Intracranial arachnoid cysts in children

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✓ The clinical and radiographic findings, surgical treatment, and outcome in 16 pediatric patients with intracranial arachnoid cysts are reviewed. The clinical presentation reflected the anatomical location of the lesions. Computerized tomography or magnetic resonance imaging scans were diagnostic in all cases. Of the nine cysts treated primarily or secondarily by craniotomy for fenestration and drainage into the basilar cisterns, five recurred. Cyst-peritoneal shunting led to diminished cyst size and clinical improvement in all seven cases in which it was used as the initial treatment and in all four cases in which fenestration had been unsuccessful. The results in this series show that cyst-peritoneal shunting is the treatment of choice for most intracranial arachnoid cysts in children.

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    Computerized tomography (CT) scans in Case 3. A: Axial CT scan at the level of the foramen of Monro showing a large temporal cyst. B: Scan of a metrizamide cisternogram showing that the cyst does not communicate with the subarachnoid or ventricular spaces. C: Axial CT scan obtained 3 weeks after cystperitoneal shunting showing a decrease in size of the cyst. D: Repeat CT scan 4 months later showing complete resolution of the cyst.

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    Case 15. A and B: Axial computerized tomography (CT) scans of a metrizamide ventriculogram at the level of the suprasellar cistern (A) and lateral bodies of the ventricle (B). The low-density region posteriorly is a large arachnoid cyst that does not communicate with either ventricular (highest density) or subarachnoid (intermediate density) spaces. C and D: Axial CT scans at the same levels obtained after cyst-ventriculoperitoneal shunting showing that the cyst and ventricle have decreased in size.

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    Case 8. A: Axial magnetic resonance scan (T1 weighted) showing a basal arachnoid cyst at the level of the suprasellar cistern. B: Coronal reformatted image showing the cyst embracing both internal carotid arteries laterally and enveloping the medially situated basilar artery. An attenuated lamina terminalis separates the cyst below from the dilated third ventricle above. The left lateral ventricle is markedly enlarged. C: Axial computerized tomography scan after cyst-peritoneal shunting showing that the cyst and lateral ventricle have decreased in size.

References

1.

Aicardi JBauman F: Supratentorial extracerebral cysts in infants and children. J Neurol Neurosurg Psychiatry 38:57681975Aicardi J Bauman F: Supratentorial extracerebral cysts in infants and children. J Neurol Neurosurg Psychiatry 38:57–68 1975

2.

Alker GJ JrGlasauer FELeslie EV: Radiology of a large cisterna magna cyst. A case report. Arch Neurol 36:3763791979Alker GJ Jr Glasauer FE Leslie EV: Radiology of a large cisterna magna cyst. A case report. Arch Neurol 36:376–379 1979

3.

Anderson FM: Arachnoid cysts. J Neurosurg 51:1321979 (Letter)Anderson FM: Arachnoid cysts. J Neurosurg 51:132 1979 (Letter)

4.

Anderson FMSegall HDCaton WL: Use of computerized tomography scanning in supratentorial arachnoid cysts. A report on 20 children and four adults. J Neurosurg 50:3333381979Anderson FM Segall HD Caton WL: Use of computerized tomography scanning in supratentorial arachnoid cysts. A report on 20 children and four adults. J Neurosurg 50:333–338 1979

5.

Bhandari YS: Non-communicating supratentorial subarachnoid cysts. J Neurol Neurosurg Psychiatry 35:7637701972Bhandari YS: Non-communicating supratentorial subarachnoid cysts. J Neurol Neurosurg Psychiatry 35:763–770 1972

6.

Bright R: Serous cysts in the arachnoid in: Diseases of the Brain and Nervous System Part I. London: Longman, Rees, Orme, Brown, and Green1831 pp 437439 (Cited in Reference 39)Bright R: Serous cysts in the arachnoid in: Diseases of the Brain and Nervous System Part I. London: Longman Rees Orme Brown and Green 1831 pp 437–439 (Cited in Reference 39)

7.

