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Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series.

Srinivasan US, Lawrence R - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved.We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.

ABSTRACT

Introduction and aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.

Materials and methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973-2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.

Results: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.

Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

No MeSH data available.


Related in: MedlinePlus

The lateral cerebello-pontine angle posterior fossa arachnoid cyst (PFAC 2a) – Pre and post op scan
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Figure 3: The lateral cerebello-pontine angle posterior fossa arachnoid cyst (PFAC 2a) – Pre and post op scan

Mentions: Among the 7 cases, in 6 cases the PFAC was located in the midline [Figures 1 and 2] and in the 7th case it was in the cerebello-pontine (CP) angle cistern [Figure 3]. All these patients were treated surgically since they were symptomatic. Excision of the cyst was performed in five of these cases. In 2 cases where the PFAC was located within the fourth ventricle, cysto-peritoneal shunt was performed [Figure 1]. Postoperative CT brain scan showed variable reduction in the in size of the cyst from complete to partial collapse of the cyst [Figures 1–3] even though clinically all patients improved. The clinical features, location of the cyst within the posterior cranial fossa, surgical procedure performed the complications that occurred following surgical intervention and the long term outcome of all the 7 cases of PFAC has been summarized and presented in Table 1.


Posterior fossa arachnoid cysts in adults: Surgical strategy: Case series.

Srinivasan US, Lawrence R - Asian J Neurosurg (2015 Jan-Mar)

The lateral cerebello-pontine angle posterior fossa arachnoid cyst (PFAC 2a) – Pre and post op scan
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352631&req=5

Figure 3: The lateral cerebello-pontine angle posterior fossa arachnoid cyst (PFAC 2a) – Pre and post op scan
Mentions: Among the 7 cases, in 6 cases the PFAC was located in the midline [Figures 1 and 2] and in the 7th case it was in the cerebello-pontine (CP) angle cistern [Figure 3]. All these patients were treated surgically since they were symptomatic. Excision of the cyst was performed in five of these cases. In 2 cases where the PFAC was located within the fourth ventricle, cysto-peritoneal shunt was performed [Figure 1]. Postoperative CT brain scan showed variable reduction in the in size of the cyst from complete to partial collapse of the cyst [Figures 1–3] even though clinically all patients improved. The clinical features, location of the cyst within the posterior cranial fossa, surgical procedure performed the complications that occurred following surgical intervention and the long term outcome of all the 7 cases of PFAC has been summarized and presented in Table 1.

Bottom Line: Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved.We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, MIOT Hospitals, Manapakkam, Chennai, Tamil Nadu, India.

ABSTRACT

Introduction and aim: The management of posterior fossa arachnoid cyst (PFAC) in adults is controversial. To review our cases and literature, propose a practically useful surgical strategy, which gives excellent long-term outcome in management of PFAC.

Materials and methods: We analyzed our case records of 26 large intracranial arachnoid cysts in adults treated over 12 years. Of them, we had 7 patients with symptomatic PFAC. Reviewed the literature of 174 PFAC cases (1973-2012) and added 7 of our new cases with a follow-up ranging from 3 to 12 years.

Results: In 6 cases the PFAC was located in the midline. In the 7(th) case, it was located laterally in the cerebello-pontine (CP) angle. All patients were treated surgically. Excision of the cyst was performed in 5 of these cases. Among the two intra-fourth ventricular cysts, in both the cases cysto-peritoneal shunt was performed. Postoperative computed tomography/magnetic resonance imaging showed variable decrease in size of the cyst even though clinically all patients improved. We propose a surgical strategy for the management of these cases which would aid the surgeon in decision making.

Discussion: We observed that these PFACs can occur either in the midline within the fourth ventricle or retroclival region or extra-fourth ventricular region. It can also develop laterally in the CP angle or behind the cerebellum or as intracerebellar cyst. Importance of this is except for Midline Intra-fourth ventricular cyst/retroclival cyst, the rest all can be safely excised with excellent long term outcome. The treatment strategy for Midline Intra-fourth ventricular cyst/retroclival cyst can be either cysto-peritoneal shunt or endoscopic fenestration of the cyst.

No MeSH data available.


Related in: MedlinePlus