Endoscopic Fenestration of an Intra-ventricular Arachnoid Cyst in a Young Male – A Rare Entity

Authors

  • Muhammad Assad Javed AKBAR NIAZI TEACHING HOSPITAL ISLAMABAD
  • Niaz Ahmad Khan
  • Ain-us-Saba

DOI:

https://doi.org/10.36552/pjns.v27i1.781

Abstract

Introduction:  Among intracranial space-occupying lesions, arachnoid cysts compromise 1% only. Abnormal collection of cerebrospinal fluid occurs in these types of cysts leading to pressure symptoms. Developmental abnormalities of cerebrospinal structures in early fetal life lead to the primary type of arachnoid cysts, while the second type of arachnoid cyst is formed after some neurological insult like head injury, tumor, meningitis, or brain surgery. In 60 – 90% of cases, the primary type predominates and presents with pressure symptoms before the age of 20 years. The adjudged incidence is 1.4% in adults, the least frequent being intraventricular location.

Clinical Case:  A 23-year-old male presented with a long-standing left-sided cranial vault headache, right-sided focal seizures, and progressive right- hemiparesis. Neurological evaluation revealed upper motor neuron signs on the right side of the body. A computerized axial tomography raised the suspicion of an arachnoid cyst for which magnetic resonance imaging was done which revealed a large intraventricular cyst of lateral ventricles causing mass effect over the ipsilateral hemisphere and mild obstructive hydrocephalous. Surgical intervention was required as per symptomology (intractable headache, seizures, and hemiparesis) and large cyst size.

Conclusion:  Cerebrospinal fluid accumulation in the brain's arachnoid layer causes non-cancerous arachnoid cysts. Larger cysts may push on brain tissue and cause neurological difficulties. MRI may diagnose arachnoid cysts, and treatment options include cystoperitoneal shunt, craniotomy, and neuro-endoscopic fenestration, the least invasive. Cyst size and location determine therapy. In this example, endoscopic treatment reduced symptoms and consequences.

References

Arachnoid cysts information page.

https://www.ninds.nih.gov/Disorders/All-Disorders/Arachnoid-Cysts-Information-Page

Vega-Sosa A, de Obieta-Cruz E, Hernández-Rojas MA. Intracranial arachnoid cysts. Surgery and Surgeons. 2010; 78 (6): 556-562. Available at:

https://www.redalyc.org/articulo.oa?id=66220323016 [ Links ]

Mustansir F, Bashir S, Darbar A. Management of Arachnoid Cysts: A Comprehensive Review. Cureus. 2018; 10 (4). Available at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991924/ [ Links ]

Rico-Cotelo M, Diaz-Cabanas L, Allut AG, Gelabert-Gonzalez M.

Intraventricular arachnoid cyst. Rev Neurol 2013; 57 (1): 25-8. Available at: https://www.neurologia.com/articulo/2013182 [ Links ]

Alexander Muacevic and John R Adler. Management of Arachnoid Cysts: A Comprehensive Review. Cureus. 2018 Apr; 10(4): e2458. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991924/ [ Links ]

Starkman SP, Brown TC, Linell EA: Cerebral arachnoid cyst. J Neuropathol Exp Neurol 17:484500, 1958.

Starkman SP, Brown TC, Linell EA: Cerebral arachnoid cyst. J Neuropathol Exp Neurol 17:484500, 1958.

Yates A, Enzman D. An intraventricular arachnoid cyst. J Comp Assist Tomogr1979; 3:697700.

Nakase H, Hisanaga M, Hashimoto S, Imanishi M, Utsumi S. Intraventricular arachnoid cyst.

Report of two cases. J Neurosurg 1988; 68:482-6.

Surgical treatment of intracranial arachnoid cyst in adult patients. Wang C, Liu C, Xiong Y, et al. Neurol India. 2013;61:60–64. [PubMed] [Google Scholar]

A population-based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. [Mar;2018 ];Helland CA, Wester K. J Neurol Neurosurg Psychiatry. 2007 78:1129–1135. [PMC free article] [PubMed] [Google Scholar]

Intracranial arachnoid cysts in the clinical and radiological aspect. Wojcik G. https://www.ncbi.nlm.nih.gov/pubmed/27717944 Wiad Lek. 2016;69:555–559. [PubMed] [Google Scholar]

Goyenechea F. Arachnoid Cysts. Cuba: SLD; 2005. Available at: http://www.sld.cu/galerias/pdf/sitios/neuroc/quistes_aracnoideos.pdf [ Links ]

Karnazes AC, Kei J, Le MV. Image Diagnosis: Arachnoid Cyst. Perm J 2015; 19 (2): 110-111. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403588/ [ Links ]

Logan C, Asadi H, Kok HK, Looby S, O'Hare A, Thornton J, et al. Arachnoid cysts - common and uncommon clinical presentations and radiological features. J Neuroimaging Psychiatry Neurol 2016; 1 (2): 79-84. Available at: http://dro.deakin.edu.au/eserv/DU:30092711/asadi-arachnoidcysts-2016.pdf [ Links ]

Qin B, Gao L, Hu J, Wang L, Chen G. Intracerebral hematoma after endoscopic fenestration of an arachnoid cyst. Medicine (Baltimore) 2018; 97 (44). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221673/ [ Links ]

Stricter indications are recommended for fenestration surgery in intracranial arachnoid cysts of children. Choi JW, Lee JY, Phi JH, Kim SK, Wang KC. Childs Nerv Sys. 2015;31:77–86. [PubMed] [Google Scholar]

Treatment and outcome of intracranial arachnoid cysts. [Mar;2018 ];Ahn JY, Chio JU, Yoon SH, Chung SS, Lee KC. https://www.jkns.or.kr/journal/view.php?number=4757 J Korean Neurosurg Soc. 1994 23:194–203. [Google Scholar]

Multiloculated hydrocephalus: open craniotomy or endoscopy? [Mar;2018 ];Lee YH, Kwon YS, Yang KH. J Korean Neurosurg Soc. 2017 60:301–305. [PMC free article] [PubMed] [Google Scholar]

Neuroendoscopic transventricular ventriculocystostomy in treatment for intracranial cysts. Di Rocco F, Yoshino M, Oi S. J Neurosurg. 2005;103:54–60. [PubMed] [Google Scholar]

ndoscopic management of cranial arachnoid cysts using extra-channel method. [Mar;2018 ];Kim MH, Jho HD. J Korean Neurosurg Soc. 2010 47:433–436. [PMC free article] [PubMed] [Google Scholar]

Downloads

Published

2023-04-13

Issue

Section

Case Reports