Choux MRaybaud CPinsard Net al: Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Childs Brain 4:15321978Choux M Raybaud C Pinsard N et al: Intracranial supratentorial cysts in children excluding tumor and parasitic cysts. Childs Brain 4:15–32 1978

8.

Cilluffo JMOnofrio BMMillet RH: The diagnosis and surgical treatment of intracranial arachnoid cysts. Acta Neurochir 67:2152291983Cilluffo JM Onofrio BM Millet RH: The diagnosis and surgical treatment of intracranial arachnoid cysts. Acta Neurochir 67:215–229 1983

9.

di Rocco CCaldarelli Mdi Trapani G: Intratentorial arachnoid cysts in children. Childs Brain 8:1191331981di Rocco C Caldarelli M di Trapani G: Intratentorial arachnoid cysts in children. Childs Brain 8:119–133 1981

10.

Dyck PGruskin P: Supratentorial arachnoid cysts in adults. A discussion of two cases from a pathophysiologic and surgical perspective. Arch Neurol 34:2762791977Dyck P Gruskin P: Supratentorial arachnoid cysts in adults. A discussion of two cases from a pathophysiologic and surgical perspective. Arch Neurol 34:276–279 1977

11.

Galassi EPiazza GGaist Get al: Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 14:2112191980Galassi E Piazza G Gaist G et al: Arachnoid cysts of the middle cranial fossa: a clinical and radiological study of 25 cases treated surgically. Surg Neurol 14:211–219 1980

12.

Geissinger JDKohler WCRobinson BWet al: Arachnoid cysts of the middle cranial fossa: surgical considerations. Surg Neurol 10:27331978Geissinger JD Kohler WC Robinson BW et al: Arachnoid cysts of the middle cranial fossa: surgical considerations. Surg Neurol 10:27–33 1978

13.

Gilles FHRockett FX: Infantile hydrocephalus: retrocerebellar “arachnoidal” cyst. J Pediatr 79:4364431971Gilles FH Rockett FX: Infantile hydrocephalus: retrocerebellar “arachnoidal” cyst. J Pediatr 79:436–443 1971

14.

Go KGHouthoff HJBlaauw EHet al: Arachnoid cysts of the Sylvian fissure. Evidence of fluid secretion. J Neurosurg 60:8038101984Go KG Houthoff HJ Blaauw EH et al: Arachnoid cysts of the Sylvian fissure. Evidence of fluid secretion. J Neurosurg 60:803–810 1984

15.

Go KGvan Dijk PLuiten ALet al: Interpretation of nuclear magnetic resonance tomograms of the brain. J Neurosurg 59:5745841983Go KG van Dijk P Luiten AL et al: Interpretation of nuclear magnetic resonance tomograms of the brain. J Neurosurg 59:574–584 1983

16.

Handa HBucy PC: Benign cysts of the brain simulating brain tumor. J Neurosurg 13:4894991956Handa H Bucy PC: Benign cysts of the brain simulating brain tumor. J Neurosurg 13:489–499 1956

17.

Hayashi TAnegawa SHonda Eet al: Clinical analysis of arachnoid cysts in the middle fossa. Neurochirurgia (Stuttg) 22:2012101979Hayashi T Anegawa S Honda E et al: Clinical analysis of arachnoid cysts in the middle fossa. Neurochirurgia (Stuttg) 22:201–210 1979

18.

Hoffman HJHendrick EBHumphreys RPet al: Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57:5976021982Hoffman HJ Hendrick EB Humphreys RP et al: Investigation and management of suprasellar arachnoid cysts. J Neurosurg 57:597–602 1982

19.

Hough DRMengel MBMalik AH: Mega cisterna magna: diagnosis using metrizamide computed tomographic cisternography. Neurosurgery 11:2602621982Hough DR Mengel MB Malik AH: Mega cisterna magna: diagnosis using metrizamide computed tomographic cisternography. Neurosurgery 11:260–262 1982

20.

Kaplan BJMickle JPParkhurst R: Cystoperitoneal shunting for congenital arachnoid cysts. Childs Brain 11:3043111984Kaplan BJ Mickle JP Parkhurst R: Cystoperitoneal shunting for congenital arachnoid cysts. Childs Brain 11:304–311 1984

21.

