1/97. The Chiari II malformation: lesions discovered within the fourth ventricle.Structural lesions associated with the Chiari II malformation have been identified within the fourth ventricle in 8 patients. During the 42-month period encompassing the operations of the 7 patients treated surgically, only 9 other patients were explored without the discovery of some associated structural lesion. The patients ranged in age from 2 to 26 years. The following lesions were identified: glial or arachnoidal cysts (3 patients), glial or choroidal nodules (3 patients) and subependymoma (2 patients). These lesions were all situated in the roof of the fourth ventricle adjacent to or interspersed with the choroid plexus. Only the cystic lesions were identified by preoperative imaging. In only 1 case did the associated lesion, a 2-cm cyst, seem to contribute to the patient's clinical presentation. Structural lesions of the fourth ventricle associated with the Chiari II malformation are common in patients who are submitted to decompression. These lesions may be dysplasias of developmental origin, or they may be reactive lesions related to chronic compression and ischemia. They do not necessarily required biopsy or excision.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/97. "Growing fontanelle": a serious complication of difficult vacuum extraction.Growing skull fractures in combination with leptomeningeal cysts are well known in childhood. A rare case of a growing fontanelle due to a leptomeningeal cyst is presented. The cyst occurred due to a traumatic delivery with vacuum extraction. Operative repair of the cyst revealed a dural tear at the border of the fontanelle. The imaging findings are discussed.- - - - - - - - - - ranking = 0.056667298640711keywords = fracture (Clic here for more details about this article) |
3/97. Multiple extradural arachnoid cysts as a cause of spinal cord compression in a child. Case report.Symptomatic arachnoid cysts of the spine are uncommon in children and have only rarely been reported to occur extradurally. The authors report a case of multiple extradural spinal arachnoid cysts in a 9-year-old child who presented with signs of spinal cord compression. The extent of the disease, which affected the thoracic, lumbar, and sacral spine, and the number of independent cysts make this case unique and suggest an underlying defect in the dura of the spinal canal that is predisposed to the formation of cysts. The investigations of choice, surgical planning, and surgical technique are considered. The literature is reviewed and mechanisms of cyst formation discussed.- - - - - - - - - - ranking = 2.5keywords = compression (Clic here for more details about this article) |
4/97. Chronic hydrocephalus and suprasellar arachnoid cyst presenting with rhinorrhea.Spontaneous CSF leak with rhinorrhea may be secondary to many intracranial congenital and acquired conditions. However, no cases of chronic hydrocephalus and suprasellar arachnoid cyst presenting with rhinorrhea as the unique clinical manifestation are reported in the literature. A 29-year-old-man with four-month history of episodic rhinorrhea had a large suprasellar arachnoid cyst with chronic hydrocephalus on magnetic resonance. Endoscopic ventricular fenestration of the cyst failed to obtain remission of the CSF leak, because it was not possible to fenestrate the cyst with the almost completely obliterated suprasellar cistern. Clinical remission occurred after restoration of the CSF flow from the cyst to the cisternal spaces by a direct approach. The CSF leak in this case was secondary to the chronic compression over the dural and bone structures of the sellar region by the cyst or chronic hydrocephalus.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
5/97. Bilateral sensorineural deafness, partial agenesis of the corpus callosum, and arachnoid cysts in two sisters.We describe two sisters (ages 10 and 3 years, respectively) with a normal development and a combination of congenital sensorineural hearing loss, partial agenesis of the corpus callosum, arachnoid cyst, and hydrocephalus. Neither girl has distinctive physical anomalies. In the oldest girl, there was a hearing loss of 80 dB bilaterally, and the most severe loss on audiogram was seen at 2,000-4,000 Hz. In the youngest girl, there was a hearing loss of 100 dB bilaterally. Above 2,000 Hz no neural reactions were seen. Cerebral magnetic resonance imaging in one girl and computed tomography in the other showed a partial agenesis of the corpus callosum and a cyst in the pineal region, causing an aqueduct stenosis by compression and consequent hydrocephalus. The parents have normal hearing, and brain magnetic resonance imaging showed no abnormalities. They are nonconsanguineous but from the same small village. This is the first report of a combination of congenital sensorineural hearing loss, partial agenesis of the corpus callosum, and an arachnoid cyst. The pattern of inheritance is probably autosomal recessive.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
6/97. Symptomatic sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst.A case of sacral extradural arachnoid cyst associated with lumbar intradural arachnoid cyst in a 35-year-old male is reported. The patient presented with a history of severe sacrococcygeal pain, constipation, and dysuria for several months. Computed tomographic (CT) myelograms and magnetic resonance imaging (MRI) scans showed a huge sacral cyst without neural components. A favorable outcome could be achieved by decompression of the cyst, obliteration of the fistulous channel between the cyst and the thecal sac, and fenestration of the arachnoid cyst into the subarachnoid space. The relevant literatures are also reviewed.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
