Posttraumatic intradiploic arachnoid cyst of the posterior fossa

Martínez‐Lage, Juan F.; Pérez, M.; Domingo, Rosario; Poza, Máximo

doi:10.1007/s003810050088

Cited by 37 publications

(40 citation statements)

References 11 publications

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“…12,14 This phenomenon occurs almost exclusively in children, resulting from pulsatile pressure of the growing brain through a fracture line associated with an unrecognized dural laceration, driving arachnoid membrane and CSF into and, in many cases, through the diploic space of the skull. A similar process may rarely follow a craniotomy in which a persistent CSF fistula leads to bony erosion and gradual defect expansion.…”

Section: Discussionmentioning

confidence: 99%

Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

Gandhoke¹,

Hauptman²,

Salvetti³

et al. 2015

PED

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The authors report a unique case of a transosseous CSF fistula that was detected more than 10 years after treatment of a symptomatic Chiari I malformation. This lesion initially presented as an intraosseous cystic lesion involving the C-2 vertebra, which was found to communicate freely with the subarachnoid space through a tiny dural opening. Surgical management involved hemilaminectomy and repair of the dural defect followed by reinforcement of the bony defect with demineralized bone matrix. Following closure of the fistula, symptoms of elevated intracranial pressure developed, necessitating a ventriculoperitoneal shunt for CSF diversion.

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Section: Discussionmentioning

confidence: 99%

Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

Gandhoke¹,

Hauptman²,

Salvetti³

et al. 2015

PED

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“…[3][4][5][6][7][8] To the best of our knowledge, no cases of intradiploic expansile CSF cysts as a complication of shunt procedures have been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…9 Intradiploic CSF-containing cysts occurring in the calvaria other than the occipital bone are extremely rare. 6,10 The pathogenesis of the occipital intradiploic cyst has been hypothesized as originating from insinuation of the arachnoid membrane into the occipital diploic space through the traumatic lent of the dura mater and inner table and subsequent intradiploic expansion by CSF pulsation. 5 Expansile driving forces such as coexisting hydrocephalus, brain edema, or an actively growing child's brain were thought to facilitate the growth of the cyst.…”

Section: Discussionmentioning

confidence: 99%

Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Sato¹,

Moritani²,

Hitchon³

2008

AJNR Am J Neuroradiol

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SUMMARY: We report a rare and unique complication of ventriculoperitoneal (VP) shunt malfunction. A progressively expansile, CSF-containing occipital intradiploic cyst developed in a 15-year-old boy at the site of cystoperitoneal shunt draining a Dandy-Walker cyst; the shunt was placed when the boy was 4 years old. A proposed pathogenesis of the lesion is discussed. Many complications of ventriculoperitoneal (VP) shunts have been previously described from common complications (eg, tube disconnection/obstruction, infection, and intraperitoneal CSF pseudocyst) to more esoteric ones (eg, bowel perforations, pleural effusions, shunt migration to the heart, and extrusion into or through the anus/vagina/scrotum).1,2 We report the case of a 15-year-old boy with a previous medical history including a diagnosis of a Dandy-Walker cyst with hydrocephalus, which required a VP shunt at age 6 months and a posterior fossa Dandy-Walker cystoperitoneal shunt connecting to the VP shunt through a Y connector at age 4 years. At 15 years old, the boy had an asymptomatic large, expansile, intradiploic occipital cyst containing CSF as a result of a disconnected VP shunt tube in the chest wall and an occluded intracranial catheter of the posterior fossa cystoperitoneal shunt. Case ReportThe reported patient is a 15-year-old boy who presented for a VP shunt evaluation before trying out for a football team. At age 6 months, the patient was diagnosed with a Dandy-Walker cyst and had a VP shunt placed for relief of his hydrocephalus. At age 4 years, the patient experienced progressive headaches and projectile vomiting and was found to have a disconnected shunt. MR imaging examination showed an enlarging Dandy-Walker cyst with compression of the brain stem and cerebellum. A cystoperitoneal shunt was placed, which was connected to the repaired VP shunt via a Y connector (Fig 1). At the time of surgery, it was found that the Dandy-Walker cyst was under pressure.When the patient presented for a football pregame check-up at age 15 years, he was asymptomatic and denied any signs or symptoms of shunt malfunction. Plain radiographs revealed a break in the shunt catheter at the level of the right upper chest. Skull radiographs showed a cystic expansion of the occipital diploic space measuring 10 ϫ 10 ϫ 5 cm in the transverse, superoinferior, and anteroposterior dimensions, respectively (Fig 2). The reservoir of the posterior fossa cystoperitoneal shunt had migrated into the enlarged diploic space. Head CT examination confirmed the intradiploic location of the reservoir and the expansion of the diploic space extending from the supraoccipital into the basioccipital part of the occipital bone, including the occipital condyle and lower clivus (Fig 3).The patient was taken to the operating room, where it was found that the protruded occipital outer table was paper thin and the expanded diploic space contained CSF under pressure. The intracranial

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“…1,3,4,6,11,13,14,18 It is thought that a fracture through the inner table of the skull and laceration of the underlying dura in the presence of focally increased pressure result in bone resorption and expansion of the diploic spaces. An intradiploic pseudomeningocele has also been suggested to possibly result from trauma, without underlying skull fracture.…”

Section: Traumatic Intradiploic Pseudomeningocelementioning

confidence: 99%

“…Intradiploic cysts (leptomeningeal cyst or arachnoid cyst) involving the cranial hemispheric convexities, the skull base, and the posterior fossa have been reported. [2][3][4][5]11,13,17,18 We report a case of a delayed finding of a posterior fossa intradiploic CSF collection related to remote treatment of Chiari malformation with associated occipitocervical bony fusion in a patient originally treated as a young child.…”

mentioning

confidence: 97%

Intradiploic occipital pseudomeningocele in a patient with remote history of surgical treatment of Chiari malformation

Mahaney¹,

Menezes²

2014

SPI

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An intradiploic CSF pseudocyst is a rare entity that has been described in association with trauma, as a sequela of untreated hydrocephalus, or occasionally as a congenital finding in older adults. The authors present the case of a woman with a remote history of a posterior fossa intradural procedure, in which she underwent Chiari malformation decompression, Silastic substitute–assisted duraplasty, and occipitocervical fusion; she presented 19 years later with recurrent symptoms of Chiari malformation. She was found to have an occipital intradiploic pseudomeningocele, arising within her dorsal occipitocervical fusion mass and resulting in dorsal hindbrain compression. She underwent a posterior fossa decompression and revision of her failed duraplasty, and she had a good recovery. This case demonstrates intradiploic CSF pseudomeningocele as a rare potential delayed complication of an intradural procedure for the treatment of Chiari malformation with occipitocervical fusion.

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Posttraumatic intradiploic arachnoid cyst of the posterior fossa

Cited by 37 publications

References 11 publications

Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management

Occipital Intradiploic CSF Pseudocyst: An Unusual Complication of a Ventriculoperitoneal Shunt Malfunction

Intradiploic occipital pseudomeningocele in a patient with remote history of surgical treatment of Chiari malformation

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