Karol ELitrenta MMCarrea R: Observaciones sobre los quistes aracnoideos encefálicos. Acta Neurol Lat Am 11:1511601965Karol E Litrenta MM Carrea R: Observaciones sobre los quistes aracnoideos encefálicos. Acta Neurol Lat Am 11:151–160 1965

22.

Kato MNakada YAriga Net al: Prognosis of four cases of primary middle fossa arachnoid cyst in children. Childs Brain 7:1952041980Kato M Nakada Y Ariga N et al: Prognosis of four cases of primary middle fossa arachnoid cyst in children. Childs Brain 7:195–204 1980

23.

Kishore PRSRao CVGKWilliams JPet al: The limitation of computerized tomographic diagnosis of intracranial midline cysts. Surg Neurol 14:4174311980Kishore PRS Rao CVGK Williams JP et al: The limitation of computerized tomographic diagnosis of intracranial midline cysts. Surg Neurol 14:417–431 1980

24.

Krawchenko JCollins GH: Pathology of an arachnoid cyst. Case report. J Neurosurg 50:2242281979Krawchenko J Collins GH: Pathology of an arachnoid cyst. Case report. J Neurosurg 50:224–228 1979

25.

Leo JSPinto RSHulvat GFet al: Computed tomography of arachnoid cysts. Radiology 130:6756801979Leo JS Pinto RS Hulvat GF et al: Computed tomography of arachnoid cysts. Radiology 130:675–680 1979

26.

Little JRGomez MRMacCarty CS: Infratentorial arachnoid cysts. J Neurosurg 39:3803861973Little JR Gomez MR MacCarty CS: Infratentorial arachnoid cysts. J Neurosurg 39:380–386 1973

27.

Loeser JD: Comment on Rengachary SS: Parasagittal arachnoid cyst: a case report. Neurosurgery 9:751981Loeser JD: Comment on Rengachary SS: Parasagittal arachnoid cyst: a case report. Neurosurgery 9:75 1981

28.

Mayr UAichner FBauer Get al: Supratentorial extracerebral cysts of the middle cranial fossa. A report of 23 consecutive cases of the so-called temporal lobe agenesis syndrome. Neurochirurgia (Stuttg) 25:51561982Mayr U Aichner F Bauer G et al: Supratentorial extracerebral cysts of the middle cranial fossa. A report of 23 consecutive cases of the so-called temporal lobe agenesis syndrome. Neurochirurgia (Stuttg) 25:51–56 1982

29.

McCullough DCHarbert JCManz HJ: Large arachnoid cysts at the cranial base. Neurosurgery 6:76811980McCullough DC Harbert JC Manz HJ: Large arachnoid cysts at the cranial base. Neurosurgery 6:76–81 1980

30.

Menezes AHBell WEPerret GE: Arachnoid cysts in children. Arch Neurol 37:1681721980Menezes AH Bell WE Perret GE: Arachnoid cysts in children. Arch Neurol 37:168–172 1980

31.

Milhorat TH: Pediatric neurosurgery. Contemp Neurol Series 16:1921971978Milhorat TH: Pediatric neurosurgery. Contemp Neurol Series 16:192–197 1978

32.

Mori KHayashi THanda H: Infratentorial retrocerebellar cysts. Surg Neurol 7:1351421977Mori K Hayashi T Handa H: Infratentorial retrocerebellar cysts. Surg Neurol 7:135–142 1977

33.

Murali REpstein F: Diagnosis and treatment of suprasellar arachnoid cysts. Report of three cases. J Neurosurg 50:5155181979Murali R Epstein F: Diagnosis and treatment of suprasellar arachnoid cysts. Report of three cases. J Neurosurg 50:515–518 1979

34.

Page LK: Comment on Albright L: Treatment of bobblehead doll syndrome by transcallosal cystectomy. Neurosurgery 8:5951981Page LK: Comment on Albright L: Treatment of bobblehead doll syndrome by transcallosal cystectomy. Neurosurgery 8:595 1981

35.