7/97. Delayed diffuse upper motor neuron syndrome after compressive thoracic myelopathy.A 54-year-old man developed progressive spastic paraparesis beginning 2 weeks after a back injury caused by a subacute compressive thoracic myelopathy attributable to a post-traumatic arachnoid cyst. Three to 18 months after surgical decompression of the thoracic arachnoid cyst, the patient developed a diffuse predominantly upper motor neuron syndrome characterized by spastic quadriparesis, pseudobulbar paresis, and pseudobulbar affect. Retrograde corticospinal tract degeneration and upper motor neuron death after spinal cord injury is recognized. This case suggests that focal upper motor neuron injury can occasionally precipitate diffuse upper motor neuron dysfunction.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
8/97. Spinal intradural arachnoid cysts located anterior to the cervical spinal cord. Report of two cases and review of the literature.The authors describe two rare occurrences of radiographically, surgically, and pathologically confirmed spinal intradural arachnoid cysts (not associated with additional pathological entities) that were located anterior to the cervical spinal cord. These lesions have been reported previously in only eight patients. The patients described in this report were young adults who presented with progressive spastic tetraparesis shortly after sustaining mild cervical trauma and in whom no neurological deficit or bone fracture was demonstrated. The presence of an intradural arachnoid cyst was detected on postcontrast computerized tomography (CT) myelography and on magnetic resonance imaging; both diagnostic tools correctly characterized the cystic nature of the lesion. Plain radiography, plain tomography, and contrast-enhanced CT scans were not diagnostic. In both cases a laminectomy was performed, and the wall of the cyst was excised and fenestrated with subarachnoid space. Postoperatively, the patients made complete neurological recoveries. Based on a review of the literature, arachnoid cysts of the spinal canal may be classified as either extra- or intradural. Intradural arachnoid cysts usually arise posterior to the spinal cord in the thoracic spine region; however, these cysts very rarely develop in the cervical region. The pathogenesis of arachnoid cysts is unclear, although congenital, traumatic and inflammatory causes have been postulated. The authors believe that the formation of an arachnoid cyst cannot be explained by simply one mechanism because, in some reported cases, there has been accidental or iatrogenic trauma in association with congenital lesions. They also note that an intradural arachnoid cyst located anterior to the cervical spinal cord is an extremely rare disorder that may cause progressive myelopathy; however, the postoperative prognosis is good.- - - - - - - - - - ranking = 0.056667298640711keywords = fracture (Clic here for more details about this article) |
9/97. diagnosis of arachnoid cysts on prenatal ultrasound.The aetiology and physiology of congenital arachnoid cysts are a source of controversy. We report a case where fetal cerebral ultrasonography shows an extraventricular sonolucent cystic formation after 20 weeks of pregnancy. ultrasonography provides its topographic relations with adjacent brain structures and is also used to diagnose possible associated malformations. MRI confirms the ultrasonographic findings by investigating cerebral gyri. The rest of the examination involves detection of extracerebral anomalies and a karyotype study. Other differential diagnoses will be considered as a function of the embryological origin and topography of arachnoid cysts. The outcome of these arachnoid cysts depends on the age at the time of diagnosis, their size and their topography. The problem is that hydrocephalus, due to compression of the cerebrospinal fluid drainage pathways, may develop. Treatment, if necessary, is nearly always surgical.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
10/97. cauda equina syndrome due to lumbosacral arachnoid cysts in children.We describe the clinical, neuroradiological and surgical aspects of two children in whom symptoms attributable to cauda equina compression were caused by spinal arachnoid cysts. The first patient presented with recurrent urinary tract infections due to neurogenic bladder dysfunction, absent deep tendon reflexes and sensory deficit in the lower limbs. The second child presented with unstable gait as a result of weakness and diminished sensation in the lower extremities. Spinal magnetic resonance imaging revealed a lumbosacral arachnoid cyst in both patients. During surgery the cysts were identified and excised. Two years after surgery, the sensory deficits of the first patient have disappeared and patellar and ankle reflexes can be elicited, but there is no improvement in bladder function. Neurological examination of the second patient was normal. We conclude that the diagnosis of cauda equina syndrome should prompt a vigorous search for its aetiology. Lumbosacral arachnoid cysts are a rare cause of cauda equina syndrome in children.- - - - - - - - - - ranking = 0.5keywords = compression (Clic here for more details about this article) |
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