Incidental Diagnosis Of Huge Arachnoid Cyst Causing Macrocrania: A Case Report

Abstract

Arachnoid cysts are the benign developmental malformations of arachnoid compromising of about 1 % of all intracranial space occupying lesions. It was reported that trauma, also, might play a role in the pathogenesis of these lesions. These cysts are frequently seen in early childhood and have a tendency to middle fossa. These cysts frequently present with headache, dizziness, or epilepsy and suboptimal cerebral function like disordered perception. Natural course and treatment of these cysts are still in debate. In this report, we are presenting a 10 month year old child having symptomatic huge arachnoid cysts in middle fossa determined incidentally after trauma. In the treatment of this case, cystoperitoneal shunt operation was performed and good result was gained even in the early postoperative period. However, the main topic of this report is to emphasize that sometimes symptomatic cases might be overlooked.

Keywords

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Makrokraniya Oluşturmuş Dev Araknoid Kistin Rastlantısal Tanısı: Olgu Sunumu

Abstract

İntrakranyal yer kaplayan oluşumların %1'ini oluşturan araknoid kistler araknoid membranın iyi huylu gelişimsel malformasyonudurlar. Travmanın da patogenez de rol oynayabileceği bildirilmiştir. Bu kistler erken çocukluk döneminde ve orta fossada daha sık görülmektedir. Sıklıkla baş ağrısı, baş dönmesi veya epilepsi ve bozulmuş algılama gibi suboptimal serebral fonksiyonla ilişkili spesifik olmayan semptomlar oluştururlar. Bu lezyonların doğal seyirleri ve tedavileri ile ilgili olarak tartışmalar halen sürmektedir. Bu yazıda aslında semptom oluşturmuş olmasına rağmen travma sonrası tesadüfen tespit edilmiş dev araknoid kist ile başvuran bir olgu sunulmaktadır. Olguya kistoperitoneal şant takılmış ve erken dönemde iyi sonuç alınmıştır. Ancak bu yazıda asıl vurgulanmak istenen ana düşünce semptomatik olguların bazen gözden kaçabilmesidir.

Keywords

• Araknoid kist, Bilgisayarlı tomografi, Manyetik rezonans görüntüleme, Hidrosefali

References

1. 1. Helland CA, Wester K. A population based study of intracranial arachnoid cysts: clinical and neuroimaging outcomes following surgical cyst decompression in adults. J Neurol Neurosurg Psychiatry 2007; 78: 1129-1135.
2. 2. Van der Meche FGA, Braakman R. Arachnoid cysts in the middle cranial fossa: cause and treatment of progressive and non-progressive symptoms. J Neurol Neurosurg Psychiatr 1983; 46: 1102-1107.
3. 3. Di Rocco C, Tamburrini G, Caldarelli M, Velardi F, Santini P. Prolonged ICP monitoring in sylvian arachnoid cysts. Surg Neurol 2003; 60: 211-218.
4. 4. Ibarra R, Kesava PP. Role of MR imaging in the diagnosis of complicated arachnoid cyst. Pediatr Radiol 2000; 30: 329-331.
5. 5. Helland CA, Wester K. Intracystic pressure in patients with temporal arachnoid cysts: a prospective study of preoperative complaints and postoperative outcome. Neurol Neurosurg Psychiatry 2007; 78: 620-623.
6. 6. Galassi E, Tognetti F, Gaist G, Frank F. CT scan and metrizamide CT cisternography in arachnoid cysts of the middle cranial fossa: Classification and pathophysiological aspects. Surg Neurol 1982; 17: 363-36.
7. 7. Choi JU, Kim DS. Pathogenesis of arachnoid cyst: congenital or traumatic. Pediatr Neurosurg 1998; 29: 260-266.
8. 8. Lütcherath V, Waaler PE. Jellum E, Wester K. Children with bilateral temporal arachnoid cysts may have glutaric aciduria type 1 (GAT1); operation without knowing that may be harmful. Acta Neurochir (Wien) 2000; 142: 1025-1030.

9. 9. Wang PJ, Lin HC, Liu HM, Tseng CL, Shen YZ. Intracranial arachnoid cysts in children: related signs and associated anomalies. Pediatr Neurol 1998; 19: 100-104.
10. 10. Wester K. Pecularities of intracranial arachnoid cysts: location, sidedness and sex distribution in 126 consecutive patients. Neurosurgery 1999; 45: 775-779.
11. 11. Hughes G, Ugokwe K, Benzel EC. A review of spinal arachnoid cysts. Cleve Clin J Med 2008; 75: 311-315.
12. 12. Arai H, Sato K, Wachi A, Okuda O, Takeda N. Arachnoid cysts of the middle cranial fossa: experience with 77 patients who were treated with cystoperitoneal shunting. Neurosurgery 1996; 39: 1108-1113.
13. 13. Öncel Ç. Araknoid kistler. Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi 2007; 8: 51-55.
14. 14. Shim K-W, Lee Y-H, Park E-K, Park Y-S, Choi J-U, Kim DS. Treatment option for arachnoid cysts. Childs Nerv Syst 2009; 25: 1459-1466
15. 15. Erman T, Gocer I, Tuna M, Ergin M, Zorludemir S, Cetinalp E. Intracranial arachnoid cysts: clinical features and management of 35 cases and review of the literature. Neurosurg Q 2004; 14: 84-88.
16. 16. Cincu R, Agrawal A, Eiras J. Intracranial arachnoid cysts: Current concepts and treatment alternatives. Clin Neurol Neurosurg 2007; 109: 837-843.
17. 17. Thompson TP, Lunsford LD, Kondziolka D. Successful management of sellar and suprasellar arachnoid cysts with stereotactic intracavitary irradiation: an expanded report of four cases. Neurosurgery 2000; 46: 1518-152