid collections of unknown etiology within the central nervous system parenchyma with no obvious ventricular or subarachnoid connection. Most cysts are asymptomatic, however, some present with seizures, mass effect, or rarely with movement disorders.Case Reports:The first patient, a 27-year-old female, presented with progressive weakness, dystonic posturing, tremor, ballismus and choreoathetotic movements of her right upper extremity. Her symptoms improved after stereotactic drainage of a neuroepithelial cyst in her basal ganglia but recurred within a year. The second case, a 56-year-old female, presented with diplopia, nystagmus, gait imbalance and hemiparesis. Her symptoms improved after stereotactic drainage of a midbrain neuroepithelial cyst. The cyst reaccumulated over the next few years and she became symptomatic with left arm tremor and facial weakness. Aspiration was again performed with symptomatic improvement for nine months. Her tremor recurred and a cyst access device was placed stereotactically. She improved and has remained stable for over a year.Conclusion:Simple stereotactic drainage of neuroepithelial cysts has a high recurrence rate. The authors recommend considering placement of a drainage device to facilitate aspiration of the cyst fluid during follow-up, if needed.

Endoscopic treatment of thalamic neuroepithelial cysts

“…Of the five cases in which patients presented with symptoms referable to the identified thalamic cyst, in four the primary complaint was a movement disorder-most commonly a contralateral upper-extremity tremor. 4,8,15,16 In contrast to our series, hydrocephalus was present in only one of the five cases. 9 On the whole, the surgical management of symptomatic intracranial cysts (including neuroepithelial, colloid, and arachnoid cysts among others) has varied widely.…”

“…1,4,12,14,15,19 Although this frequently proved to be effective, a desire for a less invasive method of treating these lesions led to later reports of stereotactic aspiration and internal or external drainage via a shunt or reservoir system. [7][8][9]16 In the cases treated by Heran, et al, 8 stereotactic aspiration proved to be less effective with both patients experiencing symptomatic worsening reflective of cyst enlargement. One patient declined additional surgical management, whereas the other underwent a second attempt at stereotactic aspiration and ultimately placement of an intracystic Ommaya reservoir when her symptoms returned a second time.…”

“…7 Nevertheless, the treatment of symptomatic lesions has varied according to their locations and the surgical treatment available. Surgical management has yielded mixed results and has included stereotactic aspiration, 8,13,16 internal drainage via placement of a cystosubarachnoid or cystoventricular shunt, 9,20 external drainage via a reservoir system, 8,9 craniotomy with cyst resection and/or fenestration, 1,3,4,12,14,15,19 and endoscopic cyst fenestration into an adjacent subarachnoid or ventricular space. 5 In this paper we describe three cases of symptomatic thalamic neuroepithelial cysts associated with hydrocephalus.…”

Microanatomy of the Intrachoroidal Vasculature of the Lateral Ventricle

“…Neuroepithelial cysts, that is, fluid collections surrounded by epithelial or ependymal lining, are rare findings in the lateral ventricle (19). Colloid cysts, which represent various tumors that are filled with gelatinous viscous material (5), more often appear in the third than in the lateral ventricle (17).…”

Response to the letter to the editor: needle aspiration as an alternative treatment for glioependymal cysts

“…Even there are previous publications reporting the use of stereotactic aspiration as a single treatment of deep-seated benign cysts with characteristics of glioependymal cysts [1][2][3]. The results of these studies show a high cyst recurrence after stereotactic drainage, which also happened in the second case presented by Apra et al…”