Plana JCClara JMCFernandez-Alvarez E: Quistes aracnoideos intracraneales en el niño. Revisión de 34 observaciones. An Esp Pediatr 19:4594701983Plana JC Clara JMC Fernandez-Alvarez E: Quistes aracnoideos intracraneales en el niño. Revisión de 34 observaciones. An Esp Pediatr 19:459–470 1983

36.

Raimondi AJShimoji TGutierrez FA: Suprasellar cysts: surgical treatment and results. Childs Brain 7:57721980Raimondi AJ Shimoji T Gutierrez FA: Suprasellar cysts: surgical treatment and results. Childs Brain 7:57–72 1980

37.

Rengachary SS: Parasagittal arachnoid cyst: a case report. Neurosurgery 9:70751981Rengachary SS: Parasagittal arachnoid cyst: a case report. Neurosurgery 9:70–75 1981

38.

Rengachary SSWatanabe I: Ultrasturcture and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61831981Rengachary SS Watanabe I: Ultrasturcture and pathogenesis of intracranial arachnoid cysts. J Neuropathol Exp Neurol 40:61–83 1981

39.

Rengachary SSWatanabe IBrackett CE: Pathogenesis of intracranial arachnoid cysts. Surg Neurol 9:1391441978Rengachary SS Watanabe I Brackett CE: Pathogenesis of intracranial arachnoid cysts. Surg Neurol 9:139–144 1978

40.

Robinson RG: Congenital cysts of the brain: arachnoid malformations. Prog Neurol Surg 4:1331741971Robinson RG: Congenital cysts of the brain: arachnoid malformations. Prog Neurol Surg 4:133–174 1971

41.

Sato KShimoji TYaguchi Ket al: Middle fossa arachnoid cyst: clinical, neuroradiological, and surgical features. Childs Brain 10:3013161983Sato K Shimoji T Yaguchi K et al: Middle fossa arachnoid cyst: clinical neuroradiological and surgical features. Childs Brain 10:301–316 1983

42.

Shaw CM: “Arachnoid cysts” of the sylvian fissure versus “temporal lobe agenesis” syndrome. Ann Neurol 5:4834851979Shaw CM: “Arachnoid cysts” of the sylvian fissure versus “temporal lobe agenesis” syndrome. Ann Neurol 5:483–485 1979

43.

Smith RASmith WA: Arachnoid cysts of the middle cranial fossa. Surg Neurol 5:2462521976Smith RA Smith WA: Arachnoid cysts of the middle cranial fossa. Surg Neurol 5:246–252 1976

44.

Sprung CMauersberger: Value of computed tomography for the diagnosis and assessment of surgical treatment. Acta Neurochir Suppl 28:6196261979Sprung C Mauersberger: Value of computed tomography for the diagnosis and assessment of surgical treatment. Acta Neurochir Suppl 28:619–626 1979

45.

Starkman SPBrown TCLinell EA: Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17:4845001958Starkman SP Brown TC Linell EA: Cerebral arachnoid cysts. J Neuropathol Exp Neurol 17:484–500 1958

46.

Stein SC: Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery 8:6476501981Stein SC: Intracranial developmental cysts in children: treatment by cystoperitoneal shunting. Neurosurgery 8:647–650 1981

47.

Taveras JMRansohoff J: Leptomeningeal cysts of the brain following trauma with erosion of the skull. A study of seven cases treated by surgery. J Neurosurg 10:2332411953Taveras JM Ransohoff J: Leptomeningeal cysts of the brain following trauma with erosion of the skull. A study of seven cases treated by surgery. J Neurosurg 10:233–241 1953

48.

Vaquero JCarrillo RCabezudo JMet al: Arachnoid cysts of the posterior fossa. Surg Neurol 16:1171211981Vaquero J Carrillo R Cabezudo JM et al: Arachnoid cysts of the posterior fossa. Surg Neurol 16:117–121 1981

49.

Vigouroux RPChoux MBaurand C: Les kystes arachnoïdiens congénitaux. Neurochirurgia (Stuttg) 9:1691871966Vigouroux RP Choux M Baurand C: Les kystes arachnoïdiens congénitaux. Neurochirurgia (Stuttg) 9:169–187 1966

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